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Latest & greatest articles for delirium
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on delirium or other clinical topics then use Trip today.
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Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. Postoperative delirium is common following cardiac surgery and may be affected by choice of analgesic and sedative.To evaluate the effect of postoperative intravenous (IV) acetaminophen (paracetamol) vs placebo combined with IV propofol vs dexmedetomidine on postoperative delirium among older (...) with dexmedetomidine or propofol starting at chest closure and continued for up to 6 hours (acetaminophen and dexmedetomidine: n = 29; placebo and dexmedetomidine: n = 30; acetaminophen and propofol: n = 31; placebo and propofol: n = 30).The primary outcome was incidence of postoperative in-hospital delirium by the Confusion Assessment Method. Secondary outcomes included delirium duration, cognitive decline, breakthrough analgesia within the first 48 hours, and ICU and hospital length of stay.Among 121 patients
Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium.To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium.Randomized clinical trial of 1232 adults aged 60 years (...) and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis. Recruitment was from January 2015 to May 2018, with follow-up until July 2018.Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery and positive vs negative recent fall history) to receive EEG-guided anesthetic administration (n = 614) or usual anesthetic care (n = 618).The primary outcome was incident delirium during postoperative days 1 through 5. Intraoperative measures
A systematic review of interventions to facilitate extubation in patients difficult-to-wean due to delirium, agitation, or anxiety and a meta-analysis of the effect of dexmedetomidine Delirium, agitation, and anxiety may hinder weaning from mechanical ventilation and lead to increased morbidity and healthcare costs. The most appropriate clinical approach to weaning in these contexts remains unclear and challenging to clinicians. The objective of this systematic review was to identify effective (...) and safe interventions to wean patients that are difficult-to-wean from mechanical ventilation due to delirium, agitation, or anxiety.A systematic review was performed using MEDLINE, EMBASE, and PubMed. Studies evaluating mechanically ventilated patients deemed difficult-to-wean due to delirium, agitation, or anxiety, and comparing the effects of an intervention with a comparator arm were sought. Time-to-extubation was the primary outcome while the secondary outcome was intensive care unit (ICU) length
Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit: A Rapid Review ICU pain, agitation, delirium, sedation and mobilisation CPGs: A Rapid Review 1 Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit: A Rapid Review Citation Corey Joseph & Angela Melder. April 2018. Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care (...) unit: A Rapid Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia. Contact firstname.lastname@example.org Executive Summary Background The Program Medical Director for Critical Care has requested a review of clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit (ICU) to inform future implementation of a new clinical practice guideline in the ICU. Objectives The objective of this review was to review and summarise current
Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit Benzodiazepines and anticholinergics are risk factors for delirium in the intensive care unit (ICU). We tested the impact of a deprescribing intervention on short-term delirium outcomes.Multisite randomized clinical trial.ICUs of three large hospitals.Two hundred adults aged 18 years or older and admitted to an ICU with delirium, according to the Richmond Agitation-Sedation Scale (...) and the Confusion Assessment Method for the ICU (CAM-ICU). Participants had a contraindication to haloperidol (seizure disorder or prolonged QT interval) or preference against haloperidol as a treatment for delirium, and were excluded for serious mental illness, stroke, pregnancy, or alcohol withdrawal. Participants were randomized to a deprescribing intervention or usual care. The intervention included electronic alerts combined with pharmacist support to deprescribe anticholinergics
Delirium is common among adults receiving palliative care and could be better recognised Delirium recognition in palliative care Discover Portal Discover Portal Delirium is common among adults receiving palliative care and could be better recognised Published on 20 November 2018 doi: Between a quarter and two-thirds of adults admitted to specialist palliative care units experience delirium, or acute confusion. The findings come from a mixed methods project which included a systematic review (...) of the number of people living with delirium. Estimates are mostly applicable to older adults with advanced cancer. The project also included interviews with nurses in Australian palliative care units to look at delirium assessment and use of screening tools. The findings highlighted that systems which formally diagnose delirium were not commonly used. Delirium guidelines made little reference to palliative care. The qualitative findings may also have relevance to the UK, though systems will differ
Comprehensive assessment may reduce risk of delirium after hip fracture Comprehensive assessment may reduce risk of delirium after hip fracture Discover Portal Discover Portal Comprehensive assessment may reduce risk of delirium after hip fracture Published on 29 August 2017 doi: Comprehensive geriatric assessment reduced the risk of delirium by 20% in patients having hip fracture surgery. Forty-three percent developed delirium on average compared with 53% who didn’t receive these assessments (...) . The assessment of the older persons’ medical condition was typically undertaken by a team of healthcare professionals who assessed functional ability, living circumstances and risk factors in order to develop a tailored plan for prevention and treatment of delirium after surgery. This review identified four trials in people having surgery for hip fracture. Two assessed teams where geriatricians visited patients on orthopaedic wards. The other trials reported ward assessments where patients were already being
