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Xiao M, Gong C, Mai M, Huang M, Xiong A, Liu H, Jiang R. Efficacy and safety of music therapy for the treatment of anxiety and delirium in ICU patients: a meta-analysis and systematic review of randomized controlled trials. Minerva Anestesiol 2024; 90:439-451. [PMID: 38619185 DOI: 10.23736/s0375-9393.24.17900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION The medical application of music therapy (MT) has received widespread attention in recent years and some researchers have attempted to apply MT to the treatment of patients with anxiety and delirium in ICU. EVIDENCE ACQUISITION Relevant randomized controlled trials (randomized controlled trials s) were searched in databases, such as Web of Science, PubMed, Embase, Cochrane Library, Medline, Scopus, and CINAHL. Researchers performed literature screening, data extraction, literature quality assessment, and heterogeneity analysis among RCTs. EVIDENCE SYNTHESIS Fourteen studies met the inclusion criteria. In general, we included RCTs with low risk of bias, and the primary outcome indicators, including the Chinese version of the State-Trait Anxiety Inventory (C-STAI), Visual Analogue Scale for Anxiety Measurement (VAS-A), and Facial Anxiety Scale (FAS), with a recommended level of evidence of "strong". The pooled results indicated that MT was effective in alleviating the anxiety state of ICU patients (95% CI, SMD=-1.09 [-1.52, -0.67], P<0.05) and could reduce mental and physical fatigue in patients with anxious delirium in ICU (95% CI, WMD=-2.35 [-3.37, -1.33], P <0.05). There were significant differences in the therapeutic effects of MT with different intervention durations. Both 15-minute and 30-minute MT were effective in reducing anxiety levels in patients with anxiety disorders in the ICU (15min: 95%CI, SMD=-1.70[-2.15, -1.24], P<0.05; 30min: 95%CI, SMD=-0.73[-1.16, - 0.29], P<0.05). However, when the duration of MT exceeded 45 min, the overtreatment of MT instead interfered with patient rest and failed to produce a positive therapeutic effect (95% CI, SMD=-1.04 [-3.06, 0.97], P=0.31). In addition, a meta-analysis of physiological outcomes found that MT was effective in maintaining the stabilization of heart rate (HR), respiratory rate (RR), and systolic blood pressure (SBP) in ICU patients with anxiety (P<0.05), but did not affect patients' oxygen saturation, mean arterial pressure and diastolic blood pressure (P>0.05). No adverse events occurred during MT treatment in the reports of included 14 studies. CONCLUSIONS MT can safely and effectively reduce the anxiety level of patients with anxiety and delirium in ICU and relieve their psychological and physical fatigue. And MT was able to maintain the stability of HR, RR, and SBP in ICU patients.
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Affiliation(s)
- Meixia Xiao
- First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Cheng Gong
- Gannan Medical University, Ganzhou City, China
| | - Miao Mai
- Gannan Medical University, Ganzhou City, China
| | - Miao Huang
- Gannan Medical University, Ganzhou City, China
| | - Anyu Xiong
- Gannan Medical University, Ganzhou City, China
| | - Hongsuo Liu
- First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Rong Jiang
- First Affiliated Hospital of Nanchang University, Nanchang City, China -
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Olney KC, de Ávila C, Todd KT, Tallant LE, Barnett JH, Gibson KA, Hota P, Pandiane AS, Durgun PC, Serhan M, Wang R, Lind ML, Forzani E, Gades NM, Thomas LF, Fryer JD. Commonly disrupted pathways in brain and kidney in a pig model of systemic endotoxemia. J Neuroinflammation 2024; 21:9. [PMID: 38178237 PMCID: PMC10765757 DOI: 10.1186/s12974-023-03002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
Sepsis is a life-threatening state that arises due to a hyperactive inflammatory response stimulated by infection and rarely other insults (e.g., non-infections tissue injury). Although changes in several proinflammatory cytokines and signals are documented in humans and small animal models, far less is known about responses within affected tissues of large animal models. We sought to understand the changes that occur during the initial stages of inflammation by administering intravenous lipopolysaccharide (LPS) to Yorkshire pigs and assessing transcriptomic alterations in the brain, kidney, and whole blood. Robust transcriptional alterations were found in the brain, with upregulated responses enriched in inflammatory pathways and downregulated responses enriched in tight junction and blood vessel functions. Comparison of the inflammatory response in the pig brain to a similar mouse model demonstrated some overlapping changes but also numerous differences, including oppositely dysregulated genes between species. Substantial changes also occurred in