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Delirium and CCU

Sanjay Lahariya, Sandeep Grover, Shiv Bagga, Akhilesh Sharma
AIM: To study the phenomenology and motor sub-types of delirium in patients admitted in a Coronary Care Unit (CCU). METHODS: Three hundred and nine consecutive patients were screened for delirium, and those found positive for the same were evaluated by a psychiatrist on DSM-IVTR criteria to confirm the diagnosis. Those with a diagnosis of delirium were evaluated on the DRS-R-98 to study the phenomenology and on the amended Delirium Motor Symptom Scale (DMSS) to study the motor sub-types...
November 2016: Nordic Journal of Psychiatry
Jonah Garry, Kelly Casey, Therese Kling Cole, Angela Regensburg, Colleen McElroy, Eric Schneider, David Efron, Albert Chi
BACKGROUND: Eye-tracking devices have been suggested as a means of improving communication and psychosocial status among patients in the intensive care unit (ICU). This study was undertaken to explore the psychosocial impact and communication effects of eye-tracking devices in the ICU. METHODS: A convenience sample of patients in the medical ICU, surgical ICU, and neurosciences critical care unit were enrolled prospectively. Patients participated in 5 guided sessions of 45 minutes each with the eye-tracking computer...
March 2016: Surgery
Réza Behrouz, Daniel A Godoy, Mahmoud R Azarpazhooh, Mario Di Napoli
Altered mental status is a common pathological entity in critically ill patients and particularly in those with preexisting cerebral injury. In the neurological critical care unit, the prevalence of altered mental status is especially high because of the inherent nervous system disease of these patients. Altered mental status can be crudely divided into encephalopathy and delirium. Although often used interchangeably, the 2 pathological entities have subtle differences in etiology and presentation. This is a review of delirium and encephalopathy in the neurological critical care unit...
December 2015: Journal of Critical Care
Niyada Naksuk, Charat Thongprayoon, Jae Y Park, Sunita Sharma, Prakriti Gaba, Andrew N Rosenbaum, Thoetchai Peeraphatdit, Tiffany Y Hu, Malcolm R Bell, Vitaly Herasevich, Peter A Brady, Suraj Kapa, Samuel J Asirvatham
BACKGROUND: Little is known about safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients. METHODS AND RESULTS: Pre-study Confusion Assessment Method-Intensive Care Unit (CAM-ICU) criteria were implemented in screening consecutive patients admitted to a referral CCU from 2004-2013. Death status was prospectively ascertained. Of 11,079 study patients, the incidence of delirium was 8...
June 29, 2015: European Heart Journal. Acute Cardiovascular Care
Valerie J Page, Daniel Davis, Xiao B Zhao, Samuel Norton, Annalisa Casarin, Thomas Brown, E Wesley Ely, Daniel F McAuley
RATIONALE: Delirium is common in intensive care unit (ICU) patients and is a predictor of worse outcomes and neuroinflammation is a possible mechanism. The antiinflammatory actions of statins may reduce delirium. OBJECTIVES: To determine whether critically ill patients receiving statin therapy had a reduced risk of delirium than those not on statins. METHODS: A prospective cohort analysis of data from consecutive ICU patients admitted to a UK mixed medical and surgical critical care unit between August 2011 and February 2012; the Confusion Assessment Method for ICU was used to determine the days each patient was assessed as being free of delirium during ICU admission...
March 15, 2014: American Journal of Respiratory and Critical Care Medicine
Sanjay Lahariya, Sandeep Grover, Shiv Bagga, Akhilesh Sharma
AIM: To assess the incidence, prevalence, risk factors and outcome of delirium in patients admitted to a cardiac intensive care unit (ICU) of a tertiary care hospital. METHODS: Three hundred nine consecutive patients admitted to a 22-bed coronary care unit were screened for presence of delirium by using Confusion Assessment Method for Intensive Care Unit (CAM-ICU), and those found positive on CAM-ICU were further evaluated by a psychiatrist to confirm the diagnosis of delirium as per DSM-IV-TR criteria...
