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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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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 Dissemination Centre Discover Portal NIHR DC Discover 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 (...) survived and were 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
Comprehensive assessment may reduce risk of delirium after hip fracture Signal - Comprehensive assessment may reduce risk of delirium after hip fracture Dissemination Centre Discover Portal NIHR DC Discover Comprehensive assessment may reduce risk of delirium after hip fracture Published on 29 August 2017 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
Delirium is common among adults receiving palliative care and could be better recognised Delirium recognition in palliative care Dissemination Centre Discover Portal NIHR DC Discover 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
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 (...) 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 Usually Not Appropriate
Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review 30556827 2019 01 12 2168-6114 2018 Dec 17 JAMA internal medicine JAMA Intern Med Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review. 10.1001/jamainternmed.2018.6975 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
Preventing Postoperative Delirium After Major Noncardiac Thoracic Surgery-A Randomized Clinical Trial 30460981 2018 12 11 1532-5415 66 12 2018 Dec Journal of the American Geriatrics Society J Am Geriatr Soc Preventing Postoperative Delirium After Major Noncardiac Thoracic Surgery-A Randomized Clinical Trial. 2289-2297 10.1111/jgs.15640 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
Interventions for preventing intensive care unit delirium in adults. BACKGROUND: 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. OBJECTIVES: 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. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, BIOSIS, International Web of Science, Latin American Caribbean Health Sciences Literature, CINAHL
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 (...) IRCCS, 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
Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. BACKGROUND: There are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU). METHODS: 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
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. Register for a free account You can save articles, manage email alerts, and easy revisit frequent searches. All fields are required. I have read (...) 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 connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process. Teleconferences and electronic
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 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 any feedback
Effect of Depth of Sedation in Older Patients Undergoing Hip Fracture Repair on Postoperative Delirium: The STRIDE Randomized Clinical Trial 30090923 2018 08 09 2168-6262 2018 Aug 08 JAMA surgery JAMA Surg Effect of Depth of Sedation in Older Patients Undergoing Hip Fracture Repair on Postoperative Delirium: The STRIDE Randomized Clinical Trial. 10.1001/jamasurg.2018.2602 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
Ability of suvorexant to prevent delirium in patients in the intensive care unit: a randomized controlled trial 30338083 2018 11 14 2052-8817 5 4 2018 Oct Acute medicine & surgery Acute Med Surg Ability of suvorexant to prevent delirium in patients in the intensive care unit: a randomized controlled trial. 362-368 10.1002/ams2.368 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
Delirium Top results for delirium - Trip Database or use your Google+ account Find evidence fast My query is: English Français Deutsch Čeština Español Magyar Svenska ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search numbers in the top search box and pressing the search (...) button. An example search might look like (#1 or #2) and (#3 or #4) Loading history... Population: Intervention: Comparison: Outcome: Population: Intervention: 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
Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial 29498534 2018 05 01 1535-4970 197 9 2018 May 01 American journal of respiratory and critical care medicine Am. J. Respir. Crit. Care Med. Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial. 1147-1156 10.1164/rccm.201710-1995OC 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
Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis 29912008 2018 06 22 1528-1175 2018 Jun 15 Anesthesiology Anesthesiology Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis. 10.1097/ALN.0000000000002323 Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource (...) utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction. A systematic search for randomized controlled trials was conducted using Ovid
Melatonin and Sleep in Preventing Hospitalized Delirium: A Randomized Clinical Trial 29729237 2018 06 23 1555-7162 2018 May 03 The American journal of medicine Am. J. Med. Melatonin and Sleep in Preventing Hospitalized Delirium: A Randomized Clinical Trial. S0002-9343(18)30386-3 10.1016/j.amjmed.2018.04.009 Studies suggest that melatonin may prevent delirium, a condition of acute brain dysfunction occurring in 20%-30% of hospitalized older adults that is associated with increased morbidity (...) and mortality. We examined the effect of melatonin on delirium prevention in hospitalized older adults while measuring sleep parameters as a possible underlying mechanism. This was a randomized clinical trial measuring the impact of 3mg of melatonin nightly on incident delirium and both objective and subjective sleep in inpatients age ≥65years, admitted to internal medicine wards (non-intensive care units). Delirium incidence was measured by bedside nurses using the confusion assessment method. Objective
Cholinesterase inhibitors for the treatment of delirium in non-ICU settings. BACKGROUND: Delirium is a common clinical syndrome defined as alterations in attention with an additional disturbance in cognition or perception, which develop over a short period of time and tend to fluctuate during the course of the episode. Delirium is commonly treated in hospitals or community settings and is often associated with multiple adverse outcomes such as increased cost, morbidity, and even mortality (...) . The first-line intervention involves a multicomponent non-pharmacological approach that includes ensuring effective communication and reorientation in addition to providing reassurance or a suitable care environment. There are currently no drugs approved specifically for the treatment of delirium. Clinically, however, various medications are employed to provide symptomatic relief, such as antipsychotic medications and cholinesterase inhibitors, among others. OBJECTIVES: To evaluate the effectiveness
Antipsychotics for treatment of delirium in hospitalised non-ICU patients. BACKGROUND: Guidelines suggest limited and cautious use of antipsychotics for treatment of delirium where nonpharmacological interventions have failed and symptoms remain distressing or dangerous, or both. It is unclear how well these recommendations are supported by current evidence. OBJECTIVES: Our primary objective was to assess the efficacy of antipsychotics versus nonantipsychotics or placebo on the duration (...) of delirium in hospitalised adults. Our secondary objectives were to compare the efficacy of: 1) antipsychotics versus nonantipsychotics or placebo on delirium severity and resolution, mortality, hospital length of stay, discharge disposition, health-related quality of life, and adverse effects; and 2) atypical vs. typical antipsychotics for reducing delirium duration, severity, and resolution, hospital mortality and length of stay, discharge disposition, health-related quality of life, and adverse
Attention, arousal and other rapid bedside screening instruments for delirium in older patients: a systematic review of test accuracy studies 29697753 2018 04 26 1468-2834 2018 Apr 25 Age and ageing Age Ageing Attention, arousal and other rapid bedside screening instruments for delirium in older patients: a systematic review of test accuracy studies. 10.1093/ageing/afy058 delirium occurs frequently in frail patients but is easily missed. Screening with a rapid, easy-to-use and highly sensitive (...) instrument might help improve recognition. The aim of this study was to review attention, arousal and other rapid bedside screening instruments for delirium in older patients. a literature search was performed in PubMed, PsycINFO and Embase. We scrutinized forward citations in Google Scholar, and references of included articles and prior reviews. We included studies among older patients that investigated the sensitivity and specificity of delirium screening instruments that could be administered in 3 min