Benzodiazepines may increase length of stay and chance of delirium in intensive care Benzodiazepines may increase length of stay and chance of delirium in intensive care Discover Portal Discover Portal Benzodiazepines may increase length of stay and chance of delirium in intensive care Published on 18 December 2018 doi: Benzodiazepines given during mechanical ventilation in intensive care could increase the risk of a longer hospital stay and delirium compared to other sedatives. A range (...) discharged from intensive care. Results suggest benzodiazepines prolong the length of stay in intensive care compared with propofol and increase the risk of delirium compared with dexmedetomidine. Share your views on the research. Why was this study needed? Most mechanically ventilated patients receive sedatives to keep them comfortable and to facilitate treatment. Inappropriate sedation can prolong the patient’s reliance on mechanical ventilation, increase the risk of infections, such as pneumonia
Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review Measurement of delirium severity has been recognized as highly important for tracking prognosis, monitoring response to treatment, and estimating burden of care for patients both during and after hospitalization. Rather than simply rating delirium as present or absent, the ability to quantify its severity would enable development and monitoring of more effective treatment approaches for the condition.To present (...) a comprehensive review of delirium severity instruments, conduct a methodologic quality rating of the original validation study of the most commonly used instruments, and select a group of top-rated instruments.This systematic review was conducted using literature from Embase, PsycINFO, PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature, from January 1, 1974, through March 31, 2017, with the key words delirium, severity, tests, measures, and intensity. Inclusion criteria were
The Effect of a Parental Visitation Program on Emergence Delirium Among Postoperative Children in the PACU. The purpose of this study was to examine the effects of parental presence on the incidence of emergence delirium (ED) of children in the postanesthesia care unit (PACU).A quasi-experimental pretest and post-test study with nonequivalent and nonsynchronized control groups.About 93 children aged 3 to 6 years undergoing general anesthesia for tonsillectomy were divided into two groups (...) : parental presence and absence. ED was recorded using the Pediatric Anesthesia Emergence Delirium Scale at 0, 10, 20, and 30 minutes after PACU admission.ED score at each time point in the experimental group was lower than the control group, but not statistically significant. ED score in the experimental group significantly decreased over time (F = 6.98; P = .010).Parental visitation programs could be effective on the degree of ED in children in the PACU setting. This result may contribute
Acute Mental Status Change, Delirium, and New Onset Psychosis New 2018 ACR Appropriateness Criteria ® 1 Acute Mental Status Change American College of Radiology ACR Appropriateness Criteria ® Acute Mental Status Change, Delirium, and New Onset Psychosis Variant 1: Acute mental status change. Increased risk for intracranial bleeding (ie, anticoagulant use, coagulopathy), hypertensive emergency, or clinical suspicion for intracranial infection, mass, or elevated intracranial pressure. Initial (...) CT head without IV contrast Usually Appropriate ??? CT head without and with IV contrast May Be Appropriate ??? CT head with IV contrast Usually Not Appropriate ??? Variant 5: New onset delirium. Initial imaging. Procedure Appropriateness Category Relative Radiation Level CT head without IV contrast Usually Appropriate ??? MRI head without and with IV contrast May Be Appropriate (Disagreement) O MRI head without IV contrast May Be Appropriate (Disagreement) O CT head without and with IV contrast
Preventing Postoperative Delirium After Major Noncardiac Thoracic Surgery-A Randomized Clinical Trial To assess the efficacy of haloperidol in reducing postoperative delirium in individuals undergoing thoracic surgery.Randomized double-blind placebo-controlled trial.Surgical intensive care unit (ICU) of tertiary care center.Individuals undergoing thoracic surgery (N=135).Low-dose intravenous haloperidol (0.5 mg three times daily for a total of 11 doses) administered postoperatively.The primary (...) outcome was delirium incidence during hospitalization. Secondary outcomes were time to delirium, delirium duration, delirium severity, and ICU and hospital length of stay. Delirium was assessed using the Confusion Assessment Method for the ICU and delirium severity using the Delirium Rating Scale-Revised.Sixty-eight participants were randomized to receive haloperidol and 67 placebo. No significant differences were observed between those receiving haloperidol and those receiving placebo in incident
Interventions for preventing intensive care unit delirium in adults. Delirium is defined as a disturbance in attention, awareness and cognition with reduced ability to direct, focus, sustain and shift attention, and reduced orientation to the environment. Critically ill patients in the intensive care unit (ICU) frequently develop ICU delirium. It can profoundly affect both them and their families because it is associated with increased mortality, longer duration of mechanical ventilation (...) , longer hospital and ICU stay and long-term cognitive impairment. It also results in increased costs for society.To assess existing evidence for the effect of preventive interventions on ICU delirium, in-hospital mortality, the number of delirium- and coma-free days, ventilator-free days, length of stay in the ICU and cognitive impairment.We searched CENTRAL, MEDLINE, Embase, BIOSIS, International Web of Science, Latin American Caribbean Health Sciences Literature, CINAHL from 1980 to 11 April 2018