March 2014: General Hospital Psychiatry
Juliana Barr, Pratik P Pandharipande
OBJECTIVE: In 2013, the American College of Critical Care Medicine published a revised version of the pain, agitation, and delirium guidelines. The guidelines included an ICU pain, agitation, and delirium care bundle designed to facilitate implementation of the pain, agitation, and delirium guidelines. DESIGN: Review article. SETTING: Multispecialty critical care units. PATIENTS: Adult ICU patients. INTERVENTIONS: This article describes: 1) the ICU pain, agitation, and delirium care bundle in more detail, linking pain, sedation/agitation, and delirium management in an integrated and interdisciplinary fashion; 2) pain, agitation, and delirium implementation strategies; and 3) the potential synergistic benefits of linking pain, agitation, and delirium management strategies to other evidence-based ICU practices, including spontaneous breathing trials, ICU early mobility programs, and ICU sleep hygiene programs, in order to improve ICU patient outcomes and to reduce costs of care...
September 2013: Critical Care Medicine
Juliana Barr, Charles P Kishman, Roman Jaeschke
OBJECTIVE: In 2006, the American College of Critical Care Medicine assembled a 20-member task force to revise the 2002 guidelines for sedation and analgesia in critically ill adults. This article describes the methodological approach used to develop the American College of Critical Care Medicine's 2013 ICU Pain, Agitation, and Delirium Clinical Practice Guidelines. DESIGN: Review article. SETTING: Multispecialty critical care units. PATIENTS: Adult ICU patients...
September 2013: Critical Care Medicine
Heidi A B Smith, Emily Brink, Dickey Catherine Fuchs, Eugene Wesley Ely, Pratik P Pandharipande
This review article updates the pediatric medical community on the current literature regarding diagnosis and treatment of delirium in critically ill children. This information will be of value to pediatricians, intensivists, and anesthesiologists in developing delirium monitoring and management protocols in their pediatric critical care units.
June 2013: Pediatric Clinics of North America
Liz Shaughnessy
AIM: To share an experience of introducing Delirium scoring into a Cardiothoracic Critical Care Unit and the lessons learnt. BACKGROUND: Delirium has serious consequences leading to increased length of stay in hospital, the possible development of dementia with the associated need for long-term care and even death. It is therefore vital that the Critical Care nurses are able to prevent, recognize and manage delirium. DATA SOURCES AND METHODS: 108 patients who were admitted over a 6 week period were audited and their delirium score, documentation and treatment plans were reviewed...
January 2013: Nursing in Critical Care
John A McPherson, Chad E Wagner, Leanne M Boehm, J David Hall, Daniel C Johnson, Leanna R Miller, Kathleen M Burns, Jennifer L Thompson, Ayumi K Shintani, E Wesley Ely, Pratik P Pandharipande, Pratik P Pandhvaripande
OBJECTIVE: Delirium, an acute organ dysfunction, is common among critically ill patients leading to significant morbidity and mortality; its epidemiology in a mixed cardiology and cardiac surgery ICU is not well established. We sought to determine the prevalence and risk factors for delirium among cardiac surgery ICU patients. DESIGN: Prospective observational study. SETTING: Twenty-seven-bed medical-surgical cardiac surgery ICU. PATIENTS: Two hundred consecutive patients with an expected cardiac surgery ICU length of stay >24 hrs...
February 2013: Critical Care Medicine
Pamela Scott, Fiona McIlveney, Marianne Mallice
AIM: To evaluate the feasibility and effectiveness of the validated Confusion Assessment Method-ICU (CAM-ICU) delirium screening tool in a critical care unit. DESIGN: A single centre service evaluation design was conducted in an 18 bed critical care unit comprising medical and surgical patients. Two self report questionnaires were administered to nursing staff (n=78) one immediately prior to and then three months following delirium education and CAM-ICU practical training...
April 2013: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Yucel Colkesen, Semih Giray, Yarkın Ozenli, Nurzen Sezgin, Isa Coskun
BACKGROUND: Delirium can be associated with cardiac system disorders. Stress plays an important role in the pathogenesis of postoperative delirium. Cortisol is one of the most important stress hormones in humans. We aimed to investigate whether a relation exists between serum cortisol and the degree of delirium after acute coronary syndromes (ACS). METHODS: We enrolled 52 consecutive patients who presented with ACS and were hospitalized in the coronary care unit...
