Effects of routine monitoring of delirium in a surgical/trauma intensive care unit

Bigatello, Luca M.; Amirfarzan, Houman; Haghighi, Asieh Kazem; Newhouse, Beverly; Rio, J. Mauricio Del; Allen, Kathrin; Chang, Anne; Schmidt, Ulrich; Razavi, Moaven

doi:10.1097/ta.0b013e31827e1b69

Cited by 39 publications

(21 citation statements)

References 32 publications

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“…In a similar study among general ICU patients, Skrobik et al 18 reported that, although the use of nonpharmacologic care strategies along with protocolized titration of analgesics, sedatives, and antipsychotic medications did not reduce rates of delirium, 30-day mortality, hospital LOS, and dependency at discharge all improved. On the other hand, Bigatello et al 19 found that early delirium recognition had no impact on the duration of delirium, mechanical ventilation, or ICU stay in a trauma/surgical critical care cohort.…”

Section: Discussionmentioning

confidence: 97%

Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit

Pauley¹,

Lishmanov²,

Schumann³

et al. 2015

American Heart Journal

102

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Section: Discussionmentioning

confidence: 97%

Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit

Pauley¹,

Lishmanov²,

Schumann³

et al. 2015

American Heart Journal

102

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“…Education regarding delirium before implementing a screening program may be effective in preventing delirium. 32,34 Use of validated assessment tools for pain, agitation, and delirium in conjunction with delirium-prevention strategies is Of the trauma intermediate care unit patients, 11% screened positive for delirium, and mechanical ventilation was not in use in any of those patients.…”

Section: Discussionmentioning

confidence: 99%

Delirium in Trauma Patients: Prevalence and Predictors

Rueden

Wallizer

Thurman

et al. 2017

Critical Care Nurse

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BACKGROUND Delirium is associated with increased mortality, morbidity, hospital costs, and postdischarge cognitive dysfunction. Most research focuses on nontrauma patients receiving mechanical ventilation in the intensive care unit. OBJECTIVES To determine the prevalence and predictors of delirium in trauma patients residing in intensive and intermediate care units of an academic medical center. METHODS Trauma patients were screened for delirium by using the Confusion Assessment Method for the Intensive Care Unit. Exclusion criteria included documented brain injury, history of psychosis or cognitive impairment, not speaking English, and hearing or vision loss. RESULTS Of the 215 study patients, 24% were positive for delirium; 36% of patients in the intensive care unit and 11% of patients in the intermediate care unit. Delirium-positive patients were older (mean age, 53.4 years) than patients who were not (mean age, 44 years; P = .004). Although mechanical ventilation (odds ratio, 4.73, P = .004) was the strongest independent risk factor for delirium, 12% of delirium-positive patients were not receiving mechanical ventilation. Other predictors of delirium were use of antipsychotic medications, higher scores on the Acute Physiology and Chronic Health Evaluation III, and lower scores on the Richmond Agitation-Sedation Scale. CONCLUSIONS Patients in both the intermediate and intensive care units, whether mechanical ventilation was used or not, were positive for delirium. Delirium prevention protocols may benefit trauma patients regardless of their inpatient location. (Critical Care Nurse. 2017;37[1]:40-48)

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“…For example, we did not use the Confusion Assessment Method to make the diagnosis of delirium, although current evidence suggests this is a preferable assessment method. 29,30 Third, only HU rooms were equipped with cameras for continuous telemedicine surveillance, and we cannot be certain that telemedicine interventions in HU patients did not contribute to reduced complications. Fourth, the database could not identify patients admitted to a boarding unit who were subsequently transferred to the HU for the remainder of their ICU stay.…”

Section: Discussionmentioning

confidence: 99%

There’s no place like home

Pascual

Blank

Holena

et al. 2014

Journal of Trauma and Acute Care Surgery

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BACKGROUND Intensive care units (ICUs) function frequently at capacity, requiring incoming critically ill patients to be placed in alternate geographically distinct ICUs. In some medical ICU populations, “boarding” in an overflow ICU has been associated with increased mortality. We hypothesized that surgical ICU patients experience more complications when boarding in an overflow ICU and that the frequency of these complications are greatest in boarders farthest from the home unit (HU). METHODS A 5-year (June 2005 to June 2010) retrospective review of a prospectively maintained ICU database was performed, and demographics, severity of illness, length of stay, and incidence of ICU complications were extracted. Distances between boarding patients’ rooms and the HU were measured. Complications occurring in patients located in the same floor (BUSF) and different floor (BUDF) boarding units were compared and stratified by distance from HU to the patient room. Logistic regression was used to develop control for known confounders. RESULTS A total of 7,793 patients were admitted to the HU and 833 to a boarding unit (BUSF, n = 712; BUDF, n = 121). Boarders were younger, had a lower length of stay, and Acute Physiology and Chronic Health Evaluation II and were more of tentrauma/emergency surgery patients. Compared with in-HU patients, the incidence of aspiration pneumonia (2.2% vs. 3.6%, p < 0.01) was greater in BUSF patients and highest in those farthest from the HU (odds ratio [OR],2.39;p =0.01). Delirium occurred less often in HU than in BUDF patients (3.3% vs. 8.3 %, p < 0.01), and both delirium (OR, 6.09, p < 0.01) and ventilator-associated pneumonia (OR, 4.49, p < 0.05) were more frequent in patients farther from the HU. CONCLUSION Certain ICU complications occur more frequently in boarding patients particularly if they are located on a different floor or far from the HU. When surgical ICU bed availability forces overflow admissions to non–home ICUs, greater interdisciplinary awareness, education, and training may be needed to ensure equivalent care and outcomes. LEVEL OF EVIDENCE Epidemiologic study, level III. Therapeutic study, level IV.

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Effects of routine monitoring of delirium in a surgical/trauma intensive care unit

Abstract: Therapeutic study, level IV.

Cited by 39 publications

References 32 publications

Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit

Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit

Delirium in Trauma Patients: Prevalence and Predictors

There’s no place like home

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