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Delirium in ICU

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https://www.readbyqxmd.com/read/28622167/statin-and-its-association-with-delirium-in-the-medical-icu
#1
Jeffrey F Mather, John P Corradi, Christine Waszynski, Adam Noyes, Yinghui Duan, James Grady, Robert Dicks
OBJECTIVES: To examine the association between statin use and the risk of delirium in hospitalized patients with an admission to the medical ICU. DESIGN: Retrospective propensity-matched cohort analysis with accrual from September 1, 2012, to September 30, 2015. SETTING: Hartford Hospital, Hartford, CT. PATIENTS: An initial population of patients with an admission to a medical ICU totaling 10,216 visits were screened for delirium by means of the Confusion Assessment Method...
June 15, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28612089/the-intensive-care-delirium-research-agenda-a-multinational-interprofessional-perspective
#2
REVIEW
Pratik P Pandharipande, E Wesley Ely, Rakesh C Arora, Michele C Balas, Malaz A Boustani, Gabriel Heras La Calle, Colm Cunningham, John W Devlin, Julius Elefante, Jin H Han, Alasdair M MacLullich, José R Maldonado, Alessandro Morandi, Dale M Needham, Valerie J Page, Louise Rose, Jorge I F Salluh, Tarek Sharshar, Yahya Shehabi, Yoanna Skrobik, Arjen J C Slooter, Heidi A B Smith
Delirium, a prevalent organ dysfunction in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy, and the neurosciences sought to address five questions: (1) What is the current standard of care in managing ICU delirium? (2) What have been the major recent advances in delirium research and care? (3) What are the common delirium beliefs that have been challenged by recent trials? (4) What are the remaining areas of uncertainty in delirium research? (5) What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium, identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda...
June 13, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28608136/early-impairment-of-intracranial-conduction-time-predicts-mortality-in-deeply-sedated-critically-ill-patients-a-prospective-observational-pilot-study
#3
Eric Azabou, Benjamin Rohaut, Nicholas Heming, Eric Magalhaes, Régine Morizot-Koutlidis, Stanislas Kandelman, Jeremy Allary, Guy Moneger, Andrea Polito, Virginie Maxime, Djillali Annane, Frederic Lofaso, Fabrice Chrétien, Jean Mantz, Raphael Porcher, Tarek Sharshar
BACKGROUND: Somatosensory (SSEP) and brainstem auditory (BAEP) evoked potentials are neurophysiological tools which, respectively, explore the intracranial conduction time (ICCT) and the intrapontine conduction time (IPCT). The prognostic values of prolonged cerebral conduction times in deeply sedated patients have never been assessed. Sedated patients are at risk of developing new neurological complications, undetected. In this prospective observational bi-center pilot study, we investigated whether early impairment of SSEP's ICCT and/or BAEP's IPCT could predict in-ICU mortality or altered mental status (AMS), in deeply sedated critically ill patients...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28606450/delirium-prevention-in-critically-ill-adults-through-an-automated-reorientation-intervention-a-pilot-randomized-controlled-trial
#4
Cindy L Munro, Paula Cairns, Ming Ji, Karel Calero, W McDowell Anderson, Zhan Liang
OBJECTIVES: Explore the effect of an automated reorientation intervention on ICU delirium in a prospective randomized controlled trial. BACKGROUND: Delirium is common in ICU patients, and negatively affects outcomes. Few prevention strategies have been tested. METHODS: Thirty ICU patients were randomized to 3 groups. Ten received hourly recorded messages in a family member's voice during waking hours over 3 ICU days, 10 received the same messages in a non-family voice, and 10 (control) did not receive any automated reorientation messages...
June 9, 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28595082/a-retrospective-analysis-of-the-effectiveness-of-antipsychotics-in-the-treatment-of-icu-delirium
#5
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
https://www.readbyqxmd.com/read/28594681/delirium-and-benzodiazepines-associated-with-prolonged-icu-stay-in-critically-ill-infants-and-young-children
#6
Heidi A B Smith, Maalobeeka Gangopadhyay, Christina M Goben, Natalie L Jacobowski, Mary Hamilton Chestnut, Jennifer L Thompson, Rameela Chandrasekhar, Stacey R Williams, Katherine Griffith, E Wesley Ely, D Catherine Fuchs, Pratik P Pandharipande
OBJECTIVES: Delirium is prevalent among critically ill children, yet associated outcomes and modifiable risk factors are not well defined. The objective of this study was to determine associations between pediatric delirium and modifiable risk factors such as benzodiazepine exposure and short-term outcomes. DESIGN: Secondary analysis of collected data from the prospective validation study of the Preschool Confusion Assessment Method for the ICU. SETTING: Tertiary-level PICU...
