Delirium in critically ill patients

Slooter, A.J.C.; Van De Leur, R.R.; Zaal, I.J.

doi:10.1016/b978-0-444-63599-0.00025-9

Cited by 89 publications

(61 citation statements)

References 138 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The main finding of this study was that the use of hydromorphone was associated with more days alive and DFCF while on ECMO support, with more time free of coma and with ~75% less narcotic exposure when compared with fentanyl. These findings are relevant to patient‐centered outcomes because the development of delirium in critically ill patients is associated with higher mortality, increased time on mechanical ventilation, increased length of stay, and higher costs 17‐24 …”

Section: Discussionmentioning

confidence: 99%

Comparison of Hydromorphone versus Fentanyl‐based Sedation in Extracorporeal Membrane Oxygenation: A Propensity‐Matched Analysis

et al. 2020

View full text Add to dashboard Cite

INTRODUCTION Data comparing sedatives in patients receiving extracorporeal membrane oxygenation (ECMO) are sparse. However, it is known that the ECMO circuit alters the pharmacokinetic properties of medications via drug sequestration of lipophilic agents and increased volume of distribution. OBJECTIVES This study evaluated the difference in days alive without delirium or coma and the sedative requirements in patients receiving fentanyl versus hydromorphone in ECMO patients. METHODS This single-center retrospective observational study evaluated adults receiving ECMO for more than 48 hours and continuous infusion of either fentanyl or hydromorphone for at least 6 hours. Of 148 patients evaluated, 88 received fentanyl and 60 received hydromorphone continuous infusion sedation. Outcomes included delirium-free and coma-free (DFCF) days, narcotic use, and sedative use. MAIN RESULTS There was an increase in the number of DFCF days in the hydromorphone group at day 7 (p=0.07) and day 14 (p=0.08) and a significant reduction in daily fentanyl equivalent exposure. Propensity score matching yielded 54 matched pairs. An 11.1% increase was observed in the proportion of ECMO days alive without delirium or coma in the hydromorphone group at 7 days (53.2% vs 42.1%, p=0.006). Patients in the hydromorphone group received significantly fewer narcotics with a median of 555 µg (interquartile range [IQR] 287-905 µg) of fentanyl equivalents per day compared with 2291 µg (IQR 1053-4023 µg) in the fentanyl group (p<0.005). CONCLUSION The use of hydromorphone-based sedation in ECMO patients resulted in more days alive without delirium or coma while significantly reducing narcotic requirements. KEY WORDS acute respiratory distress syndrome, extracorporeal membrane oxygenation, intensive care, sedation, delirium.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of Hydromorphone versus Fentanyl‐based Sedation in Extracorporeal Membrane Oxygenation: A Propensity‐Matched Analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Delirium is a clinical diagnosis; most studies detect delirium using screening tools such as the Confusion Assessment Method for the ICU (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC) (274,275). Delirium can be disturbing for affected patients and relatives and is associated with worse outcome, and much higher ICU and hospital LOS and costs (276). Many research gaps exist in this area (277).…”

Section: Deliriummentioning

confidence: 99%

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Devlin

Skrobik

Gélinas

et al. 2018

Critical Care Medicine

2,508

2,938

View full text Add to dashboard Cite

We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.

show abstract

“…Delirium is characterised by a reduced ability to direct, focus, sustain and shift attention, reduced orientation to the environment, and disturbance in cognition, which develops over a short period of time and tends to fluctuate in severity during the course of a day [1]. The pathophysiology of delirium remains poorly understood [2,3].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors related to haloperidol use for delirium in adult intensive care patients: the multinational AID-ICU inception cohort study

et al. 2018

View full text Add to dashboard Cite

show abstract

Delirium in critically ill patients

Cited by 89 publications

References 138 publications

Comparison of Hydromorphone versus Fentanyl‐based Sedation in Extracorporeal Membrane Oxygenation: A Propensity‐Matched Analysis

Comparison of Hydromorphone versus Fentanyl‐based Sedation in Extracorporeal Membrane Oxygenation: A Propensity‐Matched Analysis

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Prevalence and risk factors related to haloperidol use for delirium in adult intensive care patients: the multinational AID-ICU inception cohort study

Contact Info

Product

Resources

About