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intensive care unit delirium

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https://www.readbyqxmd.com/read/28734823/evaluation-of-early-administration-of-simvastatin-in-the-prevention-and-treatment-of-delirium-in-critically-ill-patients-undergoing-mechanical-ventilation-modus-a-randomised-double-blind-placebo-controlled-trial
#1
Valerie J Page, Annalisa Casarin, E Wesley Ely, Xiao Bei Zhao, Cliona McDowell, Lynn Murphy, Daniel F McAuley
BACKGROUND: Delirium in critically ill patients is associated with poor clinical outcomes. Neuroinflammation might be an important mechanism in the pathogenesis of delirium, and since simvastatin has anti-inflammatory properties it might reduce delirium. We aimed to establish whether early treatment with simvastatin would decrease the time that survivors of critical illness spent in delirium or coma. METHODS: We undertook this randomised, double-blind, placebo-controlled trial in a general adult intensive care unit (ICU) in Watford General Hospital (Watford, UK)...
July 19, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28733841/analgosedation-of-adult-patients-with-elevated-intracranial-pressure-survey-of-current-clinical-practice-in-austria
#2
Guenther Herzer, Claudia Mirth, Udo M Illievich, Wolfgang G Voelckel, Helmut Trimmel
BACKGROUND: Analgesia and sedation are key items in intensive care. Recently published S3 guidelines specifically address treatment of patients with elevated intracranial pressure. METHODS: The Austrian Society of Anesthesiology, Resuscitation and Intensive Care Medicine carried out an online survey of neurointensive care units in Austria in order to evaluate the current state of practice in the areas of analgosedation and delirium management in this high-risk patient group...
July 21, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28723773/development-and-validation-of-risk-stratification-delirium-prediction-model-for-critically-ill-patients-a-prospective-observational-single-center-study
#3
Yu Chen, Hang Du, Bao-Hua Wei, Xue-Ni Chang, Chen-Ming Dong
The objective is to develop a model based on risk stratification to predict delirium among adult critically ill patients and whether early intervention could be provided for high-risk patients, which could reduce the incidence of delirium.We designed a prospective, observational, single-center study. We examined 11 factors, including age, APACHE-II score, coma, emergency operation, mechanical ventilation (MV), multiple trauma, metabolic acidosis, history of hypertension, delirium and dementia, and application of Dexmedetomidine Hydrochloride...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28718100/risk-factors-for-delirium-after-cardiac-surgery-a-historical-cohort-study-outlining-the-influence-of-cardiopulmonary-bypass
#4
Jason B O'Neal, Frederic T Billings, Xulei Liu, Matthew S Shotwell, Yafen Liang, Ashish S Shah, Jesse M Ehrenfeld, Jonathan P Wanderer, Andrew D Shaw
PURPOSE: Cardiopulmonary bypass (CPB) induces a significant inflammatory response that may increase the risk for delirium. We hypothesized that exposure to CPB during coronary artery bypass grafting (CABG) surgery would correlate with an increased risk of delirium. METHODS: We reviewed clinical data from two databases at our medical centre - the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Patients undergoing elective CABG surgery (on-pump and off-pump) from November 1, 2009 to September 30, 2015 were included in the study...
July 17, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28715077/age-and-gender-related-peculiarities-of-patients-with-delirium-in-the-cardiac-intensive-care-unit
#5
Pranas Serpytis, Petras Navickas, Alvydas Navickas, Rokas Serpytis, Giedrius Navickas, Sigita Glaveckaite
BACKGROUND: The overall evidence base regarding delirium has been growing steadily over the past few decades. There has been considerable analysis of delirium concerning, for example, mechanically ventilated patients, patients in the general intensive care unit (ICU) setting, and patients with exclusively postoperative delirium. Nevertheless, there are few studies regarding delirium in a cardiovascular ICU (ICCU) setting and especially scarce literature about the particular features of delirium relating to patient age and gender...
