Costs associated with delirium in mechanically ventilated patients*

Milbrandt, Eric B; Deppen, Stephen A.; Harrison, Patricia; Shintani, Ayumi; Speroff, Theodore; Stiles, Renée A.; Truman, Brenda; Bernard, Gordon R.; Dittus, Robert S.; Ely, E. Wesley

doi:10.1097/01.ccm.0000119429.16055.92

Cited by 724 publications

(438 citation statements)

References 39 publications

Supporting

Mentioning

403

Contrasting

Unclassified

Order By: Relevance

“…The median time till first positive CAM-ICU occurred was 3 [1][2][3][4][5][6] days. Of note, apart from the considerable variation in delirium incidence there were important differences between countries concerning the incidence of delirium predictors (Table 1).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

et al. 2014

View full text Add to dashboard Cite

This is the accepted version of the paper.This version of the publication may differ from the final published version. Methods: A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The 10 predictors (age, APACHE-II, urgent and admission category, infection, coma, sedation, morphine use, urea level, metabolic acidosis) were collected within 24 hours after ICU admission. The confusion assessment method for the Intensive Care Unit (CAM-ICU) was used to identify ICU delirium. CAM-ICU screening compliance and inter-rater reliability measurements were used to secure the quality of the data. Permanent repository linkResults: 2,852 adult ICU patients were screened of which 1,824 (64%) were eligible for the study. Main reasons for exclusion were length of stay <1day (19.1%) and sustained coma (4.1%). CAM-ICU compliance was mean (SD) 82±16% and inter-rater reliability 0.87±0.17. The median delirium incidence was 22.5% (IQR 12.8%-36.6%). Although the incidence of all ten predictors differed significantly between centers, the area under the receiver operating characteristic (AUROC) curve of the 8 participating centers remained good: 0.77 (95%CI:0.74-0.79). The linear predictor and intercept of the prediction rule were adjusted and resulted in improved recalibration of the PRE-DELIRIC model. Conclusions:In this multinational study we recalibrated the PRE-DELIRIC-model. Despite differences in the incidence of predictors between the centers in the different countries the performance of the PRE-DELIRICmodel remained good. Following validation of the PRE-DELIRIC model it may facilitate implementation of strategies to prevent delirium and aid improvements in delirium management of ICU patients.4

show abstract

Section: Resultsmentioning

confidence: 99%

“…Delirium is associated with a prolonged stay in the intensive care unit (ICU) and hospital, increased morbidity and mortality rate, higher costs [2,3,5] and adverse long-term outcome [6,7]. There are several delirium assessment tools for ICU patients such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).…”

Section: Introductionmentioning

confidence: 99%

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The number of days with delirium was counted cumulatively during ICU admission, hence without taking different periods of delirium into account. The delirium severity index (DSI) was used to register daily the severity of delirium [26], based on the highest absolute RASS score in the preceding day. To determine interobserver variability in the mental status classification, the two research physicians and neurologist-intensivist assessed 36 patients simultaneously, where every observer was blinded to other observers' conclusions.…”

Section: Delirium Assessmentmentioning

confidence: 99%

Intensive care unit environment may affect the course of delirium

et al. 2012

View full text Add to dashboard Cite

Purpose: Delirium is a common disorder in intensive care unit (ICU) patients. It is unclear whether ICU environment affects delirium. We investigated the influence of ICU environment on the number of days with delirium during ICU admission. Methods: In this prospective before-after study, ICU delirium was compared between a conventional ICU with wards and a single-room ICU with, among others, improved daylight exposure. We included patients admitted for more than 24 h between March and June 2009 (ICU with wards) or between June and September 2010 (single-room ICU). Patients who remained unresponsive throughout ICU admission were excluded. The presence of delirium in the preceding 24 h was assessed daily with the confusion assessment method for the ICU (CAM-ICU) by research physicians combined with evaluation of medical and nursing charts. The number of days with delirium was investigated with Poisson regression analysis. Results: We included 55 patients (449 observation days) in the ICU with wards and 75 patients (468 observation days) in the single-room ICU. After adjusting for confounding, the number of days with delirium decreased by 0.4 days (95 % confidence interval 0.1-0.7) in the singleroom ICU (p = 0.005). The incidence of delirium during ICU stay was similar in the ICU with wards (51 %) and in the single-room ICU (45 %, p = 0.53). Conclusions: This study is the first to show that ICU environment may influence the course of delirium in ICU patients.

show abstract

“…The evidence suggested that ICU delirium is associated with increased length of stay, medical complications, and poor outcomes such as increased mortality and posttraumatic stress disorder 38,39 as well as significantly higher ICU and hospital costs. 40 Guidelines also exist to support monitoring sedation and delirium. 41 Our nurses realized that the issue of delirium was clinically significant, a priority, and needed to be assessed and managed to improve patients' outcomes.…”

Section: Is the Issue Clinically Significant? Is The Issue A Priority?mentioning

confidence: 99%

So You Want to Change Practice: Recognizing Practice Issues and Channeling Those Ideas

Lusardi

2012

Critical Care Nurse

View full text Add to dashboard Cite

Applying the best evidence to support nursing practice and generating new knowledge for use in practice are the hallmarks of excellence and allow practitioners to meet patient care quality and safety priorities. Although identifying a patient care problem comes easily to staff nurses, the process of clarifying the problem and channeling those ideas through to a practice change can be daunting for bedside nurses. This article provides guidance to staff nurses who want to identify a clinical problem and change practice.

show abstract

Costs associated with delirium in mechanically ventilated patients*

Cited by 724 publications

References 39 publications

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

Intensive care unit environment may affect the course of delirium

So You Want to Change Practice: Recognizing Practice Issues and Channeling Those Ideas

Contact Info

Product

Resources

About