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Delirium critical care

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https://www.readbyqxmd.com/read/28212172/cognitive-decline-associated-with-anesthesia-and-surgery-in-the-elderly-does-this-contribute-to-dementia-prevalence
#1
Lisbeth Evered, David A Scott, Brendan Silbert
PURPOSE OF REVIEW: To provide an update on the current state of research investigating the effects of anesthesia and surgery on cognition in the elderly, including consideration of overlap with cognitive disorders in the community. RECENT FINDINGS: The studies reviewed here identify detrimental effects of anesthesia and surgery on cognition in a proportion of elderly individuals. Animal models demonstrate an association between anesthetic agents and Alzheimer's disease pathology...
February 15, 2017: Current Opinion in Psychiatry
https://www.readbyqxmd.com/read/28190446/prognosis-of-neurologic-complications-in-critical-illness
#2
M Van Der Jagt, E J O Kompanje
Neurologic complications of critical illness require extensive clinical and neurophysiologic evaluation to establish a reliable prognosis. Many sequelae of intensive care unit (ICU) treatment, such as delirium and ICU-acquired weakness, although highly associated with adverse outcomes, are less suitable for prognostication, but should rather prompt clinicians to seek previously unnoticed persisting underlying illnesses. Prognostication can be confounded by drug administration particularly because its clearance is abnormal in critical illness...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28190430/delirium-in-critically-ill-patients
#3
A J C Slooter, R R Van De Leur, I J Zaal
Delirium is common in critically ill patients and associated with increased length of stay in the intensive care unit (ICU) and long-term cognitive impairment. The pathophysiology of delirium has been explained by neuroinflammation, an aberrant stress response, neurotransmitter imbalances, and neuronal network alterations. Delirium develops mostly in vulnerable patients (e.g., elderly and cognitively impaired) in the throes of a critical illness. Delirium is by definition due to an underlying condition and can be identified at ICU admission using prediction models...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28179250/impact-of-pharmacist-management-of-pain-agitation-and-delirium-in-the-intensive-care-unit-through-participation-in-multidisciplinary-bundle-rounds
#4
Patricia Louzon, Heath Jennings, Mahmood Ali, Marijo Kraisinger
PURPOSE: A two-phase program to increase pharmacist involvement in management of pain, agitation and delirium (PAD) at a large community teaching hospital is described. SUMMARY: Florida Orlando Hospital implemented a two-phase initiative to decrease intensive care unit (ICU) length of stay (LOS), ventilator use, sedative use, and hospital expenditures while advancing pharmacists' scope of practice. Phase 1 of the initiative involved a pilot project to evaluate pharmacist management of sedative therapy for mechanically ventilated patients...
February 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28152732/reducing-pain-agitation-and-delirium-to-optimize-outcomes-in-mechanically-ventilated-critically-ill-oncology-patients
#5
Dana Bullick, Sharon Barniak, Joanne McGovern, Trisha Patel, Jeffrey Hoag
: 233 Background: Greater than 60% of cancer patients experience chronic pain which is heightened in critical illness. Optimal pain assessment is challenging in the critically ill leading to under treatment due to sedation during mechanical ventilation (MV). The Society of Critical Care Medicine (SCCM) favors treating pain with intermittent boluses rather than continuous infusions; however,appropriate analgesic doses and means of titration are elusive leading to over sedation, prolonged ventilation, and delirium...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28124100/-treatment-with-psychotropic-agents-in-patients-with-dementia-and-delirium-gap-between-guideline-recommendations-and-treatment-practice
#6
Walter Hewer, Christine Thomas
BACKGROUND AND OBJECTIVES: Psychiatric symptoms in dementia and delirium are associated with a substantially reduced quality of life of patients and their families and often challenging for professionals. Pharmacoepidemiological surveys have shown that, in particular, patients living in nursing homes receive prescriptions of psychotropic agents in significant higher frequency than recommended by current guidelines. This article focuses on a critical appraisal of this gap from the point of view of German healthcare services...
February 2017: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/28119313/the-association-between-cognitive-impairment-and-functional-outcome-in-hospitalised-older-patients-a-systematic-review-and-meta-analysis
#7
Peter Hartley, Nathalie Gibbins, Amanda Saunders, Kerry Alexander, Eimear Conroy, Rebecca Dixon, Joseph Lang, Jasmine Luckett, Tim Luddington, Roman Romero-Ortuno
BACKGROUND: in hospitalised older adults, cognitive impairments are common and may be associated with functional outcomes. Our aim was to systematically review this association. METHOD: we systematically searched MEDLINE, CINAHL, AMED and PsycINFO from inception to April 2016. Non-English language studies were filtered out at search stage. All types of studies were considered for inclusion except reviews, conference abstracts, dissertations and case studies. POPULATION: community-dwelling or institutionalised older adults aged 65 years or more, who are acutely hospitalised and have information on history of dementia and/or cognitive scores on admission...