July 17, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28710219/comparison-of-propofol-and-dexmedetomidine-infused-overnight-to-treat-hyperactive-and-mixed-icu-delirium-a-protocol-for-the-basel-prodex-clinical-trial
#6
Alexa Hollinger, Katrin Ledergerber, Stefanie von Felten, Raoul Sutter, Stephan Rüegg, Lukas Gantner, Sibylle Zimmermann, Andrea Blum, Luzius A Steiner, Stephan Marsch, Martin Siegemund
BACKGROUND/OBJECTIVES: Delirium is a neurobehavioural disturbance that frequently develops particularly in the intensive care unit (ICU) population. It was first described more than half a century ago, where it was already discovered as a state that might come along with serious complications such as prolonged ICU and hospital stay, reduced quality of life and increased mortality. However, in most cases, there is still lack of proof for causal relationship. Its presence frequently remains unrecognised due to suggested predominance of the hypoactive form...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28698343/protocol-for-an-observational-study-of-delirium-in-the-post-anaesthesia-care-unit-pacu-as-a-potential-predictor-of-subsequent-postoperative-delirium
#7
Victoria Cui, Catherine M Tedeschi, Vanessa L Kronzer, Sherry L McKinnon, Michael S Avidan
INTRODUCTION: Postoperative delirium can be a serious consequence of major surgery, associated with longer hospital stays, readmission, cognitive and functional deterioration and mortality. Delirium is an acute, reversible disorder characterised by fluctuating course, inattention, disorganised thinking and altered level of consciousness. Delirium occurring in the hours immediately following anaesthesia and delirium occurring in the postoperative period of 1-5 days have been described as distinct clinical entities...
July 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28697802/outcomes-of-subsyndromal-delirium-in-icu-a-systematic-review-and-meta-analysis
#8
Rodrigo B Serafim, Marcio Soares, Fernando A Bozza, José R Lapa E Silva, Felipe Dal-Pizzol, Maria Carolina Paulino, Pedro Povoa, Jorge I F Salluh
BACKGROUND: Subsyndromal delirium (SSD) is a frequent condition and has been commonly described as an intermediate stage between delirium and normal cognition. However, the true frequency of SSD and its impact on clinically relevant outcomes in the intensive care unit (ICU) remains unclear. METHODS: We performed a systematic search in PubMed, Embase, CINAHL, Cochrane Library, and PsychINFO, with no language restrictions, up to 1 October 2016 to identify publications that evaluated SSD in ICU patients...
July 12, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28692620/delirium-in-the-icu-what-about-the-floor
#9
Anthony Cahill, Christopher Pearcy, Vaidehi Agrawal, Phillip Sladek, Michael S Truitt
Delirium was first described in the 1800s as acute, fluctuating confusion. Recent studies note an incidence of 15% in adult intensive care unit patients. Here we present the first prospective study to evaluate the incidence and risk factors for delirium in patients admitted to the trauma surgeon (TS) in non-critical care areas (NCCAs). Patients 18 years or older admitted to any TS in the designated NCCA were evaluated and consented for participation over a 3-month period. Participants were screened with the Confusion Assessment Method (CAM) every 12 hr...
July 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28677160/risk-factors-for-the-incidence-of-delirium-in-cerebrovascular-patients-in-a-neurosurgery-intensive-care-unit-icu-a-prospective-study
#10
Jun Wang, Yuanyuan Ji, Ning Wang, Wenjin Chen, Yuehong Bao, Qinpu Qin, Qian Xiao, Shulan Li
AIMS AND OBJECTIVES: To explore the incidence of delirium in cerebrovascular patients admitted in our Neurosurgery Intensive Care Unit (NICU) and analyze the risk factors leading to delirium. BACKGROUND: Delirium is one of the most common mental disorders in general hospitals, but the incidence of different kinds of diseases and studies varies. Cerebrovascular patients in our NICU are high-risk groups for delirium; identifying risk factors for delirium and taking early interventions are crucial for patient prognosis...
