Reducing Delirium After Hip Fracture: A Randomized Trial

Marcantonio, Edward R.; Flacker, Jonathan M.; Wright, R. John; Resnick, Neil M.

doi:10.1046/j.1532-5415.2001.49108.x

Cited by 1,216 publications

(1,010 citation statements)

References 30 publications

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“…Although preoperative risk factors, such as age and a history of depression, enable proactive intervention strategies, intraoperative risk factors (eg, aortic clamping time and blood transfusion) facilitate early postoperative multicomponent intervention to prevent postoperative delirium. 36,37 A further aim of this study was to identify the hypoactive subtype of postoperative delirium as an independent predictor of outcome variables, such as prolonged duration of mechanical ventilation and longer ICU stay, using multiple linear regression analyses. The use of extracorporeal circulation and the incidence of postoperative hypoactive delirium increased the duration of mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Hypoactive Delirium After Cardiac Surgery as an Independent Risk Factor for Prolonged Mechanical Ventilation

Stransky

Schmidt

Ganslmeier

et al. 2011

Journal of Cardiothoracic and Vascular Anesthesia

111

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Section: Discussionmentioning

confidence: 99%

Hypoactive Delirium After Cardiac Surgery as an Independent Risk Factor for Prolonged Mechanical Ventilation

Stransky

Schmidt

Ganslmeier

et al. 2011

Journal of Cardiothoracic and Vascular Anesthesia

111

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“…In a randomized controlled trial (RCT), 31 the benefit of proactive geriatric consultation on the incidence of delirium was studied in 126 patients aged 65 yr and older who were admitted for primary surgical repair of a hip fracture. The intervention involved daily consultation with a geriatrician, which began at least 24 hr before surgery and continued for the duration of the admission.…”

Section: Perioperative Carementioning

confidence: 99%

Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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Purpose Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following noncardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended. Principal findings Delirium is characterized by an acute onset and a fluctuating course, inattention, disorganized thinking and an altered level of consciousness, and occurs in up to 40% of patients in the perioperative period. The pathophysiology of delirium is multifactorial, but it is believed to be related to inflammation, altered neurotransmission, and stress in the patient who has had surgery. Acetylcholine and dopamine appear to play a significant role. There is an increased risk of a poor outcome in patients who develop delirium, including a longer hospital stay and death. Surgical and patient factors play a significant role in predicting who will subsequently develop delirium. Prevention is much more effective than treatment in the management of delirium. The most effective prevention strategies include proactive geriatric assessment and care of the patient on a geriatrics surgical ward as well as prophylactic low-dose antipsychotic agents. From an anesthetic perspective, evidence in some surgical populations would support the use of regional techniques and minimal sedation. If delirium develops, treatment with lowdose oral antipsychotics appears to be most effective.Conclusions Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Define delirium in the context of other cognitive changes following non-cardiac surgery. 2. Understand the incidence and adverse outcomes associated with delirium. 3. List predisposing and precipitating factors of postoperative delirium and identify the patient at risk. 4. Explain the underlying pathophysiologic mechanisms believed to be implicated in causing delirium. 5. Formulate an anesthetic plan that minimizes the risk of developing postoperative delirium. 6. Devise a management plan to treat postoperative delirium most effectively while minimizing the adverse effects of treatment.Like other Western nations, Canada's population is aging rapidly. Over the past 50 years, the proportion of Canadians over the age of 65 has risen from 7.7% to 13.7%. A Statistics Canada estimates that the proportion of seniors will double 123Can J Anesth/J Can Anesth (2012) 59:304-320 DOI 10.1007 yet again by 2036 and will represent 23-25% of Canada's population. B This rapid demographic shift will impact anesthesiologists and hospitals ...

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“…In non-ICU patients, non-pharmacological strategies could prevent delirium [9][10][11]. These include proactive geriatric consultation [9] and education of medical and nursing staff with special attention to known risk factors [10,11].…”

Section: Introductionmentioning

confidence: 99%

“…These include proactive geriatric consultation [9] and education of medical and nursing staff with special attention to known risk factors [10,11]. In ICU patients, non-pharmacological measures have hardly been studied in relation to delirium [12].…”

Section: Introductionmentioning

confidence: 99%

Intensive care unit environment may affect the course of delirium

et al. 2012

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Purpose: Delirium is a common disorder in intensive care unit (ICU) patients. It is unclear whether ICU environment affects delirium. We investigated the influence of ICU environment on the number of days with delirium during ICU admission. Methods: In this prospective before-after study, ICU delirium was compared between a conventional ICU with wards and a single-room ICU with, among others, improved daylight exposure. We included patients admitted for more than 24 h between March and June 2009 (ICU with wards) or between June and September 2010 (single-room ICU). Patients who remained unresponsive throughout ICU admission were excluded. The presence of delirium in the preceding 24 h was assessed daily with the confusion assessment method for the ICU (CAM-ICU) by research physicians combined with evaluation of medical and nursing charts. The number of days with delirium was investigated with Poisson regression analysis. Results: We included 55 patients (449 observation days) in the ICU with wards and 75 patients (468 observation days) in the single-room ICU. After adjusting for confounding, the number of days with delirium decreased by 0.4 days (95 % confidence interval 0.1-0.7) in the singleroom ICU (p = 0.005). The incidence of delirium during ICU stay was similar in the ICU with wards (51 %) and in the single-room ICU (45 %, p = 0.53). Conclusions: This study is the first to show that ICU environment may influence the course of delirium in ICU patients.

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Reducing Delirium After Hip Fracture: A Randomized Trial

Cited by 1,216 publications

References 30 publications

Hypoactive Delirium After Cardiac Surgery as an Independent Risk Factor for Prolonged Mechanical Ventilation

Hypoactive Delirium After Cardiac Surgery as an Independent Risk Factor for Prolonged Mechanical Ventilation

Postoperative delirium: risk factors and management: Continuing Professional Development

Intensive care unit environment may affect the course of delirium

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