Subsyndromal delirium in the ICU: evidence for a disease spectrum

Ouimet, Sébastien; Riker, Richard R.; Bergeron, Nathalie; Cossette, Mariève; Kavanagh, Brian P.; Skrobik, Yoanna

doi:10.1007/s00134-007-0618-y

Cited by 294 publications

(194 citation statements)

References 15 publications

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“…SSD is common in inpatient and post-acute settings. In these settings, the prevalence of SSD ranges from 33% to 62% [12][13][14]. The high degree of variability in published reports of delirium and SSD may be attributable to patient population, age range, frequency of measurement, or measurement technique.…”

Section: Introductionmentioning

confidence: 91%

Delirium in patients with head and neck cancer in the outpatient treatment setting

Bond

Dietrich

Shuster

et al. 2011

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Section: Introductionmentioning

confidence: 91%

Delirium in patients with head and neck cancer in the outpatient treatment setting

Bond

Dietrich

Shuster

et al. 2011

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“…Levkoff et al (1996) and others assert that delirium symptoms represent a spectrum of neurobehavioral impairments rather than a condition with distinct clinical profiles and outcomes (Levkoff et al, 1996; Ouimet et al, 2007; Shim & Leung, 2012). However, others question the notion that subsyndromal delirium is a graded step in the spectrum of brain dysfunction severity due to differences in risk factors (Skrobik, 2009).…”

Section: Introductionmentioning

confidence: 99%

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery

Denny

Lindseth

2017

Orthopaedic Nursing

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Background Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. Purpose This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. Methods Delirium assessments of a sample of 62 adults age 65 or older were completed on postoperative day 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. Results Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). Conclusions Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.

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“…However, it is commonly overused [1], and, when in excess, it is associated with increased time on mechanical ventilation [2], higher mortality [3], delirium [4] and psychological disturbances [5]. Fortunately, there are some strategies which have been shown to be effective in reducing the burden of excessive sedation.…”

Section: Introductionmentioning

confidence: 99%

Daily sedative interruption versus intermittent sedation in mechanically ventilated critically ill patients: a randomized trial

Nassar

Park

2014

Ann Intensive Care

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BackgroundDaily sedative interruption and intermittent sedation are effective in abbreviating the time on mechanical ventilation. Whether one is superior to the other has not yet been determined. Our aim was to compare daily interruption and intermittent sedation during the mechanical ventilation period in a low nurse staffing ICU.MethodsAdult patients expected to need mechanical ventilation for more than 24 hours were randomly assigned, in a single center, either to daily interruption of continuous sedative and opioid infusion or to intermittent sedation. In both cases, our goal was to maintain a Sedation Agitation Scale (SAS) level of 3 or 4; that is patients should be calm, easily arousable or awakened with verbal stimuli or gentle shaking. Primary outcome was ventilator-free days in 28 days. Secondary outcomes were ICU and hospital mortality, incidence of delirium, nurse workload, self-extubation and psychological distress six months after ICU discharge.ResultsA total of 60 patients were included. There were no differences in the ventilator-free days in 28 days between daily interruption and intermittent sedation (median: 24 versus 25 days, P = 0.160). There were also no differences in ICU mortality (40 versus 23.3%, P = 0.165), hospital mortality (43.3 versus 30%, P = 0.284), incidence of delirium (30 versus 40%, P = 0.472), self-extubation (3.3 versus 6.7%, P = 0.514), and psychological stress six months after ICU discharge. Also, the nurse workload was not different between groups, but it was reduced on day 5 compared to day 1 in both groups (Nurse Activity Score (NAS) in the intermittent sedation group was 54 on day 1 versus 39 on day 5, P < 0.001; NAS in daily interruption group was 53 on day 1 versus 38 on day 5, P < 0.001). Fentanyl and midazolam total dosages per patient were higher in the daily interruption group. The tidal volume was higher in the intermittent sedation group during the first five days of ICU stay.ConclusionsThere was no difference in the number of ventilator-free days in 28 days between both groups. Intermittent sedation was associated with lower sedative and opioid doses.Trial registrationClinicalTrials.gov Identifier: NCT00824239.

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Subsyndromal delirium in the ICU: evidence for a disease spectrum

Abstract: Clinical delirium is common, important and adverse in the critically ill. A graded diagnostic scale permits detection of a category of subsyndromal delirium which occurs in many ICU patients, and which is associated with adverse outcome.

Cited by 294 publications

References 15 publications

Delirium in patients with head and neck cancer in the outpatient treatment setting

Delirium in patients with head and neck cancer in the outpatient treatment setting

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery

Daily sedative interruption versus intermittent sedation in mechanically ventilated critically ill patients: a randomized trial

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