Delirium in critically ill patients

Boogaard, Mark van den; Schoonhoven, Lisette; Evers, Andrea W M; Hoeven, Johannes G. van der; Achterberg, Theo van; Pickkers, Peter

doi:10.1097/ccm.0b013e31822e9fc9

Cited by 316 publications

(67 citation statements)

References 30 publications

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“…Delirium is a complex neuropsychiatric syndrome that is highly prevalent among elderly hospitalized patients (1,2) and that adversely impacts on mortality, functional decline, incidence of falling, institutional admission, increased length of hospital stay and medical cost (1,(3)(4)(5)(6). In addition, delirium is a significant cause of distress to patients and family members, caregivers and medical/nursing staff (7,8).…”

Section: Introductionmentioning

confidence: 99%

Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study

Uchida

Okuyama

Ito

et al. 2015

Jpn. J. Clin. Oncol.

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Objective: The aim of this study was to investigate the prevalence of delirium on admission, the course of delirium during a 2-week period after admission and factors associated with delirium on admission, among elderly patients with advanced cancer. Methods: Patients aged ≥65 years with incurable lung or gastroenterological cancer and the Eastern Cooperative Oncology Group Performance Status 2 or greater were continuously sampled after admission to a university hospital. Participants were evaluated for DSM-IV-TR delirium by trained psychiatrists and the delirium subtype was assessed using the Delirium Motor Subtype Scale within 4 days after admission and again 2 weeks later. In addition, we assessed associated factors with delirium on admission. Results: Among 73 eligible patients, complete data were available from 61 on admission and 49 after 2 weeks. Twenty-six patients (43%) met delirium criteria on admission (hypoactive: 58%, unspecified: 35%, hyperactive: 4%, mixed: 4%). Of these, 19 (73%) remained delirious 2 weeks later. Of 35 patients without delirium on admission, 21 (60%) remained delirium-free 2 weeks later and 7(20%) became delirious. Overall, 33/61 (54%) developed delirium at some point during the study. Patients receiving steroids at admission were more likely to have delirium (odds ratio = 5.0; 95% confidence interval = 1.5-16). Conclusions: Given the high prevalence of the delirium, all patients with advanced cancer should be screened for delirium both on admission and regularly thereafter. In addition, medical staff should be aware that steroid use on admission is an additional indicator of elevated risk for delirium.

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Section: Introductionmentioning

confidence: 99%

Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study

Uchida

Okuyama

Ito

et al. 2015

Jpn. J. Clin. Oncol.

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“…(29) A positive CAM-ICU prompted treatment with haloperidol per their protocol. The effect of haloperidol on Cognitive Function HRQoL in our patient population is not clear, as we had too few patients treated with haloperidol for a meaningful analysis.…”

Section: Resultsmentioning

confidence: 99%

Agitation, Delirium, and Cognitive Outcomes in Intracerebral Hemorrhage

et al. 2017

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Introduction Delirium predicts higher long-term cognitive morbidity. We previously identified a cohort of patients with spontaneous intracerebral hemorrhage and delirium, and found worse outcomes in Health Related Quality of Life (HRQoL) in the domain of Cognitive Function. We tested the hypothesis that agitation would have additional prognostic significance on later Cognitive Function HRQoL. Materials and Method Prospective identification of 174 patients with acute intracerebral hemorrhage, measuring stroke severity, agitation, and delirium with a standardized protocol and measures. HRQoL was assessed using the Neuro-QOL at 28 days, three months, and one year. Functional outcomes were measured with the modified Rankin Scale. Results Among the 81 patients with health related quality of life follow up data available, patients who had agitation and delirium had worse Cognitive Function HRQoL scores at 28 days (T-scores for delirium with agitation 20.9 ± 7.3, delirium without agitation 30.4 ± 16.5, agitation without delirium 36.6 ± 17.5, neither agitated nor delirious 40.3 ± 15.9, P=0.03), and at 1 year (P=0.006). The effect persisted in mixed models after correction for severity of neurologic injury, age, and time of assessment (P=0.0006), and was not associated with medication use, seizures or infection. Conclusions The presence of agitation with delirium in patients with intracerebral hemorrhage may predict higher risk of unfavorable cognitive outcomes up to one year later.

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“…[5][6][7][8][9][10] At this time, no effective drug treatment exists for delirium, 4 making the identification of a safe and effective prevention therapy a clinical imperative. Exogenous melatonin is inexpensive to administer and demonstrates a wide safety margin across adult and paediatric clinical populations.…”

Section: Resultsmentioning

confidence: 99%

“…4 Critically ill patients who develop delirium experience worse outcomes including increased mortality, prolonged mechanical ventilation, increased duration of ICU and hospital length of stay, functional and cognitive decline, and increased likelihood of placement in long-term care facilities. [5][6][7][8][9][10] These adverse clinical and systems-level implications underscore the imperative of identifying safe and effective strategies for the prevention of delirium in critically ill patients. At this time, however, no pharmacological agent has been shown to effectively…”

Section: Introductionmentioning

confidence: 99%

Feasibility of melatonin for prevention of delirium in critically ill patients: a protocol for a multicentre, randomised, placebo-controlled study

et al. 2017

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IntroductionDelirium is highly prevalent in the intensive care unit (ICU) and is associated with adverse clinical outcomes. At this time, there is no drug that effectively prevents delirium in critically ill patients. Alterations in melatonin secretion and metabolism may contribute to the development of delirium. Administration of exogenous melatonin has been shown to prevent delirium in non-critically ill surgical and medical patients. This trial will demonstrate the feasibility of a planned multicentre, randomised controlled trial to test the hypothesis that melatonin can prevent delirium in critically ill patients compared with placebo.Methods and analysisThis feasibility trial is a randomised, 3-arm, placebo-controlled study of melatonin (2 vs 0.5 mg vs placebo, administered for a maximum of 14 days) for the prevention of delirium in critically ill patients. A total of 69 patients aged 18 years and older with an expected ICU length of stay >48 hours will be recruited from 3 Canadian ICUs. The primary outcome is protocol adherence (ie, overall proportion of study drug doses administered in the prescribed administration window). Secondary outcomes include pharmacokinetic parameters, incidence, time to onset, duration of delirium, number of delirium-free days, adverse events, self-reported sleep quality, rest-activity cycles measured by wrist actigraphy, duration of mechanical ventilation, ICU length of stay and mortality. Data will be analysed using an intention-to-treat approach.Ethics and disseminationThe study has been approved by Health Canada and the research ethics board of each study site. Trial results will be presented at international conferences and published in a peer-reviewed journal.Trial registration numberNCT02615340: Pre-results.

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Delirium in critically ill patients

Cited by 316 publications

References 30 publications

Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study

Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study

Agitation, Delirium, and Cognitive Outcomes in Intracerebral Hemorrhage

Feasibility of melatonin for prevention of delirium in critically ill patients: a protocol for a multicentre, randomised, placebo-controlled study

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