the kidneys following LPS with several enriched upregulated pathways (cytokines, lipids, unfolded protein response, etc.) and downregulated gene sets (tube morphogenesis, glomerulus development, GTPase signal transduction, etc.). We also found significant dysregulation of genes in whole blood that fell into several gene ontology categories (cytokines, cell cycle, neutrophil degranulation, etc.). We observed a strong correlation between the brain and kidney responses, with significantly shared upregulated pathways (cytokine signaling, cell death, VEGFA pathways) and downregulated pathways (vasculature and RAC1 GTPases). In summary, we have identified a core set of shared genes and pathways in a pig model of systemic inflammation.
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Affiliation(s)
- Kimberly C Olney
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Camila de Ávila
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Kennedi T Todd
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Lauren E Tallant
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Scottsdale, AZ, USA
| | - J Hudson Barnett
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Scottsdale, AZ, USA
- MD/PhD Training Program, Mayo Clinic, Scottsdale, AZ, USA
| | - Katelin A Gibson
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Piyush Hota
- Division of Nephrology & Hypertension, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | | | - Pinar Cay Durgun
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Michael Serhan
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Ran Wang
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Mary Laura Lind
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Erica Forzani
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Naomi M Gades
- Department of Comparative Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Leslie F Thomas
- Division of Nephrology & Hypertension, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA.
| | - John D Fryer
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA.
- Mayo Clinic Graduate School of Biomedical Sciences, Scottsdale, AZ, USA.
- MD/PhD Training Program, Mayo Clinic, Scottsdale, AZ, USA.
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Wu N, Zhang Y, Wang S, Zhao Y, Zhong X. Incidence, prevalence and risk factors of delirium in
ICU
patients: A systematic review and meta‐analysis. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nan‐Nan Wu
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Ya‐Bin Zhang
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Shu‐Yun Wang
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Yu‐Hua Zhao
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Xue‐Mei Zhong
- Guangdong Women and Children Hospital Guangzhou China
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Thisayakorn P, Tangwongchai S, Tantavisut S, Thipakorn Y, Sukhanonsawat S, Wongwarawipat T, Sirivichayakul S, Maes M. Immune, Blood Cell, and Blood Gas Biomarkers of Delirium in Elderly Individuals with Hip Fracture Surgery. Dement Geriatr Cogn Disord 2021; 50:161-169. [PMID: 34350874 DOI: 10.1159/000517510] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Postoperative delirium in elderly people with hip fracture is associated with various adverse clinical outcomes. Nevertheless, the pathophysiological processes underpinning delirium have remained elusive. OBJECTIVES The aim of this study was to explore the associations between delirium and its features and immune-inflammatory and blood gas biomarkers. METHODS In this prospective study, we examined 65 patients who underwent a hip fracture surgery and assessed the Confusion Assessment Method for the Intensive Care Unit, Richmond Agitation-Sedation Scale (RASS), and Delirium Rating Scale Revised-98 (DRS-R-98) before and during 4 days after the surgery. Complete blood count and venous blood gas markers were obtained at the same time points. RESULTS Delirium was observed in 19 patients and was accompanied by significantly increased pO2, number of white blood cells, neutrophil percentage, and neutrophil/lymphocyte ratio, and lower mean platelet volume (MPV) after adjusting for age, central nervous system (CNS) disease, blood loss during surgery, sleep disorders, and body mass index. The severity of delirium was associated with lowered number of platelets and MPV. Psychomotor disorders were associated with lower bicarbonate levels. The requirement of physical restraint of the patients was predicted by increased percentages of neutrophils and lymphocytes. Prior CNS disease was together with these biomarkers a significant predictor of delirium and severity of delirium. CONCLUSION Delirium and psychomotor disorders following hip fracture and surgery may be caused by immune-inflammatory and oxidative stress pathways probably attributable to an aseptic inflammatory process.