January 2013: American Journal of Emergency Medicine
Jennifer A Frontera
PURPOSE OF REVIEW: This article summarizes the most common etiologies and approaches to management of metabolic encephalopathy. RECENT FINDINGS: Metabolic encephalopathy is a frequent occurrence in the intensive care unit setting. Common etiologies include hepatic failure, renal failure, sepsis, electrolyte disarray, and Wernicke encephalopathy. Current treatment paradigms typically focus on supportive care and management of the underlying etiology. Directed therapies that target neurochemical and neurotransmitter pathways that mediate encephalopathy are not currently available and represent an important area for future research...
June 2012: Continuum: Lifelong Learning in Neurology
Gary H Mills, Richard S Bourne
Quality sleep is a problem for the critically ill who are cared for in an environment where interventions night and day are common, staff members are constantly present in relatively high numbers, and treatment is accompanied by a range of changing warning tones and alarms and lights. These critical care units are generally designed without a focus on patient comfort, sleep, and rest and often lack access to appropriate natural daylight. To add to this problem, critical illness, particularly sepsis, disrupts circadian rhythms and sleep patterns, and disruption of circadian rhythms, in turn, impairs immunity and contributes to delirium...
2012: Critical Care: the Official Journal of the Critical Care Forum
Hussein A Algahtani, Abduljaleel P Abdu
Delirium is among the most common potentially preventable neurological disorders encountered in diverse patient populations, especially in critical care units and the elderly. It may present with highly variable clinical features, prolong hospital stay, and herald a poor prognosis. It is also a source of distress for patients and their caregivers. A high degree of clinical suspicion is required for detecting delirium and a detailed history, physical examination, and targeted investigations are necessary to determine the underlying etiology and ensure proper management...
July 2012: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
Hiroyuki Jinnouchi, Kenichi Sakakura, Hiroshi Wada, Norifumi Kubo, Yoshitaka Sugawara, Tomohiro Nakamura, Hiroshi Funayama, Junya Ako, Shin-ichi Momomura
Transradial percutaneous coronary intervention (PCI), which is less invasive than transfemoral PCI, may facilitate early rehabilitation of patients with acute myocardial infarction (AMI). The aim of our study was to investigate whether transradial PCI is associated with a shorter coronary care unit (CCU) stay in very elderly AMI patients (≥ 80 years old). We enrolled 116 AMI patients aged ≥ 80 years. There were 39 patients in the transradial group and 77 patients in the non-transradial group. The length of CCU stay, the length of hospital stay, in-hospital mortality, the day of the monitored sitting and standing test, and the occurrence of delirium were compared between the two groups...
2012: International Heart Journal
Richard S Bourne, Chui Lynn Choo
BACKGROUND: Specific data on the actual clinical practice of United Kingdom pharmacists in Critical Care are limited. Within the general critical care units of Sheffield Teaching Hospitals, clinical pharmacists have the facility to electronically document, communicate and follow-up proactive recommendations using a Pharmacy Review Form via the Clinical Information System, MetaVision(®). OBJECTIVE: The objective of the service evaluation was to describe the acceptance rate by medical staff of pharmacist proactive medication recommendations; including data on the types of recommendations and reasons thereof, for general intensive care patients of a UK teaching hospital trust...
April 2012: International Journal of Clinical Pharmacy
Jeanne S Teitelbaum, Omar Ayoub, Yoanna Skrobik
Administering analgesics, sedatives and antipsychotics is challenging in the Neurological Intensive Care Unit (NICU). We reviewed this literature and our current practice to better inform the critical care practitioner and to identify gaps for future research. We electronically searched observational, intervention and outcome studies addressing sedation, analgesia and delirium in the NICU, and their bibliographies. Practice patterns were assessed in three critical care units with specialized neurological care in Montreal...
November 2011: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Christina George, Jayakrishnan Sukumaran Nair, Johann Alex Ebenezer, Alan Gangadharan, Anna Christudas, Libu Kanakamma Gnanaseelan, K S Jacob
OBJECTIVE: Delirium is a common, difficult-to-diagnose clinical condition in critical care units. The lack of recognition of delirium often results in increased morbidity and mortality. The study aimed to determine the validity and reliability of the Intensive Care Delirium Screening Checklist (ICDSC) in a resource-poor medical intensive care setting in South India. MATERIALS AND METHODS: Fifty-three patients admitted into the medical intensive care unit of a teaching hospital who were neither mute nor intubated were recruited for the study...
April 2011: Journal of Critical Care
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