Delirium in Adult Cancer Patients: ESMO Clinical Practice Guidelines CLINICAL PRACTICE GUIDELINES Delirium in adult cancer patients: ESMO Clinical Practice Guidelines † S. H. Bush 1,2,3,4 , P. G. Lawlor 1,2,3,4 , K. Ryan 5,6,7 , C. Centeno 8,9,10 , M. Lucchesi 11 , S. Kanji 2,12 , N. Siddiqi 13,14 , A. Morandi 15 , D. H. J. Davis 16 , M. Laurent 17,18 , N. Schofield 19 , E. Barallat 20 & C. I. Ripamonti 21 , on behalf of the ESMO Guidelines Committee * 1 Division of Palliative Care, Department (...) , Istituto Nazionale dei Tumori, Milano, Italy *Correspondence to: ESMO Guidelines Committee, ESMO Head Of?ce, Via Ginevra 4, 6900 Lugano, Switzerland. E-mail: email@example.com † Approved by the ESMO Guidelines Committee: April 2018. Delirium is a neurocognitive syndrome that commonly occurs in older populations and people with cancer, particularly in those with advanced disease and in the last hours or days of life. While an underlying malignancy and its complications predispose a person
Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. There are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU).In a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume (...) and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention. The primary end point was the number of days alive without delirium or coma during the 14-day intervention period. Secondary end points included 30-day and 90-day survival, time to freedom from mechanical ventilation, and time to ICU and hospital discharge
Mind the gap on UTI?s and delirium Core IM: Mind the Gap on UTI’s and Delirium – Clinical Correlations Search Core IM: Mind the Gap on UTI’s and Delirium September 12, 2018 4 min read Podcast: | Subscribe: | Join us in this episode as we question everything you ever thought you knew about… urinary tract infections (UTI) and delirium. || By Steven R. Liu MD, Charlie Madeira MD and Dr. Janine Knudsen MD || Graphic Design by Ramon Thompson Time Stamps: The basics – what are the official (IDSA (...) ) definitions for bacteriuria, pyuria, and UTI? (02:07) The lay of the land – how common are bacteriuria and delirium? (07:09) The big money question – do UTIs really cause delirium and what does the evidence tell us? (10:50) Review of teaching points (15:59) Thank you to infectious disease attendings from NYU and Bellevue Hospitals, Dr. Ellie Carmody and Dr. Tania Kupferman, for peer reviewing this podcast! Subscribe to CORE IM on any podcast app! Follow us on Facebook || Twitter || Instagram . Please give
Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Clinical Practice Guidelines for the Prevention and Manageme... : Critical Care Medicine You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Login No user account? Lippincott Journals Subscribers , use your username or email along with your password to log in. Remember me (...) Note Procite Reference Manager Save my selection doi: 10.1097/CCM.0000000000003299 Online Special Article Free Objective: To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain , Agitation, and Delirium in Adult Patients in the ICU. Design: Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual
Effect of Depth of Sedation in Older Patients Undergoing Hip Fracture Repair on Postoperative Delirium: The STRIDE Randomized Clinical Trial Postoperative delirium is the most common complication following major surgery in older patients. Intraoperative sedation levels are a possible modifiable risk factor for postoperative delirium.To determine whether limiting sedation levels during spinal anesthesia reduces incident delirium overall.This double-blind randomized clinical trial (A Strategy (...) to Reduce the Incidence of Postoperative Delirum in Elderly Patients [STRIDE]) was conducted from November 18, 2011, to May 19, 2016, at a single academic medical center and included a consecutive sample of older patients (≥65 years) who were undergoing nonelective hip fracture repair with spinal anesthesia and propofol sedation. Patients were excluded for preoperative delirium or severe dementia. Of 538 hip fractures screened, 225 patients (41.8%) were eligible, 10 (1.9%) declined participation, 15
Ability of suvorexant to prevent delirium in patients in the intensive care unit: a randomized controlled trial There are no effective, tolerable, and established medications for preventing delirium in critically ill patients admitted to the intensive care unit (ICU). We investigated whether suvorexant was effective in preventing ICU delirium.This randomized controlled study evaluated 70 adult patients (age ≥20 years) admitted to the mixed medical ICU of the Tokyo Medical University Hospital (...) (Tokyo, Japan) between May 2015 and February 2017. Patients were randomized using a sealed envelope method to receive either suvorexant (n = 34; 15 mg for elderly patients and 20 mg for younger adults) or conventional treatment (n = 36) for a 7-day period. The primary outcome was delirium incidence based on the definition in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders.No significant between-group differences were observed in the demographic or clinical characteristics
Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial Dexmedetomidine is associated with less delirium than benzodiazepines and better sleep architecture than either benzodiazepines or propofol; its effect on delirium and sleep when administered at night to patients requiring sedation remains unclear.To determine if nocturnal dexmedetomidine prevents delirium and improves sleep in critically ill adults.This two-center, double-blind, placebo-controlled (...) trial randomized 100 delirium-free critically ill adults receiving sedatives to receive nocturnal (9:30 p.m. to 6:15 a.m.) intravenous dexmedetomidine (0.2 μg/kg/h, titrated by 0.1 μg /kg/h every 15 min until a goal Richmond Agitation and Sedation Scale score of -1 or maximum rate of 0.7 μg/kg/h was reached) or placebo until ICU discharge. During study infusions, all sedatives were halved; opioids were unchanged. Delirium was assessed using the Intensive Care Delirium Screening Checklist every 12