June 7, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28583014/evaluation-of-the-effects-of-quetiapine-on-qtc-prolongation-in-critically-ill-patients
#7
Kevin M Dube, Jeremy DeGrado, Benjamin Hohlfelder, Paul M Szumita
Quetiapine, an atypical antipsychotic used in the intensive care unit (ICU) to manage delirium, has a possible adverse effect of corrected QT (QTc) interval prolongation. The objective of this analysis was to describe the impact of quetiapine on QTc interval prolongation in critically ill patients. This was a single-center, prospective cohort analysis of ICU patients who received quetiapine between October 2015 and February 2016. The major end point was the incidence of QTc prolongation greater than 60 milliseconds above baseline during therapy...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28569132/a-pilot-study-of-the-use-of-dexmedetomidine-for-the-control-of-delirium-by-reducing-the-serum-concentrations-of-brain-derived-neurotrophic-factor-neuron-specific-enolase-and-s100b-in-polytrauma-patients
#8
Yong Li, Zhi-Xin Yu, Mu-Sen Ji, Jun Yan, Yan Cai, Jing Liu, Hong-Feng Yang, Zhao-Chen Jin
BACKGROUND: Delirium is very common among patients with polytrauma, although no suitable means exist to feasibly reduce the incidence and duration of delirium in these patients. Recent reports have suggested that continuous intravenous (IV) infusions of dexmedetomidine, rather than benzodiazepine, be administered for sedation to reduce the duration of delirium in this population. However, serum neuron-specific enolase (NSE), S100 calcium binding protein B (S100B), and brain-derived neurotrophic factor (BDNF) levels have not yet been investigated in polytrauma patients who received sedation with dexmedetomidine rather than other conventional sedatives...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28561887/reconciling-patient-and-provider-priorities-for-improving-the-care-of-critically-ill-patients-a-consensus-method-and-qualitative-analysis-of-decision-making
#9
Emily McKenzie, Melissa L Potestio, Jamie M Boyd, Daniel J Niven, Rebecca Brundin-Mather, Sean M Bagshaw, Henry T Stelfox
BACKGROUND: Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations. OBJECTIVE: To describe the decision-making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list...
May 31, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28560042/acetylcholinesterase-and-butyrylcholinesterase-in-cardiosurgical-patients-with-postoperative-delirium
#10
Mira John, E Wesley Ely, Dorothee Halfkann, Julika Schoen, Beate Sedemund-Adib, Stefan Klotz, Finn Radtke, Sebastian Stehr, Michael Hueppe
BACKGROUND: Patients in intensive care units (ICU) are often diagnosed with postoperative delirium; the duration of which has a relevant negative impact on various clinical outcomes. Recent research found a potentially important role of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) in delirium of critically ill patients on non-surgical ICU or in non-cardiac-surgery patients. We tested the hypothesis that AChE and BChE have an impact on patients after cardiac surgery with postoperative delirium...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28547318/a-systematic-review-of-alpha-2-agonists-for-sedation-in-mechanically-ventilated-neurocritical-care-patients
#11
Alexandre Tran, Henrietta Blinder, Brian Hutton, Shane W English
The use of sedative medications is commonplace in intensive care units (ICUs) and an invaluable clinical tool for the intensive care physician. Sedation for critically ill, mechanically ventilated patients provides an opportunity to reduce anxiety, discomfort as well as ventilator intolerance and dyssynchrony. Alpha-2 agonists in particular have become increasingly popular for use in the neurocritical care population due to their proposed effectiveness in facilitating examinations and procedures as well as reducing the need for adjunctive agents...
May 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28539958/cognitive-impairment-and-psychological-distress-at-discharge-from-intensive-care-unit
#12
Chi Ryang Chung, Hye Jin Yoo, Jinkyeong Park, Seunghyong Ryu
This study aimed to investigate cognitive impairment and psychological distress of critically ill patients at discharge from intensive care unit (ICU). This study included 30 critically ill patients who had neither pre-existing dementia nor ongoing delirium. At ICU discharge, they performed a screening test for cognitive impairment (Mini-Cog test) and completed questionnaires for depression (Patient Health Questionnaire-2, PHQ-2) and for 4 stressful experiences during ICU stay including nightmares, severe anxiety or panic, severe pain, and trouble to breathe or feeling of suffocation (Post-Traumatic Stress Syndrome 14-Question Inventory, PTSS-14 Part A)...
May 2017: Psychiatry Investigation
https://www.readbyqxmd.com/read/28523268/the-sedative-effect-of-propranolol-on-critically-ill-patients-a-case-series
#13
Junji Shiotsuka, Andrew Steel, James Downar
INTRODUCTION: Recent studies have examined the effectiveness of alpha-2 adrenergic agonists for controlling delirium and agitation. Propranolol, a non-selective beta-adrenergic antagonist with good penetration of the blood-brain barrier, has not been investigated for this purpose. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all patients who were prescribed propranolol in our Medical Surgical ICU from January 1, 2010, to December 31, 2013...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28506741/evaluation-of-a-sound-environment-intervention-in-an-icu-a-feasibility-study
#14
Lotta Johansson, Berit Lindahl, Susanne Knutsson, Mikael Ögren, Kerstin Persson Waye, Mona Ringdal
BACKGROUND: Currently, it is well known that the sound environment in intensive care units (ICU) is substandard. Therefore, there is a need of interventions investigating possible improvements. Unfortunately, there are many challenges to consider in the design and performance of clinical intervention studies including sound measurements and clinical outcomes. OBJECTIVES: (1) explore whether it is possible to implement a full-scale intervention study in the ICU concerning sound levels and their impact on the development of ICU delirium; (2) discuss methodological challenges and solutions for the forthcoming study; (3) conduct an analysis of the presence of ICU delirium in the study group; and (4) describe the sound pattern in the intervention rooms...