July 5, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28668927/delirium-after-transcatheter-aortic-valve-replacement
#11
Jennifer L Giuseffi, Nyal E Borges, Leanne M Boehm, Li Wang, John A McPherson, Joseph L Fredi, Rashid M Ahmad, E Wesley Ely, Pratik P Pandharipande
BACKGROUND: Postoperative delirium is associated with increased mortality. Patients undergoing transcatheter aortic valve replacement are at risk for delirium because of comorbid conditions. OBJECTIVE: To compare the incidence, odds, and mortality implications of delirium between patients undergoing transcatheter replacement and patients undergoing surgical replacement. METHODS: The Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit were used to assess arousal level and delirium prospectively in all patients with severe aortic stenosis who had transcatheter or surgical aortic valve replacement at an academic medical center...
July 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28668925/perceptions-of-workload-burden-and-adherence-to-abcde-bundle-among-intensive-care-providers
#12
Leanne M Boehm, Mary S Dietrich, Eduard E Vasilevskis, Nancy Wells, Pratik Pandharipande, E Wesley Ely, Lorraine C Mion
BACKGROUND: Use of the interprofessional Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle is recommended practice in intensive care, but its adoption remains limited. OBJECTIVE: To examine the relationship between intensive care unit provider attitudes regarding the ABCDE bundle and ABCDE bundle adherence. METHODS: A 1-time survey of 268 care providers in 10 intensive care units across the country who had worked at least 4 shifts per month to examine their attitudes toward workload burden, difficulty carrying out the bundle, perceived safety, confidence, and perceived strength of evidence...
July 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28668768/low-brain-tissue-oxygenation-contributes-to-the-development-of-delirium-in-critically-ill-patients-a-prospective-observational-study
#13
Michael D Wood, David M Maslove, John G Muscedere, Andrew G Day, J Gordon Boyd
PURPOSE: To test the hypothesis that poor brain tissue oxygenation (BtO2) during the first 24h of critical illness correlates with the proportion of time spent delirious. We also sought to define the physiological determinants of BtO2. MATERIALS AND METHODS: Adult patients admitted to the ICU within the previous 24h were considered eligible for enrollment if they required mechanical ventilation, and/or vasopressor support. BtO2 was measured using near-infrared spectroscopy, for 24h after enrollment...
June 15, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28652635/-risk-factors-for-delirium-in-intensive-care-unit-br-in-liver-transplant-patients
#14
Filippo Binda, Alessandro Galazzi, Alessandra Brambilla, Ileana Adamini, Dario Laquintana
. Risk factors for delirium in intensive care unit in liver transplant patients. INTRODUCTION: Delirium is a disorder of the state of consciousness characterized by acute onset and temporal variability of cognitive abilities. It is frequent in intensive care unit (ICU) and it is associated with worst outcomes. AIM: To identify risk factors for the development of delirium in patients in intensive care unit (ICU) after orthotopic liver transplantation (OLTx). METHODS: Observational retrospective study on all the patients undergoing OLTx between January 2014 and December 2015...
April 2017: Assistenza Infermieristica e Ricerca: AIR
https://www.readbyqxmd.com/read/28651508/quality-sleep-using-earplugs-in-the-intensive-care-unit-the-quiet-pilot-randomised-controlled-trial
#15
Edward Litton, Rosalind Elliott, Janet Ferrier, Steven A R Webb
OBJECTIVE: To assess the feasibility of a definitive, randomised controlled trial of earplugs as a noise-abatement strategy to improve sleep and reduce delirium in patients admitted to the intensive care unit. DESIGN AND SETTING: An open-label trial of 40 patients randomised in a 1:1 ratio to receive earplugs in addition to standard care, or standard care alone, conducted in a 10-bed ICU of a large, private hospital in Perth, Western Australia. PARTICIPANTS AND INTERVENTION: Patients were eligible for participation if they were expected to be undergoing mechanical ventilation (MV) on admission to the ICU...