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Affiliation(s)
- Paul Thisayakorn
- Department of Psychiatry, Hip Fracture Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Saran Tantavisut
- Department of Orthopedics, Hip Fracture Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yanin Thipakorn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Siree Sukhanonsawat
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Sunee Sirivichayakul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Delirium and Associated Length of Stay and Costs in Critically Ill Patients. Crit Care Res Pract 2021; 2021:6612187. [PMID: 33981458 PMCID: PMC8088381 DOI: 10.1155/2021/6612187] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/27/2021] [Accepted: 04/15/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Delirium frequently affects critically ill patients in the intensive care unit (ICU). The purpose of this study is to evaluate the impact of delirium on ICU and hospital length of stay (LOS) and perform a cost analysis. Materials and Methods Prospective studies and randomized controlled trials of patients in the ICU with delirium published between January 1, 2015, and December 31, 2020, were evaluated. Outcome variables including ICU and hospital LOS were obtained, and ICU and hospital costs were derived from the respective LOS. Results Forty-one studies met inclusion criteria. The mean difference of ICU LOS between patients with and without delirium was significant at 4.77 days (p < 0.001); for hospital LOS, this was significant at 6.67 days (p < 0.001). Cost data were extractable for 27 studies in which both ICU and hospital LOS were available. The mean difference of ICU costs between patients with and without delirium was significant at $3,921 (p < 0.001); for hospital costs, the mean difference was $5,936 (p < 0.001). Conclusion ICU and hospital LOS and associated costs were significantly higher for patients with delirium, compared to those without delirium. Further research is necessary to elucidate other determinants of increased costs and cost-reducing strategies for critically ill patients with delirium. This can provide insight into the required resources for the prevention of delirium, which may contribute to decreasing healthcare expenditure while optimizing the quality of care.
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Jin Z, Rahman A, Pattnaik S, Smith M. Postoperative delirium: the findings from a multidisciplinary survey. Psychogeriatrics 2020; 20:495-500. [PMID: 32045090 DOI: 10.1111/psyg.12518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/24/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Delirium is a common postoperative neurocognitive complication in the older population and can lead to significant morbidity and mortality, as well as cognitive and functional impairment. Hypoactive delirium is characterised by drowsiness and inactivity, and expert opinions suggest that it is more likely to be missed and can lead to more complications. Current guidelines and literature evidence both support the use of non-pharmacological management of delirium. METHODS To investigate the recognition of hyperactive and hypoactive delirium by the surgical multidisciplinary team, and to investigate staff understanding regarding the management and prognosis of postoperative delirium. We conducted a single-centre, multidisciplinary survey on the diagnosis, management and complication of postoperative delirium. RESULTS We found that hypoactive delirium is significantly less likely to be identified. In contrast, acute psychosis is likely to be misdiagnosed as delirium. Only a small proportion of the respondents had knowledge of the supportive management options for delirium; and the medical complications and higher mortality risk associated with postoperative delirium. DISCUSSION The finding of the survey demonstrates a need for delirium education. Surveys such as this may be conducted in other centres to identify areas of focus on staff delirium education.