January 23, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28105784/what-prevents-critically-ill-patients-with-respiratory-failure-from-using-non-invasive-positive-pressure-ventilation-a-mixed-methods-study
#8
Hiroaki Murata, Tomoko Inoue, Osamu Takahashi
AIM: To identify the factors that prevent patients in respiratory failure from using noninvasive positive pressure ventilation (NPPV). The following were evaluated: (i) the patients who converted from NPPV to endotracheal intubation; and (ii) the patients who abandoned NPPV. METHODS: Patients were interviewed regarding their experience with NPPV. Next, the factors that prevented the continuation of NPPV were identified and those data were collected retrospectively from medical records...
January 20, 2017: Japan Journal of Nursing Science: JJNS
https://www.readbyqxmd.com/read/28100176/effect-of-training-and-structured-medication-review-on-medication-appropriateness-in-nursing-home-residents-and-on-cooperation-between-health-care-professionals-the-intherakt-study-protocol
#9
Angelika Mahlknecht, Nadja Nestler, Ulrike Bauer, Nadine Schüßler, Jochen Schuler, Sebastian Scharer, Ralf Becker, Isabel Waltering, Georg Hempel, Oliver Schwalbe, Maria Flamm, Jürgen Osterbrink
BACKGROUND: Pharmacotherapy in residents of nursing homes is critical due to the special vulnerability of this population. Medical care and interprofessional communication in nursing homes are often uncoordinated. As a consequence, polypharmacy and inappropriate medication use are common and may lead to hospitalizations and health hazards. The aim of this study is to optimize communication between the involved professional groups by specific training and by establishing a structured medication review process, and to improve medication appropriateness and patient-relevant health outcomes for residents of nursing homes...
January 18, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28099642/sedation-protocols-versus-daily-sedation-interruption-a-systematic-review-and-meta-analysis
#10
Antonio Paulo Nassar, Marcelo Park
Objective: The aim of this study was to systematically review studies that compared a mild target sedation protocol with daily sedation interruption and to perform a meta-analysis with the data presented in these studies. Methods: We searched Medline, Scopus and Web of Science databases to identify randomized clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The primary outcome was mortality in the intensive care unit...
October 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28099638/risk-factors-for-agitation-in-critically-ill-patients
#11
Thiago Miranda Lopes de Almeida, Luciano Cesar Pontes de Azevedo, Paulo Maurício Garcia Nosé, Flavio Geraldo Resende de Freitas, Flávia Ribeiro Machado
Objective: To evaluate the incidence of agitation in the first 7 days after intensive care unit admission, its risk factors and its associations with clinical outcomes. Methods: This single-center prospective cohort study included all patients older than 18 years with a predicted stay > 48 hours within the first 24 hours of intensive care unit admission. Agitation was defined as a Richmond Agitation Sedation Scale score ≥ +2, an episode of agitation or the use of a specific medication recorded in patient charts...
October 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28098628/the-abcdef-bundle-science-and-philosophy-of-how-icu-liberation-serves-patients-and-families
#12
E Wesley Ely
Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called "the postintensive care syndrome." Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28079605/delirium-in-critically-ill-children-an-international-point-prevalence-study
#13
Chani Traube, Gabrielle Silver, Ron W Reeder, Hannah Doyle, Emily Hegel, Heather A Wolfe, Christopher Schneller, Melissa G Chung, Leslie A Dervan, Jane L DiGennaro, Sandra D W Buttram, Sapna R Kudchadkar, Kate Madden, Mary E Hartman, Mary L deAlmeida, Karen Walson, Erwin Ista, Manuel A Baarslag, Rosanne Salonia, John Beca, Debbie Long, Yu Kawai, Ira M Cheifetz, Javier Gelvez, Edward J Truemper, Rebecca L Smith, Megan E Peters, A M Iqbal O'Meara, Sarah Murphy, Abdulmohsen Bokhary, Bruce M Greenwald, Michael J Bell
OBJECTIVES: To determine prevalence of delirium in critically ill children and explore associated risk factors. DESIGN: Multi-institutional point prevalence study. SETTING: Twenty-five pediatric critical care units in the United States, the Netherlands, New Zealand, Australia, and Saudi Arabia. PATIENTS: All children admitted to the pediatric critical care units on designated study days (n = 994). INTERVENTION: Children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the bedside nurse...