June 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28637741/the-closed-trial-clonidine-compared-with-midazolam-for-sedation-of-paediatric-patients-in-the-intensive-care-unit-study-protocol-for-a-multicentre-randomised-controlled-trial
#16
Antje Neubert, Manuel Alberto Baarslag, Monique van Dijk, Joost van Rosmalen, Joseph F Standing, Yucheng Sheng, Wolfgang Rascher, Deborah Roberts, Jackie Winslade, Louise Rawcliffe, Sara M Hanning, Tuuli Metsvaht, Viviana Giannuzzi, Peter Larsson, Pavla Pokorná, Alessandra Simonetti, Dick Tibboel
INTRODUCTION: Sedation is an essential part of paediatric critical care. Midazolam, often in combination with opioids, is the current gold standard drug. However, as it is a far-from-ideal agent, clonidine is increasingly being used in children. This drug is prescribed off-label for this indication, as many drugs in paediatrics are. Therefore, the CLOSED trial aims to provide data on the pharmacokinetics, safety and efficacy of clonidine for the sedation of mechanically ventilated patients in order to obtain a paediatric-use marketing authorisation...
June 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28632519/age-is-the-most-significantly-associated-risk-factor-with-the-development-of-delirium-in-patients-hospitalized-for-more-than-five-days-in-surgical-wards-retrospective-cohort-study
#17
Keisuke Kubota, Akihiro Suzuki, Sachiko Ohde, Ui Yamada, Takashi Hosaka, Fumiko Okuno, Ikumi Fujitani, Aya Koitabashi, Gen Shimada, Akihiro Kishida
OBJECTIVE: The primary purpose of this study was to assess risk factors for delirium in patients staying in a surgical ward for more than 5 days. The secondary purpose was to assess outcomes in patients with delirium. BACKGROUND: Delirium is a syndrome characterized by acute fluctuations in mental status. Patients with delirium are at increased risk of adverse inpatient events, higher mortality and morbidity rates, prolonged hospital stays, and increased health care costs...
June 19, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28628893/one-year-mortality-after-hip-fracture-in-older-individuals-the-effects-of-delirium-and-dementia
#18
Rebecca Mitchell, Lara Harvey, Henry Brodaty, Brian Draper, Jacqueline Close
BACKGROUND: Delirium is common in older hip fracture patients, yet its association with mortality after hip fracture remains uncertain. This study aimed to determine whether delirium was associated with all-cause one-year mortality after hip fracture in older patients and whether the effect of delirium was independent of dementia status. METHOD: A retrospective analysis of linked hospitalisation and mortality data for patients aged ≥65 years with a hip fracture during 1 January 2010 to 30 June 2014 in New South Wales, Australia...
September 2017: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/28601133/assessment-and-management-of-toxidromes-in-the-critical-care-unit
#19
REVIEW
J J Rasimas, Courtney M Sinclair
The most important diagnostic factor in uncovering a toxic etiology for delirium or critical illness is the clinician's openness to the possibility of its existence. Therefore, a consulting psychiatrist, already prepared to perform the detail-oriented work of sorting out behavioral manifestations of disease, can be a vital asset at the bedside if also attuned to the role of purposeful, accidental, and iatrogenic exposures in the intensive care unit. This article summarizes the presentation, evaluation, and treatment of toxidromes relevant to the work of acute psychosomatic medicine...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28595082/a-retrospective-analysis-of-the-effectiveness-of-antipsychotics-in-the-treatment-of-icu-delirium
#20
Cory B Weaver, Sandra L Kane-Gill, Scott R Gunn, Levent Kirisci, Pamela L Smithburger
PURPOSE: Conflicting data exists on the efficacy of antipsychotics for treatment of intensive care unit (ICU) delirium. The purpose of this study was to compare time to delirium resolution for ICU patients who were managed with and without antipsychotics. MATERIALS AND METHODS: This retrospective cohort evaluation included patients admitted to 12 ICUs at 5 sites over 5 weeks diagnosed with delirium. The primary outcome was time to delirium resolution. Secondary outcomes included ICU length of stay (LOS), mortality, discharge disposition and delirium redevelopment...
June 1, 2017: Journal of Critical Care
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