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Affiliation(s)
- Zhaosheng Jin
- Departments of Anaesthesia and care of the elderly, Queen's Hospital, Barking Havering and Redbridge NHS Trust, London, UK.,Central London School of Anaesthesia, London, UK
| | - Aktar Rahman
- Departments of Anaesthesia and care of the elderly, Queen's Hospital, Barking Havering and Redbridge NHS Trust, London, UK.,Barts and the London School of Anaesthesia, London, UK
| | - Sudhansu Pattnaik
- Departments of Anaesthesia and care of the elderly, Queen's Hospital, Barking Havering and Redbridge NHS Trust, London, UK.,Royal College of Anaesthesia, London, UK
| | - Maurice Smith
- Departments of Anaesthesia and care of the elderly, Queen's Hospital, Barking Havering and Redbridge NHS Trust, London, UK
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7
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Lee S, Lee SM. [Path Analysis for Delirium on Patient Prognosis in Intensive Care Units]. J Korean Acad Nurs 2020; 49:724-735. [PMID: 31932567 DOI: 10.4040/jkan.2019.49.6.724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/25/2019] [Accepted: 11/20/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE This study was conducted to investigate relationship between delirium, risk factors on delirium, and patient prognosis based on Donabedian's structure-process-outcome model. METHODS This study utilized a path analysis design. We extracted data from the electronic medical records containing delirium screening data. Each five hundred data in a delirium and a non-delirium group were randomly selected from electronic medical records of medical and surgical intensive care patients. Data were analyzed using SPSS 20 and AMOS 24. RESULTS In the final model, admission via emergency department (B=.06, p=.019), age over 65 years (B=.11, p=.001), unconsciousness (B=.18, p=.001), dependent activities (B=.12, p=.001), abnormal vital signs (B=.12, p=.001), pressure ulcer risk (B=.12, p=.001), enteral nutrition (B=.12, p=.001), and use of restraint (B=.30, p=.001) directly affecting delirium accounted for 56.0% of delirium cases. Delirium had a direct effect on hospital mortality (B=.06, p=.038), hospital length of stay (B=5.06, p=.010), and discharge to another facility (not home) (B=.12, p=.001), also risk factors on delirium indirectly affected patient prognosis through delirium. CONCLUSION The use of interventions to reduce delirium may improve patient prognosis. To improve the dependency activities and risk of pressure ulcers that directly affect delirium, early ambulation is encouraged, and treatment and nursing interventions to remove the ventilator and drainage tube quickly must be provided to minimize the application of restraint. Further, delirium can be prevented and patient prognosis improved through continuous intervention to stimulate cognitive awareness and monitoring of the onset of delirium. This study also discussed the effects of delirium intervention on the prognosis of patients with delirium and future research in this area.
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Affiliation(s)
- Sunhee Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Sun Mi Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea.
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8
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Cai S, Lv M, Latour JM, Lin Y, Pan W, Zheng J, Cheng L, Li J, Zhang Y. Incidence and risk factors of PostopeRativE delirium in intensive care unit patients: A study protocol for the PREDICt study. J Adv Nurs 2019; 75:3068-3077. [PMID: 31197839 DOI: 10.1111/jan.14097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/18/2019] [Accepted: 04/09/2019] [Indexed: 01/14/2023]
Abstract
AIM The aims of this study are: (a) to determine the incidence of postoperative delirium (POD) among surgical intensive care unit (ICU) patients in China and identify risk factors, especially, which are modifiable and have value for developing a prediction model; (b) to develop and validate a prediction model of delirium to recognize high-risk patients in surgical ICUs; (c) to investigate the short- and long-term outcomes of delirious patients and identify the predictors of patient outcomes. DESIGN A single-centre prospective cohort study. METHODS Patients will be enrolled from three surgical ICUs in a tertiary teaching hospital. Delirium assessment and perioperative data will be collected throughout the hospitalization. Delirious patients will be followed up for 2 years. The study was approved by the ethics committee in May 2018 and was funded by the clinical research grant from Zhongshan hospital, Fudan University, Shanghai. DISCUSSION Developing POD can be a burden to patients both for the short- and long-term period. Due to the lack of effective treatments for POD, prevention remains the best strategy. This study will provide an effective tool for early screening of high-risk patients of POD and provide a better understanding of the aetiology and outcome of delirium. IMPACT In clinical practice, a prediction model will offer an effective tool for ICU nurses to assess high-risk patients, which can support them to implement preventive strategies at the early stages to targeted patients. The follow-up results will help us better understand the impact of delirium on patients' long-term outcome.
