A Preoperative, Nurse-Led Intervention Program Reduces Acute Postoperative Delirium

Guo, Ying; Fan, Yuying

doi:10.1097/jnn.0000000000000220

Cited by 22 publications

(26 citation statements)

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“…Among these, environmental factors are believed to be modifiable 12 . Some preventive and early non‐pharmacological management interventions targeting environmental factors have been recommended as effective, including family participation, early mobilization, and sleep promotion 13‐15 . A stratified prediction model may therefore be used to identify patients at high risk of developing delirium, allowing targeted prophylactic interventions to then be taken to prevent delirium, thus making the best use of available medical resources 16 …”

Section: Introductionmentioning

confidence: 99%

Validation of PREdiction of DELIRium in ICu patients (PRE‐DELIRIC) among patients in intensive care units: A retrospective cohort study

Liang

Chau

et al. 2020

Nursing in Critical Care

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Background: An intensive care unit (ICU) delirium prediction tool, PREdiction of DELIRium in ICu patients (PRE-DELIRIC), has been developed and calibrated in a multinational project. However, there is a lack of evidence regarding the predictive ability of the PRE-DELIRIC among Chinese ICU patients.Aim: To evaluate the predictive validity (discrimination and calibration) of PRE- DELIRIC.Design: This is a retrospective cohort study.Methods: A retrospective cohort study was conducted. Consecutive participants (a) admitted to the ICU for ≥24 hours, (b) aged ≥18 years, and (c) admitted to the ICU for the first time were included. Ten predictors (age, APACHE-II, urgent and admission category, urea level, metabolic acidosis, infection, coma, sedation, and morphine use) assessed within 24 hours upon ICU admission were assessed. Delirium was assessed using the Confusion Assessment Method for ICU. Outcomes included ICU length of stay and mortality. Discrimination and calibration were determined by the areas under the receiver operating characteristic curve (AUROC), box plot, and calibration plot.Results: A total of 375 ICU patients were included, with 44.0% of patients being delirious. Delirium was significantly associated with age, PRE-DELIRIC score, ICU length of stay, and mortality. The AUROC was 0.81 (95% confidence interval, 0.77-0.86). The optimal cut-off point identified by max Youden index was 49%. The calibration plot of pooled data demonstrated a calibration slope of 0.894 and an intercept of −0.178. Conclusions:The PRE-DELIRIC has high predictive value and is suggested to be adopted in ICUs for early initiation of preventive interventions against delirium among high-risk patients.Relevance to clinical practice: Clinicians can adopt the PRE-DELIRIC among ICU patients to screen patients at high risk of developing delirium. Early initiative interventions could be implemented to reduce the negative impacts of ICU delirium.

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Section: Introductionmentioning

confidence: 99%

Validation of PREdiction of DELIRium in ICu patients (PRE‐DELIRIC) among patients in intensive care units: A retrospective cohort study

Liang

Chau

et al. 2020

Nursing in Critical Care

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“…Identifying the risk factors for developing delirium could allow for earlier intervention to prevent delirium following spine surgery, significantly reducing the associated morbidity and mortality (1,4,23,24). Currently, our understanding of the prominent risk factors is limited and further research is needed to identify preventable risk factors for postoperative delirium (4,25,26).…”

Section: Introductionmentioning

confidence: 99%

The risk factors associated with delirium after lumbar spine surgery in elderly patients

Zhimin¹,

Huang²,

Huang³

et al. 2019

Quant. Imaging Med. Surg

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Background: To prospectively explore the incidence and risk factors for postoperative delirium in elderly patients following lumbar spine surgery.Methods: This prospective study enrolled 148 consecutive patients over the age of 65 who were scheduled to undergo spine surgery. Patients were screened for delirium using the short Confusion Assessment Method (CAM) postoperatively. Patient demographics and relevant medical information were collected. Logistic regression analysis was used to identify the risk factors associated with postoperative delirium.Results: Eighty-three patients (56.1%) who underwent lumbar spine surgery (not coexisting with cervical or thoracic spine surgery) were enrolled in our study. Post-operative delirium was noted in 14.5% of patients over 65 years old. The presence of preoperative Parkinsonism was significantly higher in the delirium group (41.7% vs. 8.5%, P=0.002), as was a higher preoperative C-reactive protein (CRP) (7.0±15.2 vs. 1.3±2.3 mg/L, P=0.017) when compared with the non-delirium group. Of the risk factors, male sex [odds ratio (OR) =0.10, 95% confidence interval (CI): 0.01-0.66, P=0.017], Parkinsonism (OR =5.83, 95% CI: 1.03-32.89, P=0.046), and lower baseline MMSE score (OR =0.71, 95% CI: 0.52-0.97, P=0.032) were independently associated with postoperative delirium in elderly patients undergoing lumbar spine surgery.Conclusions: Post-operative delirium occurred in 14.5% of elderly patients who underwent lumbar spine surgery. Male sex, Parkinsonism, and lower baseline MMSE score were identified as independent risk factors for postoperative delirium in elderly patients following lumbar surgery.

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“…We divided these factors into two groups, which are shown in the following tables with the items ordered according to their level of evidence and quality (John Hopkins Nursing Evidence-Based Practice [66]) according to the studies from which they were extracted. [19,29,40,44,80,88] Low level of education [4,9,28,58,67] Hypertension [75,80,87,88] Hypotension [14,16,23,76,81] High creatinine level [29,84,100] Immobilisation [30,32,75,91] Anaemia [44,70,81,83,91] Arterial fibrillation [17,26,44,83,90] Abnormally high albumin level [3,44,60,74,100] Cerebral aging [16,81,95] Functional deficit [29,78,…”

Section: Factors Associated With the Onset And Development Of Postoperative Deliriummentioning

confidence: 99%

“…[19,29,40,44,80,88] Low level of education [4,9,28,58,67] Hypertension [75,80,87,88] Hypotension [14,16,23,76,81] High creatinine level [29,84,100] Immobilisation [30,32,75,91] Anaemia [44,70,81,83,91] Arterial fibrillation [17,26,44,83,90] Abnormally high albumin level [3,44,60,74,100] Cerebral aging [16,81,95] Functional deficit [29,78,89,91] Malnutrition [2,3,…”

Section: Factors Associated With the Onset And Development Of Postoperative Deliriummentioning

confidence: 99%

“…The physiopathology of postoperative delirium is currently unclear; its onset has been correlated with several factors, but it is by no means fully defined. Some of these factors include age, sex, preoperative state of health, type and duration of surgical intervention, previous drug consumption, hypotension, time spent in cardiac bypass during heart surgery, presence of inflammation, presence of stress hormones, ischemia, hypoxemia, certain neurotransmitters, water–electrolyte balance, pain, and nutritional status, among others [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Because the pathophysiology of postoperative delirium is not exactly known, it is important to know its predisposing factors (vulnerability of the patient; that is, factors that are present in many of the patients who develop it) as well as the precipitating factors (factors, generally external, that facilitate the occurrence of postoperative delirium).…”

Section: Introductionmentioning

confidence: 99%

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A Preoperative, Nurse-Led Intervention Program Reduces Acute Postoperative Delirium

Cited by 22 publications

References 1 publication

Validation of PREdiction of DELIRium in ICu patients (PRE‐DELIRIC) among patients in intensive care units: A retrospective cohort study

Validation of PREdiction of DELIRium in ICu patients (PRE‐DELIRIC) among patients in intensive care units: A retrospective cohort study

The risk factors associated with delirium after lumbar spine surgery in elderly patients

Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review

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