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Early recognition of delirium

Craig Nolan, Lisa M DeAngelis
PURPOSE OF REVIEW: The purpose of this review is to provide a practical clinical approach to confusion in the patient with cancer. Confusion in the cancer population has a broader differential diagnosis than in the general medical population. The clinician must consider the usual differential diagnoses as well as causes unique to the cancer patient including direct complications from the cancer and indirect complications related to cancer treatment. RECENT FINDINGS: In the recent age of precision medicine, the oncologist now utilizes the genomic profile of both the patient and the tumor to provide advanced biologic therapies including targeted anticancer drugs, antiangiogenic agents, and immunotherapy...
September 26, 2016: Current Opinion in Neurology
Emily J Tomlinson, Nicole M Phillips, Mohammadreza Mohebbi, Alison M Hutchinson
AIMS AND OBJECTIVES: To determine predisposing and precipitating risk factors for incident delirium in medical patients during an acute hospital admission. BACKGROUND: Incident delirium is the most common complication of hospital admission for older patients. Up to 30% of hospitalised medical patients experience incident delirium. Determining risk factors for delirium is important for identifying patients that are most susceptible to incident delirium. DESIGN: Retrospective case-control study with two controls per case...
August 18, 2016: Journal of Clinical Nursing
Emel Ünal Bilge, Menşure Kaya, Gülçin Özalp Şenel, Süheyla Ünver
OBJECTIVE: In this study, we aimed to determine the risk factors and the incidence of delirium in patients who were followed postoperatively in our surgical intensive care unit for 24 h using the confusion assessment method (CAM). METHODS: After obtaining approval from the ethics committee, 250 patients were included in the study. Patients who were operated under general anaesthesia or regional anaesthesia and followed in the surgical intensive care unit were evaluated by the Ramsay Sedation Scale on the first postoperative day...
August 2015: Turk J Anaesthesiol Reanim
Paul Rizk, William Morris, Philip Oladeji, Michael Huo
Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise...
June 2016: Geriatric Orthopaedic Surgery & Rehabilitation
Jean P Gelinas, Keith R Walley
Recognition and management of agitation, delirium, and pain are key areas. Reduced use of sedatives is an important measure that must be coupled with increased patient engagement, mobilization, and exercise. Use of low tidal volumes and low mean airway pressures during mechanical ventilation is helpful. A key hemodynamic principle following early aggressive volume resuscitation is subsequent careful assessment to avoid unnecessary additional volume administration and adverse consequences of frank volume overload...
June 2016: Clinics in Chest Medicine
Vicente Cés Souza-Dantas, Pedro Póvoa, Fernando Bozza, Marcio Soares, Jorge Salluh
Delirium is the most frequent and severe clinical presentation of brain dysfunction in critically ill septic patients with an incidence ranging from 9% to 71%. Delirium represents a significant burden for patients and relatives, as well as to the health care system, resulting in higher costs, long-term cognitive impairment and significant risk of death after 6 months. Current interventions for the prevention of delirium typically involve early recognition and amelioration of modifiable risk factors and treatment of underlying conditions that predisposes the individual to delirium...
June 3, 2016: Hospital Practice (Minneapolis)
Deepali Dixit, Jeffrey Endicott, Lisa Burry, Liz Ramos, Siu Yan Amy Yeung, Sandeep Devabhakthuni, Claire Chan, Anthony Tobia, Marilyn N Bulloch
Approximately 16-31% of patients in the intensive care unit (ICU) have an alcohol use disorder and are at risk for developing alcohol withdrawal syndrome (AWS). Patients admitted to the ICU with AWS have an increased hospital and ICU length of stay, longer duration of mechanical ventilation, higher costs, and increased mortality compared with those admitted without an alcohol-related disorder. Despite the high prevalence of AWS among ICU patients, no guidelines for the recognition or management of AWS or delirium tremens in the critically ill currently exist, leading to tremendous variability in clinical practice...
July 2016: Pharmacotherapy
Angela Malik, Todd Harlan, Janice Cobb
AIMS AND OBJECTIVES: The paper examines the ability of nursing staff to detect delirium and apply early intervention to decrease adverse events associated with delirium. To characterise nursing practices associated with staff knowledge, delirium screening utilising the Modified Richmond Assessment Sedation Score (mRASS), and multicomponent interventions in an acute inpatient medical unit. BACKGROUND: Delirium incidence rates are up to 60% in frail elderly hospitalised patients...
April 22, 2016: Journal of Clinical Nursing
Margaret J Bull, Lesley Boaz, Martha Jermé
BACKGROUND: Delirium in older adults is considered a medical emergency; it contributes to a cascade of functional decline and to increased mortality. Early recognition of delirium symptoms is critical to prevent these negative consequences. Family caregivers who are educated about delirium could partner with nurses and other healthcare professionals in early recognition of delirium symptoms. Before implementing such partnership models, it is important to examine the effectiveness of educating family caregivers about delirium...