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Affiliation(s)
- Shining Cai
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jos M Latour
- Faculty of Health and Human Sciences, School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Ying Lin
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenyan Pan
- Department of Surgery Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jili Zheng
- Department of Cardiac Surgery Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lihong Cheng
- Department of Liver Surgery Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingjing Li
- Department of Surgery Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxia Zhang
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
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Incidence, risk factors, and cumulative risk of delirium among ICU patients: A case-control study. Int J Nurs Sci 2019; 6:247-251. [PMID: 31508442 PMCID: PMC6722464 DOI: 10.1016/j.ijnss.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 05/25/2019] [Accepted: 05/31/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives Delirium is a common acute cognitive impairment syndrome among intensive care unit (ICU) patients. This study was aimed to investigate the incidence, risk factors, and cumulative risk of delirium among ICU patients. Methods A case-control study including clinical records of 452 patients were retrospectively analyzed. Delirium was assessed using the Confusion Assessment Method for the ICU and Richmond Agitation–Sedation Scale. Results We found that 163 out of the 452 patients (36.1%) had delirium. Multivariate analysis showed that use of sedatives, length of ICU hospitalization, and physical restraint were independent risk factors for delirium. The additive effect of all three factors resulted to an odds ratio of 30.950. Conclusion The incidence of delirium remained high. Thus, nurses shall strengthen the monitoring of delirium, regularly access the patient's level of calmness, and limit the use of physical restraint.
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Chaiwat O, Chanidnuan M, Pancharoen W, Vijitmala K, Danpornprasert P, Toadithep P, Thanakiattiwibun C. Postoperative delirium in critically ill surgical patients: incidence, risk factors, and predictive scores. BMC Anesthesiol 2019; 19:39. [PMID: 30894129 PMCID: PMC6425578 DOI: 10.1186/s12871-019-0694-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/11/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A common postoperative complication found among patients who are critically ill is delirium, which has a high mortality rate. A predictive model is needed to identify high-risk patients in order to apply strategies which will prevent and/or reduce adverse outcomes. OBJECTIVES To identify the incidence of, and the risk factors for, postoperative delirium (POD) in surgical intensive care unit (SICU) patients, and to determine predictive scores for the development of POD. METHODS This study enrolled adults aged over 18 years who had undergone an operation within the preceding week and who had been admitted to a SICU for a period that was expected to be longer than 24 h. The CAM - ICU score was used to determine the occurrence of delirium. RESULTS Of the 250 patients enrolled, delirium was found in 61 (24.4%). The independent risk factors for delirium that were identified by a multivariate analysis comprised age, diabetes mellitus, severity of disease (SOFA score), perioperative use of benzodiazepine, and mechanical ventilation. A predictive score (age + (5 × SOFA) + (15 × Benzodiazepine use) + (20 × DM) + (20 × mechanical ventilation) + (20 × modified IQCODE > 3.42)) was created. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.84 (95% CI: 0.786 to 0.897). The cut point of 125 demonstrated a sensitivity of 72.13% and a specificity of 80.95%, and the hospital mortality rate was significantly greater among the delirious than the non-delirious patients (25% vs. 6%, p < 0.01). CONCLUSIONS POD was experienced postoperatively by a quarter of the surgical patients who were critically ill. A risk score utilizing 6 variables was able to predict which patients would develop POD. The identification of high-risk patients following SICU admission can provide a basis for intervention strategies to improve outcomes. TRIAL REGISTRATION Thai Clinical Trials Registry TCTR20181204006 . Date registered on December 4, 2018. Retrospectively registered.
