Delirium: pathophysiology, recognition, prevention and treatment

Rabinowitz, Terry; Murphy, Katharine M.; Nagle, Keith J.; Bodor, Cristina I; Kennedy, Suzanne M; Hirdes, John P.

doi:10.1586/14737175.3.3.343

Cited by 11 publications

(6 citation statements)

References 80 publications

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“…11,12,20 During coma, the different systems of neurotransmission, such as the cholinergic and adrenergic systems, are involved in the determination of the state of consciousness 39 and may be responsible for the onset of delirium. 19,40 Delirium is a disturbance in cognitive function that is characterized by impaired attention and is associated with an altered level of consciousness and a fluctuating course. Contrary to coma, during delirium, elements of arousal and awareness are retained.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of delirium in the intensive care unit: An observational study

Gravante¹,

Giannarelli²,

Pucci

et al. 2020

Nursing in Critical Care

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Background: Several risk factors, such as age, alcohol abuse, dementia, and severe illness, can contribute to the development of delirium. However, limited information is available in the literature regarding the risk of delirium among surgical, trauma, neurological, and medical intensive care patients.Aim: To describe the prevalence of risk factors associated with delirium in intensive care units.Design: This study used an observational design.Methods: We enrolled 165 patients hospitalized in two intensive care units in Italy.Patients were first evaluated using the Prediction of Delirium model and were subsequently evaluated using the Intensive Care Delirium Screening Checklist; evaluation lasted a maximum of 5 days for each admitted patient after sedation. A logistic regression model was used to identify the prevalence and risk factors of delirium. Results:The average age of the patients was 57.6 (SD = 18.3) years, and the patients were predominantly male (65.0%). The majority of patients had been subjected to trauma (38.8%); 37.6% had undergone general surgical interventions, and 23.6% had undergone medical interventions. Delirium occurred in 55.8% of the 165 patients.The risk of delirium was independently associated with coma (odds ratio = 10.6; 95% confidence interval, 3.08-39.9) and the Acute Physiology and Chronic Health Evaluation II score (odds ratio = 4.27; 95% confidence interval, 1.58-11.53). Conclusions: This study confirmed that coma and the Acute Physiology and ChronicHealth Evaluation II score were non-modifiable risk factors for delirium. Further studies could categorize the different types of coma. Proper delirium management could limit the impact on the recovery of these patients, their autonomy, and their reintegration into the social and professional world.Relevance to clinical practice: Delirium increases intensive care unit and hospital length of stay. Early identification and risk factor assessment by critical care nurses are considered the key factors in the treatment of delirium.

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Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of delirium in the intensive care unit: An observational study

Gravante¹,

Giannarelli²,

Pucci

et al. 2020

Nursing in Critical Care

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“…Previous studies mostly report on delirium in hospitalized older people, where prevalence estimates vary between 15% and 24% Marcantonio et al 2003;Ouimet et al 2007). Reported rates of incidence of delirium among older people admitted to hospitals range from 5% to 35% Ouimet et al 2007;Rabinowitz et al 2003). Dosa et al reported between 16% and 23% of possible cases of delirium in a subgroup of post-acute hospitalized older patients discharged to nursing homes depending on the diagnostic criteria used (Dosa et al 2007).…”

Section: Introductionmentioning

confidence: 99%

The prevalence, incidence and risk factors for delirium in Dutch nursing homes and residential care homes

Boorsma

Joling

Frijters

et al. 2011

Int J Geriat Psychiatry

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“…The mental health research in long-term care with the LTCF and HC includes depression (193), bipolar disorder (194,195), suicidal behaviors (196,197), traumatic brain injury (198)(199)(200), delirium (201,202), aggressive behavior (203)(204)(205), and cognitive impairment (206)(207)(208)(209)(210).…”

Section: Home Care and Nursing Homesmentioning

confidence: 99%

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

et al. 2020

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The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection

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Delirium: pathophysiology, recognition, prevention and treatment

Cited by 11 publications

References 80 publications

Prevalence and risk factors of delirium in the intensive care unit: An observational study

Prevalence and risk factors of delirium in the intensive care unit: An observational study

The prevalence, incidence and risk factors for delirium in Dutch nursing homes and residential care homes

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

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