June 2016: Worldviews on Evidence-based Nursing
Kari Johnson, Shelly Diana, Jodi Todd, Amanda McFarren, Alisa Domb, Alicia Mangram, Kevin Veale
OBJECTIVE: Evaluate change in practice and beliefs regarding delirium among nurses, pharmacists, respiratory therapists and physicians in a trauma intensive care unit. METHODOLOGY/DESIGN/SETTING: Descriptive pre and post-design at a Level One Trauma Center. Education on causes of delirium, risk factors, strategies to prevent delirium and routine screening. OUTCOME MEASURES: Change in practice and beliefs regarding delirium. RESULTS: McNemars test measured the differences between pre- and post-questionnaires comparing the proportion of staff changed their responses in one direction to those who went in the opposite direction...
June 2016: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
S J Moug, M Stechman, K McCarthy, L Pearce, P K Myint, J Hewitt
INTRODUCTION: Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. METHODS: This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes...
March 2016: Annals of the Royal College of Surgeons of England
William P Cheshire
Thermoregulation is a vital function of the autonomic nervous system in response to cold and heat stress. Thermoregulatory physiology sustains health by keeping body core temperature within a degree or two of 37°C, which enables normal cellular function. Heat production and dissipation are dependent on a coordinated set of autonomic responses. The clinical detection of thermoregulatory impairment provides important diagnostic and localizing information in the evaluation of disorders that impair thermoregulatory pathways, including autonomic neuropathies and ganglionopathies...
April 2016: Autonomic Neuroscience: Basic & Clinical
Elaine McCleary, Pamela Cumming
Delirium is a serious condition associated with poor outcomes which can be prevented and treated if recognised early. Older people and people with dementia or severe illness are more at risk of delirium. SQiD is a simple prompt question which asks, "Is this patient more confused than before?" Focusing specifically on patients aged 75 and over, this project aimed to increase awareness and usage of SQiD to help improve early recognition of delirium, in accordance with the Healthcare Improvement Scotland national initiative...
2015: BMJ Quality Improvement Reports
Mary Bozzo
No abstract text is available yet for this article.
September 2015: Australian Nursing & Midwifery Journal
Willem A van Eijsden, Jelle W Raats, Paul Gh Mulder, Lijckle van der Laan
OBJECTIVE: The primary objective was to identify possible risk factors for delirium in patients with critical limb ischemia undergoing surgery. The secondary objective was to study the effect of delirium on complications, the length of hospital stay, health care costs, and mortality. METHODS: All patients 65 years or older with critical limb ischemia undergoing surgery from February 2013 to July 2014 at Amphia Hospital, were included and followed up until December 31, 2014...
2015: Clinical Interventions in Aging
Jeff Gadsden, Alicia Warlick
Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform...
2015: Local and Regional Anesthesia
Louise Rose
Identification and adoption of strategies to promote timely and successful weaning from mechanical ventilation remain a research and quality improvement priority. The most important steps in the weaning process to prevent unnecessary prolongation of mechanical ventilation are timely recognition of both readiness to wean and readiness to extubate. Strategies shown to be effective in promoting timely weaning include weaning protocols and use of spontaneous breathing trials. This review explores various other strategies that also may promote timely and successful weaning including bundling of spontaneous breathing trials with sedation and delirium monitoring/management as well as early mobility, the use of automated weaning systems and modes that improve patient-ventilator interaction, mechanical insufflation-exsufflation as a weaning adjunct, early extubation to non-invasive ventilation and high flow humidified oxygen...
August 2015: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Valerie J Page, Daniel F McAuley
PURPOSE OF REVIEW: There is recognition that the use of sedative drugs in critically ill patients is potentially harmful, particularly in relation to ICU delirium and clinical outcomes. In that context, there is an increasing interest in maintaining light sedation, the use of non-gamma-aminobutyric acid agonist agents and antipsychotics. RECENT FINDINGS: The sedative drugs currently available have limitations relating to duration of action, cost or variability in response...
April 2015: Current Opinion in Anaesthesiology
Donna M Fick, Ann M Kolanowski, Nikki L Hill, Andrea Yevchak, Brittney DiMeglio, Paula M Mulhall
The purpose of this study is to describe nursing home staff knowledge regarding delirium detection and the most common causes of delirium. Specific aims that guided this study include identifying the rate of nurse recognition of delirium and delirium superimposed on dementia (DSD), including different motoric subtypes of delirium, using standardized case vignettes, and exploring what nursing home staff describe as the potential causes of delirium. The study showed overall poor recognition of delirium and DSD, which did not improve over time...
September 1, 2013: Annals of Long-term Care: the Official Journal of the American Medical Directors Association
Enrique Calvo-Ayala, Babar Khan
Delirium among critically ill patients is common. Presence of delirium imparts a poorer prognosis to patients, including longer ICU and hospital length of stay, increased risk of institutionalization, higher health related costs, and elevated mortality. Even with such grave consequences, the rates of delirium diagnosis are dire. The importance of early recognition through validated tools and appropriate management of this life-threatening condition cannot be over emphasized. This article provides an overview of delirium pathophysiology, diagnosis, and management with a focus on critically ill patients...
2013: Journal of Symptoms and Signs
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