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Affiliation(s)
- Onuma Chaiwat
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. .,Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Mellada Chanidnuan
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Worapat Pancharoen
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Kittiya Vijitmala
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Praniti Danpornprasert
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Puriwat Toadithep
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Chayanan Thanakiattiwibun
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Crozes F, Planton M, Silva S, Haubertin C. Mesures de prévention non pharmacologiques du delirium de réanimation. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le delirium est défini par un changement brutal ou rapidement progressif de l’état mental ou une modification de l’humeur associés à une baisse des capacités de concentration, à une désorganisation de la pensée, à une confusion et à une altération du niveau de conscience. L’incidence du delirium en réanimation est variable d’environ 4 à 83 %, selon les études. Cela est probablement lié à la variété des outils de mesure employés, au niveau d’entraînement des professionnels de santé établissant ces scores, à la profondeur de la sédation et aux différences de populations étudiées. Son étiologie semble être multifactorielle. Il a été montré que la survenue du delirium a un fort impact sur le pronostic vital et fonctionnel des patients en réanimation, car son incidence est associée à une augmentation de la mortalité hospitalière précoce et tardive, et le déclin cognitif qui lui est associé peut persister à distance du séjour en réanimation. Il est important de souligner que la prise en charge dans les soins critiques est très hétérogène. Néanmoins, de nouvelles données de la littérature apportent des éléments concrets sur la prise charge de ce syndrome et fournissent un guide utile à la pratique paramédicale dans la prévention et le dépistage de ce trouble cognitif. L’objectif de ce travail est d’apporter une synthèse autour de la littérature disponible dans ce domaine, mettant en lumière le rôle clé de la profession paramédicale dans ce contexte afin d’identifier des éléments diagnostiques et thérapeutiques susceptibles de modifier pertinemment les pratiques soignantes.
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12
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Pan Y, Jiang Z, Yuan C, Wang L, Zhang J, Zhou J, Tao M, Quan M, Wu Q. Influence of physical restraint on delirium of adult patients in ICU: A nested case-control study. J Clin Nurs 2018; 27:1950-1957. [PMID: 29495083 DOI: 10.1111/jocn.14334] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 12/16/2022]
Abstract
AIMS AND OBJECTIVES To investigate the impact of physical restraint on delirium of adult patients in intensive care unit. BACKGROUND Delirium is a common clinical syndrome in intensive care unit, correlated with various adverse clinical outcomes. Physical restraint is a precipitating factor for delirium; however, the effect of physical restraint on delirium, such as duration, number and appliance is still unclear. DESIGN A nested case-control study. METHODS A cohort of 593 intensive care unit patients were observed for 12 months, and 447 of them who received physical restraint were included for analysis. Delirium was assessed using the Confusion Assessment Method for the intensive care unit. During hospitalisation in intensive care unit, newly-onset delirium patients (the delirium group), and nondelirium patients of similar age, same gender, and conditions of mechanical ventilation and sedative drug usage (the nondelirium group) were included as the matching criteria. Patient data were acquired by reviewing medical and nursing electronic records. RESULTS Among the 447 patients that had been physically restrained, 178 (39.8%) developed delirium. Delirium risk in patients with restraint ≥6 days was 26.30 times higher than in those <6 days. Patients who had two and three times of restraint had a 2.38-fold and 3.62-fold higher risk of delirium than those with one time of restraint. However, the appliance, site, time to apply and remove restraint had no effect on the incidence of delirium. CONCLUSIONS The incidence of delirium is high when patients use physical restraint. Duration and number of restraint are positively related to delirium. Restrictions on the use of restraint in intensive care unit are required to reduce the occurrence of delirium. RELEVANCE TO CLINICAL PRACTICE To reduce delirium risk of patients in intensive care unit, nurses need to assess the risk of physical restraint and consider alternative measures, thereby to achieve the minimisation of the use of restraint.
