ICU Architectural Design Affects the Delirium Prevalence

Caruso, Pedro; Guardian, Lilian; Tiengo, Tatiane; Santos, Lucio Souza dos; Medeiros, Paulo José de

doi:10.1097/ccm.0000000000000502

Cited by 48 publications

(22 citation statements)

References 27 publications

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“…All but one have used CAM-ICU and RASS for delirium detection and subtyping, respectively. HD prevalence rates were broadly ranged (36–100%) and the development of HD was associated with adverse short-term outcome in most studies [ 38 – 43 ]. Neurologic conditions were associated with HD in two studies [ 39 , 44 ].…”

Section: Hypoactive Delirium In Different Wardsmentioning

confidence: 99%

Recent Insights on Prevalence and Corelations of Hypoactive Delirium

Peritogiannis¹,

Bolosi

Lixouriotis³

et al. 2015

Behavioural Neurology

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Delirium is a complex neuropsychiatric syndrome which is common in all medical settings. It often goes unrecognized due to difficulties in the detection of its hypoactive variant. This review aims to provide an up-to-date account on recent research on hypoactive delirium (HD). Thirty-eight studies, which were conducted in various clinical settings, including the Intensive Care Unit (ICU), were included in this review. Those studies involved recent research that has been published during the last 6 years. Prevalence of HD was found to vary considerably among different settings. HD seems to be more common in critically ill patients and less common in patients examined by consultation-liaison psychiatric services and in mixed patient populations. The presence of HD in ICU patients was associated with higher short- and long-term mortality and other adverse outcomes, but no such association was reported in other settings. Research on other possible associations of HD with clinical variables and on symptom presentation yielded inconclusive results, although there is some evidence for a possible association of HD with benzodiazepine use. There are several methodological issues that need to be addressed by future research. Future studies should examine HD in the primary care setting; treatment interventions should also be the objective of future research.

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Section: Hypoactive Delirium In Different Wardsmentioning

confidence: 99%

Recent Insights on Prevalence and Corelations of Hypoactive Delirium

Peritogiannis¹,

Bolosi

Lixouriotis³

et al. 2015

Behavioural Neurology

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“…The deprivation of exposure to natural light and exposure to artificial light have been related to changes in the circadian rhythm, sleep disorders, and delirium . ( 3 , 12 ) However, Khon et al found no effect of the presence of windows and exposure to sunlight on outcomes in critically ill patients. ( 13 ) Measures such as exposure to natural light, maintenance of the circadian rhythm, and minimization of artificial light exposure at night are part of a bundle for promoting sleep, with satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

Practices for promoting sleep in intensive care units in Brazil: a national survey

Ramos

Taniguchi

Azevedo

2020

Revista Brasileira De Terapia Intensiva

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Objective To conduct a national survey of intensive care professionals to identify the practices for promoting sleep in adult intensive care units in Brazil and describe the professionals’ perceptions of the importance of sleep for patients. Methods An electronic questionnaire was distributed by the clinical research cooperation network of the Associação de Medicina Intensiva Brasileira and by the Brazilian Research in Intensive Care Network to physicians and nurses registered with the association. The questionnaire evaluated the profile of the respondents, the profile of their intensive care units, whether protocols for promoting sleep were present, the pharmacological and nonpharmacological measures typically employed in the unit, and the professionals’ perceptions regarding sleep in critically ill patients. Results A total of 118 questionnaires were evaluated. The Southeast region of the country was the most represented (50 questionnaires, 42.4%). The majority of units had a clinical-surgical profile (93 questionnaires; 78.8%), and 26 had a continuous visitation policy (22.0%). Only 18 intensive care units (15.3%) reported having protocols for promoting sleep. The most cited measure for sleep promotion was reducing light during the night (95 questionnaires; 80.5%), which was more often performed in private intensive care units. Almost all of the responders (99%) believed that poor-quality sleep has a negative impact on patient recovery. Conclusion The responses to this Brazilian survey revealed that few intensive care units had a program for promoting sleep, although almost all participants recognized the importance of sleep in patient recovery.

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“…Previous studies have described how sleep deprivation can trigger episodes of delirium in ICU patients. 26 55 Admittance to individual rooms, 62 and the application of protocols targeted towards eliminating sleep disruptors are effective interventions for avoiding delirium. 55 The role of nursing staff is fundamental, as some of the activities (changing bed linen, manipulation of venous catheters, the administration of medications, taking vital signs) are great sleep disruptors.…”

Section: Discussionmentioning

confidence: 99%

How do doctors and nurses manage delirium in intensive care units? A qualitative study using focus groups

et al. 2016

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ObjectivesThe aim of this study was to explore the experiences of doctors and nurses caring for patients with delirium in the intensive care unit (ICU) and to describe the process of delirium management.SettingThis study was performed in 5 ICUs located within 4 hospitals in Madrid (Spain).ParticipantsPurposeful sampling was performed which included (1) doctors and nurses working in ICUs, (2) with >1 year experience in the ICU and (3) clinical experience with delirium. 38 professionals participated (19 doctors, 19 nurses), including 22 women and 16 men. The total mean age was 39 years.DesignA qualitative study using focus groups.Methods7 focus groups were held to collect data: 3 nurse focus groups, 3 doctor focus groups and 1 mixed focus group. Each group comprised 6–10 participants. A semistructured questions guide was used. Thematic analysis methods were used to analyse the data.Results3 themes were identified: (1) the professional perspective on delirium; (2) implementing pharmacological and non-pharmacological treatment for delirium and (3) work organisation in the ICU. The professionals regarded patients with delirium with uncertainty, and felt they were often underdiagnosed and poorly managed. Doctors displayed discrepancies regarding pharmacological prescriptions and decision-making. The choice of medication was determined by experience. Nurses felt that, for many doctors, delirium was not considered a matter of urgency in the ICU. Nurses encountered difficulties when applying verbal restraint, managing sleep disorders and providing early mobilisation. The lack of a delirium protocol generates conflicts regarding what type of care management to apply, especially during the night shift. A degree of group pressure exists which, in turn, influences the decision-making process and patient care.ConclusionsPatients with delirium represent complex cases, requiring the implementation of specific protocols. These results serve to improve the process of care in patients with delirium.

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ICU Architectural Design Affects the Delirium Prevalence

Abstract: Critically ill patients admitted in single-bed rooms have a lower prevalence of delirium than those admitted in multibed rooms. However, coma/delirium-free days, first day in delirium, and motoric subtypes were not different.

Cited by 48 publications

References 27 publications

Recent Insights on Prevalence and Corelations of Hypoactive Delirium

Recent Insights on Prevalence and Corelations of Hypoactive Delirium

Practices for promoting sleep in intensive care units in Brazil: a national survey

How do doctors and nurses manage delirium in intensive care units? A qualitative study using focus groups

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