Focus on delirium, sedation and neuro critical care 2019: towards a more brain-friendly environment?

Meyfroidt, Geert; Smith, Martin

doi:10.1007/s00134-019-05701-2

Cited by 16 publications

(21 citation statements)

References 15 publications

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“…However, as no direct measurements of sleep duration or quality were taken, this cannot be evaluated as part of this trial. Mobilization in the evening may also reduce delirium contributing factors such as immobility, sleep disorders or hormonal misbalance and others [3]. Another hypothesis is that early mobilisation improves brain Anecdotally, we observed a reduction in delirium severity by mobilizing agitated patients, but delirium severity was not systematically assessed.…”

Section: Discussionmentioning

confidence: 77%

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Mobilization in the evening reduces delirium in critically ill patients: the MENTAL randomized, controlled trial

Nydahl

McWilliams

Weiler

et al. 2019

Preprint

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Background : Delirium is a common complication in patients on Intensive Care Units (ICU). Caring interventions such as early mobilization are effective in prevention and treatment of delirium, but are recommended during daytime. It may be effective in the night, too. Method : The aim of this study was to prove the effect of mobilization in the evening to prevent or treat ICU patients from delirium. The design was a multicentric, randomized, controlled trial in 5 mixed ICUs over a period of 2 weeks with max. 28 days follow-up. Patients in the intervention group were mobilized onto the edge of the bed or more between 9:00 and 11:00 p.m. by an additional mobilization team, following safety criteria. Patients in the control group received usual care. Primary outcome parameter was the duration of a delirium. Secondary parameters were presence of delirium, mortality, duration of mechanical ventilation (MV) and stay, feasibility, and mobilization-related complications. Results : In summary, n=69 patients could be analysed (intervention n=36, control n=33). Due to limited resources, the trial was stopped and reached 62% of targeted sample size. Mobilization in the evening did not significantly reduce duration of existing delirium, delirium presence, length of MV or days in ICU and hospital for 28 days follow-up. In an unplanned post-hoc analysis, mobilization in the evening prevented patients from delirium in the first four days (6 (16.7%) vs. 13 (39.4%), p=0.032), with a number needed to treat of 5. The intervention was feasible in 71.7% of eligible patients, with 13.6% unwanted safety events. Conclusions : In a mixed ICU population, mobilization in the evening did not show a reduction in duration of delirium, MV or length of stay, but a reduction in the incidence of early onset delirium. Mobilization between 9:00 and 11:00 pm. by an interprofessional mobilization team may prevent patients from delirium. The intervention was feasible, safe, and accepted by most patients.

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Section: Discussionmentioning

confidence: 77%

“…procedures or medications [2,3]. The causes of a delirium are manifold and result from predisposing and triggering factors [4][5][6][7].…”

mentioning

confidence: 99%

Mobilization in the evening reduces delirium in critically ill patients: the MENTAL randomized, controlled trial

Nydahl

McWilliams

Weiler

et al. 2019

Preprint

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“…Physical restraint defined as "any manual method, physical, or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient's movement" have been commonly indicated for patients with brain dysfunction in neurocritical care [1][2][3]. Its effect on outcomes of critically ill adult patients remains controversial as no randomized controlled trials (RCTs) have compared its safety and efficacy [1,4].…”

Section: Introductionmentioning

confidence: 99%

Association between physical restraint requirement and unfavorable neurologic outcomes in subarachnoid hemorrhage

et al. 2021

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Background Physical restraint has been commonly indicated to patients with brain dysfunction in neurocritical care. The effect of physical restraints on outcomes of critically ill adults remains controversial as no randomized controlled trials have compared its safety and efficacy, and the association between physical restraint requirement and neurological outcome in patients with subarachnoid hemorrhage (SAH) has not been fully examined. The aim of this study was to examine the association between physical restraint requirement and neurological outcomes in patients with SAH. Methods A single-center, retrospective study was conducted on patients with acute phase SAH treated for > 72 h in the intensive care unit from 2014 to 2020. Patients were divided into three groups based on the amount of time required for physical restraint during the first 24–72 h after admission: no, intermittent, and continuous use of physical restraint. Unfavorable neurologic outcome, assessed using the modified Rankin scale upon hospital discharge, has been considered as primary end point. Results Overall, 101 patients were included in the study, with 52 patients (51.5%) having unfavorable neurological outcomes. Among them, 46 patients (45.5%) did not use physical restraint, and 55 (54.5%) patients used physical restraint during the first 24–72 h after admission: 26 (25.7%) intermittent and 29 (28.7%) continuous. Multivariable logistic regression analysis showed that continuous use of physical restraint during the first 24–72 h after admission was significantly associated with unfavorable neurological outcomes in patients with SAH (odds ratio, 3.54; 95% confidence interval, 1.05–13.06; p = 0.042) compared with no physical restraint. Conclusions Continuous use of physical restraint during the first 24–72 h after admission was more significantly associated with unfavorable neurological outcomes than no physical restraint among patients with SAH during the acute phase.

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“…Physical restraint de ned as "any manual method, physical, or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient's movement" have been commonly indicated for patients with brain dysfunction in neurocritical care (1)(2)(3). Its effect on outcomes of critically ill adult patients remains controversial as no RCTs have compared its safety and e cacy (1,4).…”

Section: Introductionmentioning

confidence: 99%

Association of physical restraint requirement with unfavorable neurologic outcomes in subarachnoid hemorrhage

Akiyama

Inoue

Hifumi

et al. 2020

Preprint

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BackgroundThe association between physical restraint requirement and neurological outcome in patients with subarachnoid hemorrhage (SAH) has not been fully examined. The aim of this study was to examine the association between physical restraint and neurological outcomes in patients with SAH.MethodsA single-center, retrospective study was conducted on patients with acute phase SAH treated for >72 h in the intensive care unit from 2014 to 2020. Patients were divided into three groups based on the amount of time required for physical restraint during the first 24–72 h after admission: no，intermittent，and continuous use of physical restraint. Unfavorable neurologic outcome, assessed using the modified Rankin scale upon hospital discharge, has been considered as primary end-point.ResultsOverall, 101 patients were included in the study, with 52 patients (51.5%) having unfavorable neurological outcomes. Among them, 46 patients (45.5%) did not use physical restraint, and 55 (54.5%) patients used physical restraint during the first 24–72 h after admission: 26 (25.7%) intermittent and 29 (28.7%) continuous. Multivariable logistic regression analysis showed that continuous use of physical restraint during the first 24–72 h after admission compared to no physical restraint was significantly associated with unfavorable neurological outcomes in patients with SAH (odds ratio [OR], 3.31; 95% confidence interval [CI], 1.02–11.54; p = 0.045]).ConclusionsContinuous use of physical restraint during the first 24–72 h after admission was more significantly associated with unfavorable neurological outcomes than no physical restraint among patients with SAH during the acute phase.

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Focus on delirium, sedation and neuro critical care 2019: towards a more brain-friendly environment?

Cited by 16 publications

References 15 publications

Mobilization in the evening reduces delirium in critically ill patients: the MENTAL randomized, controlled trial

Mobilization in the evening reduces delirium in critically ill patients: the MENTAL randomized, controlled trial

Association between physical restraint requirement and unfavorable neurologic outcomes in subarachnoid hemorrhage

Association of physical restraint requirement with unfavorable neurologic outcomes in subarachnoid hemorrhage

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