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Affiliation(s)
- Yanbin Pan
- Department of Intensive Care, Affiliated Hospital of Zunyi Medical University, Guizhou, China.,College of Nursing, Zunyi Medical University, Guizhou, China
| | - Zhixia Jiang
- College of Nursing, Zunyi Medical University, Guizhou, China.,Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | | | - Lianhong Wang
- Department of Intensive Care, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Jingjing Zhang
- College of Nursing, Zunyi Medical University, Guizhou, China
| | - Jing Zhou
- Department of Intensive Care, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Ming Tao
- Department of Intensive Care, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Mingtao Quan
- Department of Intensive Care, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Qiong Wu
- College of Nursing, Zunyi Medical University, Guizhou, China
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Lee H, Ju JW, Oh SY, Kim J, Jung CW, Ryu HG. Impact of timing and duration of postoperative delirium: a retrospective observational study. Surgery 2018; 164:S0039-6060(18)30035-7. [PMID: 29551203 DOI: 10.1016/j.surg.2018.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/09/2018] [Accepted: 02/02/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent reports suggest that not all critically ill patients with delirium share the same consequences. The outcomes of surgical intensive care unit patients with postoperative delirium were evaluated depending on the onset and duration of delirium. METHODS A total of 527 patients who were admitted from the operating theater and cared for in the surgical intensive care unit for >24 hours were evaluated for delirium using the Confusion Assessment Method for intensive care unit, 3 times a day. Patients were analyzed according to the onset time and duration of delirium. Patients were classified into 4 groups according to the onset and duration of delirium: no delirium, early brief delirium (delirium for <1 day on postoperative day 0), late brief delirium (delirium for <1 day after postoperative day 0), and persistent delirium (delirium for ≥1 days). Duration of stay (intensive care unit and hospital) and mortality (intensive care unit, hospital, and 1-year) were outcomes of interest. RESULTS Of the 527 patients, delirium developed in 119 (22.6%) patients. More than two-thirds of the patients developed delirium on postoperative day 0 or 1, and 70% of patients developed delirium for >24 hours (persistent). Persistent delirium was associated with longer intensive care unit (4.6 [1.1-53.3] vs 1.6 [1.1-37.5] days) and hospital duration of stay (24 [3-112] vs 16 [2-225] days) and higher hospital mortality (14.5% vs 2.2%) compared to no delirium (P < .01). CONCLUSION For postoperative intensive care unit patients, intensive care unit and hospital duration of stay did not seem to differ between patients with early brief delirium or no delirium, whereas patients with late brief or persistent delirium seemed to show longer intensive care unit and hospital duration of stay and higher mortality.
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Affiliation(s)
- Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Woo Ju
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Young Oh
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeongsoo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul Woo Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Rood P, Huisman-de Waal G, Vermeulen H, Schoonhoven L, Pickkers P, van den Boogaard M. Effect of organisational factors on the variation in incidence of delirium in intensive care unit patients: A systematic review and meta-regression analysis. Aust Crit Care 2018; 31:180-187. [PMID: 29545081 DOI: 10.1016/j.aucc.2018.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 01/05/2018] [Accepted: 02/01/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Delirium occurs frequently in intensive care unit (ICU) patients and is associated with numerous deleterious outcomes. There is a large variation in reported delirium occurrence rates, ranging from 4% to 89%. Apart from patient and treatment-related factors, organisational factors could influence delirium incidence, but this is currently unknown. OBJECTIVE To systematically review delirium incidence and determine whether or not organisational factors may contribute to the observed delirium incidence in adult ICU patients. METHODS Systematic review of prospective cohort studies reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Included articles were independently assessed by two researchers. Quality of the articles was determined using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Subsequently, apart from patient characteristics, a meta-regression analysis was performed on available organisational factors, including hospital type, screening method and screening frequency. DATA SOURCES PubMed, Embase, CINAHL, and Cochrane Library databases were searched from inception to 27 January 2017, without language limitation. RESULTS A total of 9357 articles were found, of which 19 articles met the inclusion criteria and were considered as true delirium incidence studies. The articles were of good methodological quality (median [interquartile range] 32/38 [30-35] points), published between 2005 and 2016, originated from 17 countries. A total of 9867 ICU patients were included. The incidence rate of delirium varied between 4% and 55%, with a mean ± standard deviation of 29 ± 14%. Data relating to three organisational factors were included in the studies, but they were not significantly associated with the reported delirium incidence: hospital type (p 0.48), assessment methods (p 0.41), and screening frequency (p 0.28). CONCLUSIONS The mean incidence of delirium in the ICU was 29%. The organisational factors found including methods of delirium assessment, screening frequency, and hospital type were not related to the reported ICU delirium incidence.
