Ätiologie und Therapie des Delirs

Müllges, Wolfgang

doi:10.1055/s-0034-1395526

Cited by 3 publications

(4 citation statements)

References 77 publications

(100 reference statements)

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“…Delirium is a direct result of one or more physical disorders, interventions or medications [5]. The causes of delirium are manifold and result from predisposing and triggering factors [6][7][8][9]. Consequences are an increased risk of prolonged ventilation and length of stay in SU and hospital, increased mortality, permanent cognitive disturbances and institutionalization [10].…”

Section: Introductionmentioning

confidence: 99%

Delirium on stroke units: a prospective, multicentric quality-improvement project

et al. 2022

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Background Post-stroke delirium (POD) in patients on stroke units (SU) is associated with an increased risk for complications and poorer clinical outcome. The objective was to reduce the severity of POD by implementing an interprofessional delirium-management. Methods Multicentric quality-improvement project on five SU implementing a delirium-management with pre/post-comparison. Primary outcome was severity of POD, assessed with the Nursing Delirium Screening Scale (Nu-DESC). Secondary outcome parameters were POD incidence, duration, modified Rankin Scale (mRS), length of stay in SU and hospital, mortality, and others. Results Out of a total of 799 patients, 59.4% (n = 475) could be included with 9.5% (n = 45) being delirious. Implementation of a delirium-management led to reduced POD severity; Nu-DESC median: pre: 3.5 (interquartile range 2.6–4.7) vs. post 3.0 (2.2–4.0), albeit not significant (p = 0.154). Other outcome parameters were not meaningful different. In the post-period, delirium-management could be delivered to 75% (n = 18) of delirious patients, and only 24 (53.3%) of delirious patients required pharmacological treatments. Patients with a more severe stroke and POD remained on their disability levels, compared to similar affected, non-delirious patients who improved. Conclusions Implementation of delirium-management on SU is feasible and can be delivered to most patients, but with limited effects. Nursing interventions as first choice could be delivered to the majority of patients, and only the half required pharmacological treatments. Delirium-management may lead to reduced severity of POD but had only partial effects on duration of POD or length of stay. POD hampers rehabilitation, especially in patients with more severe stroke. Registry DRKS, DRKS00021436. Registered 04/17/2020, www.drks.de/DRKS00021436.

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Section: Introductionmentioning

confidence: 99%

Delirium on stroke units: a prospective, multicentric quality-improvement project

et al. 2022

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“…Delirium is characterized by impaired attention and concentration, rapid onset and fluctuating course as well as flawed cognition, and is a direct result of one or more physical disorders, procedures, or medications 4,5 . The causes of a delirium are manifold and result from predisposing and triggering factors 6‐9 . The consequences of delirium are an increased risk of prolonged duration of mechanical ventilation (MV) and length of stay, increased mortality, permanent cognitive damage, and institutionalization 10…”

Section: Introductionmentioning

confidence: 99%

“…4,5 The causes of a delirium are manifold and result from predisposing and triggering factors. [6][7][8][9] The consequences of delirium are an increased risk of prolonged duration of mechanical ventilation (MV) and length of stay, increased mortality, permanent cognitive damage, and institutionalization. 10 For the prevention and treatment of a delirium, non-pharmacological interventions, such as early mobilization, are recommended.…”

mentioning

confidence: 99%

Mobilization in the evening to prevent delirium: A pilot randomized trial

Nydahl

McWilliams

Weiler

et al. 2021

Nursing in Critical Care

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Background: Delirium is a common complication in patients in Intensive Care Units (ICU). Interventions such as mobilization are effective in the prevention and treatment of delirium, although this is usually completed during the daytime. Aim:The aim of this study was to assess the feasibility of mobilization in the evening to prevent and treat ICU patients from delirium by an additional mobility team over 2 weeks. Methods:The design was a pilot, multi-centre, randomized, controlled trial in four mixed ICUs over a period of 2 weeks. The mobility team consisted of trained nurses and physiotherapists. Patients in the intervention group were mobilized onto the edge of the bed or more between 21.00 and 23.00. Patients in the control group received usual care. The primary outcome parameter was the feasibility of the study, measured as recruitment rate, delivery rate, and safety. Secondary outcomes were duration and incidence of delirium, mortality, duration of mechanical ventilation (MV), and hospital length of stay for 28 days follow-up, and power calculation for a full trial.Results: Out of 185 patients present in the ICUs, 28.6% (n = 53) were eligible and could be recruited, of which 24.9% (n = 46, Intervention = 26, Control = 20) were included in the final analysis. In the intervention group, mobilization could be delivered in 75% (n = 54) of 72 possible occasions; mobilization-related safety events appeared in 16.7% (n = 9) without serious consequences. Secondary parameters Matthias Lindner and Rebecca von Haken contributed equally to this manuscript and are co-senior authors.

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“…procedures or medications [2,3]. The causes of a delirium are manifold and result from predisposing and triggering factors [4][5][6][7]. The consequences of delirium are an increased risk of prolonged duration of mechanically ventilation (MV) and length of stay, increased mortality, permanent cognitive damage, and institutionalization [8].…”

mentioning

confidence: 99%

Mobilization in the evening reduces delirium in critically ill patients: the MENTAL randomized, controlled trial

Nydahl

McWilliams

Weiler

et al. 2019

Preprint

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Background : Delirium is a common complication in patients on Intensive Care Units (ICU). Caring interventions such as early mobilization are effective in prevention and treatment of delirium, but are recommended during daytime. It may be effective in the night, too. Method : The aim of this study was to prove the effect of mobilization in the evening to prevent or treat ICU patients from delirium. The design was a multicentric, randomized, controlled trial in 5 mixed ICUs over a period of 2 weeks with max. 28 days follow-up. Patients in the intervention group were mobilized onto the edge of the bed or more between 9:00 and 11:00 p.m. by an additional mobilization team, following safety criteria. Patients in the control group received usual care. Primary outcome parameter was the duration of a delirium. Secondary parameters were presence of delirium, mortality, duration of mechanical ventilation (MV) and stay, feasibility, and mobilization-related complications. Results : In summary, n=69 patients could be analysed (intervention n=36, control n=33). Due to limited resources, the trial was stopped and reached 62% of targeted sample size. Mobilization in the evening did not significantly reduce duration of existing delirium, delirium presence, length of MV or days in ICU and hospital for 28 days follow-up. In an unplanned post-hoc analysis, mobilization in the evening prevented patients from delirium in the first four days (6 (16.7%) vs. 13 (39.4%), p=0.032), with a number needed to treat of 5. The intervention was feasible in 71.7% of eligible patients, with 13.6% unwanted safety events. Conclusions : In a mixed ICU population, mobilization in the evening did not show a reduction in duration of delirium, MV or length of stay, but a reduction in the incidence of early onset delirium. Mobilization between 9:00 and 11:00 pm. by an interprofessional mobilization team may prevent patients from delirium. The intervention was feasible, safe, and accepted by most patients.

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Ätiologie und Therapie des Delirs

Cited by 3 publications

References 77 publications

Delirium on stroke units: a prospective, multicentric quality-improvement project

Delirium on stroke units: a prospective, multicentric quality-improvement project

Mobilization in the evening to prevent delirium: A pilot randomized trial

Mobilization in the evening reduces delirium in critically ill patients: the MENTAL randomized, controlled trial

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