January 10, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28066556/does-the-combination-use-of-two-pain-assessment-tools-have-a-synergistic-effect
#14
EDITORIAL
Takeshi Suzuki
Pain management is a very important aspect in the intensive care unit (ICU), as adequate pain control has been shown to be associated with better clinical outcomes in critically ill patients. A Numerical Rating Scale (NRS) ranging from 0 to 10 (0, no pain; 10, maximum pain), which is based on a patient's self-report, is the gold standard for pain evaluation in patients who can communicate their pain intensity. On the other hand, it is very difficult to evaluate the degree of pain in critically ill patients owing to decreased consciousness level, delirium, and the effect of sedation for mechanical ventilation management...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28061873/prophylactic-melatonin-for-delirium-in-intensive-care-pro-medic-study-protocol-for-a-randomised-controlled-trial
#15
F Eduardo Martinez, Matthew Anstey, Andrew Ford, Brigit Roberts, Miranda Hardie, Robert Palmer, Lynn Choo, David Hillman, Michael Hensley, Erin Kelty, Kevin Murray, Bhajan Singh, Bradley Wibrow
BACKGROUND: Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium...
January 6, 2017: Trials
https://www.readbyqxmd.com/read/28028790/autoimmune-encephalitis-at-the-neurological-intensive-care-unit-etiologies-reasons-for-admission-and-survival
#16
Gayane Harutyunyan, Larissa Hauer, Martin W Dünser, Anush Karamyan, Tobias Moser, Slaven Pikija, Markus Leitinger, Helmut F Novak, Eugen Trinka, Johann Sellner
BACKGROUND: Early recognition and treatment of autoimmune encephalitis (AE) has become an essential issue in clinical practice. However, little is known about patients with deteriorating conditions and the need for intensive care treatment. Here, we aimed to characterize underlying aetiologies, clinical symptoms, reasons for intensive care admission, and mortality of critically ill patients with AE. METHODS: We conducted a retrospective chart review of all patients with "definite" or "probable" diagnoses of AE treated at our neurological intensive care unit between 2002 and 2015...
December 27, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/28024558/detection-prevention-and-management-of-delirium-in-the-critically-ill-cardiac-patient-and-patients-who-undergo-cardiac-procedures
#17
REVIEW
Rakesh C Arora, George Djaiani, James L Rudolph
Delirium is an acute change in cognitive functioning, characterized by inattention and associated with alterations in awareness and fluctuation in arousal, disorganized thinking, or altered level that preferentially affects older adult patients. In the acutely ill cardiac patient, the incidence of delirium has been reported as high as 73%, depending on the type and sensitivity of delirium assessment. Cardiac patients with delirium experience higher rates of in-hospital and longer-term mortality and are at risk for progressive cognitive impairment, loss of functional independence, and increased hospitalization costs...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27965233/research-in-review-advancing-critical-care-practice
#18
Elizabeth Bridges, Margaret M McNeill, Nancy Munro
Research published in 2016 identified strategies to enhance acute and critical care, initiated discussions on professional roles and responsibilities, clarified complex care issues, and led to robust debate. Some of this important work addressed strategies to prevent delirium and pressure ulcers, considerations for pain management within the context of the opioid abuse crisis, strategies to guide fluid resuscitation in patients with sepsis and heart failure, and ways to enhance care for family members of intensive care patients...
December 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/27965224/feasibility-and-effectiveness-of-a-delirium-prevention-bundle-in-critically-ill-patients
#19
Claudia DiSabatino Smith, Petra Grami
BACKGROUND: Strategies for preventing delirium include early identification and avoiding or modifying patient, environmental, and iatrogenic factors. Minimal research exists on a prescriptive delirium prevention bundle that details elements or strategies for each bundle component. Even less research has been focused on nurse-driven interventions or components. OBJECTIVE: To evaluate the effectiveness of a delirium prevention bundle in decreasing delirium incidence in 2 medical-surgical intensive care units in a large Texas medical center...
December 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/27923397/pharmacological-interventions-for-delirium-in-intensive-care-patients-a-protocol-for-an-overview-of-reviews
#20
Marija Barbateskovic, Laura Krone Larsen, Marie Oxenbøll-Collet, Janus Christian Jakobsen, Anders Perner, Jørn Wetterslev
BACKGROUND: The prevalence of delirium in intensive care unit (ICU) patients is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer ICU stay, increased long-term mortality and cognitive impairment. Thus, the burden of delirium for patients, relatives and societies is considerable. Today, reviews of randomised clinical trials are produced in large scales sometimes making it difficult to get an overview of the available evidence. A preliminary search identified several reviews investigating the effects of pharmacological interventions for the management and prevention of delirium in ICU patients...
December 7, 2016: Systematic Reviews
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