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Affiliation(s)
- Paul Rood
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Getty Huisman-de Waal
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisette Schoonhoven
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), United Kingdom
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Bright light and oxygen therapies decrease delirium risk in critically ill surgical patients by targeting sleep and acid-base disturbances. Psychiatry Res 2018; 261:21-27. [PMID: 29276990 DOI: 10.1016/j.psychres.2017.12.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 11/07/2017] [Accepted: 12/16/2017] [Indexed: 12/20/2022]
Abstract
This study examined the effects of bright light therapy (BLT) on the incidence of delirium in post-operative patients admitted to a surgical intensive care unit (SICU) and delineates risk and protective factors. We included 62 patients in a single-blind, randomized controlled study. The intervention group was treated with care as usual plus BLT for three consecutive days. Delirium was diagnosed by DSM-5 criteria with the Confusion Assessment Method-Intensive Care Unit (CAM-ICU). Risk factors for delirium were measured, including the APACHE II score, Insomnia Severity Index (ISI), as well as hematocrit and bicarbonate levels. Results were adjusted for treatment with nasal cannula oxygen and medications. Thirteen patients developed delirium within the three days following surgery. Generalized estimating equations analysis showed a significant preventive effect of BLT on delirium, which was independent of risk or treatment factors. Higher APACHE-II and ISI scores, lower hematocrit and lower bicarbonate levels increased the risk of developing delirium. BLT plus nasal cannula oxygen significantly reduced the likelihood of delirium. BLT significantly lowered ISI scores, while nasal cannula oxygen significantly enhanced bicarbonate levels. The results indicate that BLT and supplementary oxygen therapy may protect against delirium by targeting sleep-wake and deficits in the bicarbonate buffer system.
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Abstract
OBJECTIVE To better understand variation in reported rates of delirium, this study characterized delirium occurrence rate by department of service and primary admitting diagnosis. METHOD Nine consecutive years (2005-2013) of general hospital admissions (N=831,348) were identified across two academic medical centers using electronic health records. The primary admitting diagnosis and the treating clinical department were used to calculate occurrence rates of a previously published delirium definition composed of billing codes and natural language processing of discharge summaries. RESULTS Delirium rates varied significantly across both admitting diagnosis group (X210=12786, p<0.001) and department of care (X26=12106, p<0.001). In both cases obstetrical admissions showed the lowest incidences of delirium (86/109764; 0.08%) and neurological admissions the greatest (2851/25450; 11.2%). Although the rate of delirium varied across the two hospitals the relative rates within departments (r=0.96, p<0.001) and diagnostic categories (r=0.98, p<0.001) were consistent across the two institutions. CONCLUSIONS The frequency of delirium varies significantly across admitting diagnosis and hospital department. Both admitting diagnosis and department of care are even stronger predictors of risk than age; as such, simple risk stratification may offer avenues for targeted prevention and treatment efforts.
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Affiliation(s)
- Thomas H McCoy
- Center for Quantitative Health, Division of Clinical Research, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, United States; Avery D. Weisman Psychiatry Consultation Service, Massachusetts General Hospital, Warren Building 6th Floor, 55 Fruit St, Boston, MA 02114, United States.
| | - Kamber L Hart
- Center for Quantitative Health, Division of Clinical Research, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, United States
| | - Roy H Perlis
- Center for Quantitative Health, Division of Clinical Research, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, United States
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Underreporting of Delirium in Statewide Claims Data: Implications for Clinical Care and Predictive Modeling. PSYCHOSOMATICS 2016; 57:480-8. [DOI: 10.1016/j.psym.2016.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 01/27/2023]
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