May 12, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28495595/low-plasma-leptin-level-at-admission-predicts-delirium-in-critically-ill-patients-a-prospective-cohort-study
#15
Guicheng Li, Xiaobao Lei, Chenmu Ai, Tao Li, Zhongqing Chen
The pathophysiology of delirium remains poorly understood. Low leptin level has been associated with features leading to delirium such as dysregulated immune functions and loss of neuroprotective effects. The purpose of the present study was to investigate the relationship between plasma leptin level at intensive care unit (ICU) entry and subsequent occurrence of delirium in critically ill patients. This single-center prospective cohort study in China allocated 336 critically ill patients admitted to ICU between 05/2015 and 05/2016 into a delirium group (n=102) and non-delirium group (n=234) based on whether delirium occurred during their stay at the ICU...
May 8, 2017: Peptides
https://www.readbyqxmd.com/read/28489649/a-novel-computerized-test-for-detecting-and-monitoring-visual-attentional-deficits-and-delirium-in-the-icu
#16
Cameron Green, Kirsty Hendry, Elizabeth S Wilson, Timothy Walsh, Mike Allerhand, Alasdair M J MacLullich, Zoë Tieges
OBJECTIVES: Delirium in the ICU is associated with poor outcomes but is under-detected. Here we evaluated performance of a novel, graded test for objectively detecting inattention in delirium, implemented on a custom-built computerized device (Edinburgh Delirium Test Box-ICU). DESIGN: A pilot study was conducted, followed by a prospective case-control study. SETTING: Royal Infirmary of Edinburgh General ICU. PATIENTS: A pilot study was conducted in an opportunistic sample of 20 patients...
July 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28487184/symptom-assessment-in-non-vocal-or-cognitively-impaired-icu-patients-implications-for-practice-and-future-research
#17
REVIEW
JiYeon Choi, Margaret L Campbell, Céline Gélinas, Mary Beth Happ, Judith Tate, Linda Chlan
BACKGROUND: Symptom assessment in critically ill patients is challenging because many cannot provide a self-report. OBJECTIVES: To describe the state of the science on symptom communication and the assessment of selected physical symptoms in non-vocal ICU patients. METHODS: This paper summarizes a 2014 American Thoracic Society Annual International Conference symposium presenting current evidence on symptom communication, delirium, and the assessment of common physical symptoms (i...
May 6, 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28485318/a-national-multicenter-survey-on-management-of-pain-agitation-and-delirium-in-intensive-care-units-in-china
#18
Jing Wang, Zhi-Yong Peng, Wen-Hai Zhou, Bo Hu, Xin Rao, Jian-Guo Li
BACKGROUND: The management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available in China. This study aimed to investigate the practice of PAD in ICUs in China. METHODS: A multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016...
May 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28466149/potentially-modifiable-factors-contributing-to-sepsis-associated-encephalopathy
#19
Romain Sonneville, Etienne de Montmollin, Julien Poujade, Maïté Garrouste-Orgeas, Bertrand Souweine, Michael Darmon, Eric Mariotte, Laurent Argaud, François Barbier, Dany Goldgran-Toledano, Guillaume Marcotte, Anne-Sylvie Dumenil, Samir Jamali, Guillaume Lacave, Stéphane Ruckly, Bruno Mourvillier, Jean-François Timsit
PURPOSE: Identifying modifiable factors for sepsis-associated encephalopathy may help improve patient care and outcomes. METHODS: We conducted a retrospective analysis of a prospective multicenter database. Sepsis-associated encephalopathy (SAE) was defined by a score on the Glasgow coma scale (GCS) <15 or when features of delirium were noted. Potentially modifiable risk factors for SAE at ICU admission and its impact on mortality were investigated using multivariate logistic regression analysis and Cox proportional hazard modeling, respectively...
May 2, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28459497/assessment-of-delirium-in-intensive-care-unit-patients-educational-strategies
#20
Judith M Smith, M Nancy Van Aman, Mary Elizabeth Schneiderhahn, Robin Edelman, Patrick M Ercole
BACKGROUND: Delirium is an acute brain dysfunction associated with poor outcomes in intensive care unit (ICU) patients. Critical care nurses play an important role in the prevention, detection, and management of delirium, but they must be able to accurately assess for it. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument is a reliable and valid method to assess for delirium, but research reveals most nurses need practice to use it proficiently. METHOD: A pretest-posttest design was used to evaluate the success of a multimodal educational strategy (i...
May 1, 2017: Journal of Continuing Education in Nursing
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