Delirium in the Acute Care Setting: Characteristics, Diagnosis and Treatment

Maldonado, José R.

doi:10.1016/j.ccc.2008.05.008

Cited by 241 publications

(179 citation statements)

References 255 publications

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“…Pain is the most common memory patients have of their experience in the ICU, 25 and sedatives and analgesics are the most commonly administered ICU drugs. 26 Short-term consequences of unrelieved pain are higher energy expenditure and immunomodulation. Unrelenting pain leads to posttraumatic stress disorder in the long term.…”

Section: Components Of the Dpbmentioning

confidence: 99%

“…Unrelenting pain leads to posttraumatic stress disorder in the long term. 26 Nurses routinely assessed and documented pain by using a numeric rating scale of 0 to 10. Nurses recorded patient-reported comfort goals (0-10), patients' perceived pain scores (0-10), time of analgesic administration, and patients' follow-up pain score 1 hour later.…”

Section: Components Of the Dpbmentioning

confidence: 99%

“…The mean sleep time for an ICU patient may be as little as 1 to 2 hours per day, with less than 6% of ICU patients achieving rapid eye movement sleep. 26 Environmental factors such as noise, crowded conditions, and bright lights contribute to sleep deprivation. The DPB promotes uninterrupted sleep by clustering patient care interventions (eg, measurement of vital signs, radiographs, phlebotomy) around the designated sleep period (midnight to 4 AM); not administering hypnotic agents after 2 AM; dimming overhead lights; closing window blinds; and minimizing ambient noise (< 80 decibels) by turning off televisions and radios.…”

Section: Components Of the Dpbmentioning

confidence: 99%

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Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

Smith

Grami

2017

American Journal of Critical Care

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Background Strategies for preventing delirium include early identification and avoiding or modifying patient, environmental, and iatrogenic factors. Minimal research exists on a prescriptive delirium prevention bundle that details elements or strategies for each bundle component. Even less research has been focused on nurse-driven interventions or components. Objective To evaluate the effectiveness of a delirium prevention bundle in decreasing delirium incidence in 2 medical-surgical intensive care units in a large Texas medical center. Methods Researchers used the Confusion Assessment Method for the Intensive Care Unit to assess delirium incidence by using a controlled interventional cohort design with 447 delirium-negative critically ill patients. Bundle components consist of sedation cessation, pain management, sensory stimulation, early mobilization, and sleep promotion. Results The intervention, analyzed by using a logistic regression model, reduced the odds of delirium by 78% (odds ratio, 0.22; P = .001). Conclusions The delirium prevention bundle was effective in reducing the incidence of delirium in critically ill medical-surgical patients. Further validation studies are under way.

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Section: Components Of the Dpbmentioning

confidence: 99%

Section: Components Of the Dpbmentioning

confidence: 99%

Section: Components Of the Dpbmentioning

confidence: 99%

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Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

Smith

Grami

2017

American Journal of Critical Care

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“…This improvement may also be attributed to an indirect effect of KMM, for example, improvement in respiratory symptoms (i.e., alleviating anoxia). In addition pain reduction improved delirium [18]. Notably, neuropsychiatric symptoms were not reported in patients whose symptoms improved suggesting that the KMM protocol did not cause any neuropsychiatric adverse events in this patient population.…”

Section: Discussionmentioning

confidence: 77%

Effect of the Sedative Combination of Ketamine, Morphine and Midazolam on the Quality-of-Life in the Final Days of Terminally Ill Cancer Patients

Asna¹,

Shemesh²,

Arbel³

et al. 2017

Arch Med

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“…About 15% of elderly inpatients in acute medical-surgical services have delirium at any time, and the rate is even higher among nursing home patients. Approximately 30 to 40 percent of hospitalized patients older than age 65 have an episode of delirium, and another 10 to 15 percent of elderly persons exhibit delirium on admission to the hospital [10,11].…”

Section: Introductionmentioning

confidence: 99%

Whether Delirium Acts as ECT?

Tripathi¹

2013

Aging Sci

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Delirium is defined by the acute onset of fluctuating cognitive impairment and a disturbance of consciousness with reduced ability to attend. It may occur at any age but is more common in older adults. By virtue of working in the psychogeriatric hospital (Department of Geriatric Mental Health, King George's Medical University, Lucknow, India), authors experienced that many elderly patients with psychiatric illness develops delirium because of various reasons. Subsequently, we observed that psychiatric manifestations of the patients improved significantly following recovery from delirium. A series of such four cases (case 1-Depression with psychotic features, 2-Manic episode, 3-Bipolar affective disorder current episode mania and 4-Depressive episode) later developed delirium has been presented and discussed in this paper. ICD-10 criteria were used for the diagnosis of delirium and psychiatric illnesses. Average stay of these patients in the hospital was 10 days. We found that signs and symptoms of these psychiatric disorders disappeared almost completely following the recovery from delirium. Therefore, it can be assumed that delirium potentially acts similar to ECT. By reporting such case we open a new dimension of research for effective treatment of the psychiatric patients. Inducing delirium in a patient is unethical but understanding pathophysiology behind it will certainly open the door for better cure of the ailing psychiatric patients.

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Delirium in the Acute Care Setting: Characteristics, Diagnosis and Treatment

Cited by 241 publications

References 255 publications

Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

Effect of the Sedative Combination of Ketamine, Morphine and Midazolam on the Quality-of-Life in the Final Days of Terminally Ill Cancer Patients

Whether Delirium Acts as ECT?

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