Intensive Care Unit Delirium

Hayhurst, Christina J.; Pandharipande, Pratik P.; Hughes, Christopher

doi:10.1097/aln.0000000000001378

Cited by 142 publications

(68 citation statements)

References 95 publications

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“…24, 25 In addition, since delirium is more prevalent in older adults, we focused on studies in populations 65 years and older. For selected studies on pharmacologic prevention and treatment, article quality was rated with the Cochrane Collaboration tool for assessing risk of bias.…”

Section: Methodsmentioning

confidence: 99%

Delirium in Older Persons

Fong

Hshieh

et al. 2017

JAMA

687

306

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Importance-Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effect with substantial health care costs.Objective-To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field.Evidence Review-We searched Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011 until March 16, 2017 using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non-English-language articles were excluded.Findings-Of 127 articles included, 25 were clinical trials, 42 cohort studies, 5 systematic reviews and meta-analyses, and 55 were other categories. A total of 11 616 patients were represented in the treatment studies. Advances in diagnosis have included the development of brief screening tools with high sensitivity and specificity, such as the 3-Minute Diagnostic Assessment, 4 A's test, and proxy-based measures such as the Family Confusion Assessment Method. Measures of severity, such as the Confusion Assessment Method-Severity Score, can aid in monitoring response to treatment, risk stratification, and assessing prognosis. Nonpharmacologic approaches focused on risk factors such as immobility, functional decline, visual or hearing impairment, dehydration, and sleep deprivation are effective for delirium prevention and also are recommended for delirium treatment. Current recommendations for pharmacologic treatment of

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Section: Methodsmentioning

confidence: 99%

Delirium in Older Persons

Fong

Hshieh

et al. 2017

JAMA

687

306

View full text Add to dashboard Cite

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“…The literature reports describe more than 25 factors significantly increasing the risk of delirium, including respiratory diseases, advanced age, alcohol abuse, dementia, ionic imbalance, demand for vasopressors, increased doses of opioids, or metabolic acidosis. The identified risk factors can be divided into the factors predisposing to and accelerating the development of delirium [15] (Table 2). Advanced age, senile frailty and a severe systemic disease (especially of the respiratory system) substantially increase the risk of delirium [16].…”

Section: Risk Factorsmentioning

confidence: 99%

“…The detailed presentation of pathophysiology of acute mental disorders in ICU patients is beyond the scope of this review; however, it should be stressed that the pathogenesis of delirium is multifactorial. One of the hypothesis assumes that the cascade of events starts with a generalised inflammatory reaction, endothelial dysfunction, increased permeability of the blood-brain barrier and reduced cholinergic control over the inflammatory response, which combined with the body debility predispose to the development of inflammatory changes in the nervous tissue, damage to neurons and overreactive responses of microglial cells [15,24].…”

Section: Pathophysiologymentioning

confidence: 99%

“…The potential mechanism of drug action is based on the current understanding of the pathophysiology of delirium and assumes a decrease in the activity of dopamine and improvement of neurotransmitter balance as well as the use of drugs increasing cholinergic activity since anticholinergic agents can increase the risk of delirium (e.g. inhibitors of acetylcholinesterase) [15]. In the study involving cardiac surgery patients, risperidone supplied during recovery from general anaesthesia has been shown to reduce the incidence of delirium [33].…”

Section: Prevention Of Deliriummentioning

confidence: 99%

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ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Kotfis

Marra

Ely

2018

Anaesthesiol Intensive Ther

146

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ICU delirium is a common medical problem occurring in patients admitted to the intensive care units (ICUs). Studies have shown that ICU delirium is associated with increased mortality, prolonged hospitalization, prolonged mechanical ventilation, costs and the occurrence of cognitive disoders after discharge from ICU. The tools available for ICU delirium screening and diagnosis are validated tests available for all members if the medical team (physicians, nurses, physiotherapists). Their use for routine patient assessment is recommended by international medical and scientific societies. They have been implemented as Pain, Agitation, Delirium (PAD) Guidelines by the Society of Critical Care Medicine. Apart from monitoring, a strategy of prevention and treatment is recommended, based on non-pharmacological approach (restoration of senses, early mobilization, physiotherapy, improvement in sleep hygiene and family involvement) as well as pharmacological treatment (typical and atypical antipsychotics and dexmedetomidine). In this article, we present the risk factors of ICU delirium, available tools for monitoring, as well as options for prevention and treatment of delirium that can be used to improve care over critically ill patients.

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“…The foundation of treating and preventing Delirium is understanding the risk factors which are then addressed through a multi-system approach. King and Gratix [17] argue that the diverse management strategies for Delirium should consider the causes, symptoms, and comorbidities. Central in managing the condition is applying the patient-centered model.…”

Section: Managing Deliriummentioning

confidence: 99%

Non-pharmacological Treatment of Intensive Care Unit Delirium

Liu¹

2019

AJNS

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Objective: To understand whether non-pharmacological treatment can reduce intensive care units. Methods: A review was conducted by searching the literature in the CINAHL, PubMed, PsycINFO, and EMBASE database. The prevalence of sputum in the ICU is 16%-89%. It is characterized by short-term memory loss, disorientation and impaired attention. There are three types of sputum, including hyperactivity, hyperactivity, and mixing. Both pharmacology and non-pharmacology include ABCDE care bundles, sedation, early mobilization, promotion of personal sleep quality, reduced noise and artificial lighting, and patient education. Music therapy as a non-pharmacological intervention has not been fully studied. CONCLUSIONS: Non-pharmacological treatment of sputum in the ICU remains an effective method because it eliminates the use of sedatives. However, this depends on the health of the patient, such as vision and hearing impairment. Exploring the effectiveness of music therapy for this condition will help to further improve the multi-component approach, which requires a combination of non-pharmacological interventions to promote patient health.

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Intensive Care Unit Delirium

Abstract: This review examines the most recent evidence for the diagnosis, prevention, and treatment of delirium in the ICU.

Cited by 142 publications

References 95 publications

Delirium in Older Persons

Delirium in Older Persons

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Non-pharmacological Treatment of Intensive Care Unit Delirium

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