Interventions for preventing delirium in hospitalised patients

Siddiqi, Najma; Stockdale, Rachel; Holmes, John; Britton, AM

doi:10.1002/14651858.cd005563

Cited by 66 publications

(86 citation statements)

References 29 publications

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“…6 Variability in the frequency of clinical assessment is a factor that makes comparison of prevalence rates across studies difficult in delirium research. 61 Regardless, these numbers are disturbing because clinical guidelines for the routine postoperative care of patients after colorectal surgery rarely include regular assessment for delirium in the early stage of recovery or subsequently. Therefore, patients may not be receiving the most safe and suitable care necessary.…”

Section: No (%)mentioning

confidence: 99%

Postoperative Delirium After Colorectal Surgery in Older Patients

Mangnall¹,

Gallagher²,

Stein‐Parbury³

2010

American Journal of Critical Care

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Background Postoperative delirium in older patients results in worse outcomes and increased costs. The prevalence and predictors of postoperative delirium in patients undergoing major colorectal surgery are not clear. Objectives To determine the prevalence and predictors of postoperative delirium in older patients after major colorectal surgery. Methods Patients older than 50 years, without preexisting cognitive impairment, were recruited before surgery. These patients were assessed after surgery for delirium daily for 3 days by using the Confusion Assessment Method. Regression analysis was used to determine independent predictors of postoperative delirium. Results Patients (n = 118) had a mean age of 71.81 years, and approximately half were women (54%). Most participants (64%) were married, and comorbid conditions were common. Delirium developed in 35% of the patients in the 3 days after surgery and in 21% in the first 24 hours. New cases of delirium were identified on each of the 3 days after surgery, and a few patients (7%) had delirium for the entire 3 days. Odds for delirium in the first 24 hours were increased for patients who had early admission (odds ratio [OR] = 4.48; P = .06) and decreased for patients who were married (OR = 0.25; P = .01). Odds for delirium in the first 3 days after surgery were increased for men (OR = 4.27; P = .02), older patients (OR = 1.05; P = .04), and patients who stayed overnight in the critical care unit (OR = 2.97; P = .06). Conclusions Postoperative delirium is common and persistent in older patients in the first 3 days after colorectal surgery.

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Section: No (%)mentioning

confidence: 99%

Postoperative Delirium After Colorectal Surgery in Older Patients

Mangnall¹,

Gallagher²,

Stein‐Parbury³

2010

American Journal of Critical Care

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“…El delirium puede ser reversible hasta en el 50% de los (1) casos, y su tratamiento de fondo consiste en tratar su etiología de base . (27,28,29) Entre las intervenciones no farmacológicas se incluyen las siguientes : (6,28,29) Recomendaciones generales · Revisar medicación del paciente a fin de minimizar la exposición a fármacos asociados a delirium (véase tabla 1). Asegurar que todas las dosis son apropiadas.…”

Section: Tratamientounclassified

Delirium: an update for internists and psychiatrists

Torales

Barrios

Armoa

2017

Rev. virtual Soc. Parag. Med. Int

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RESUMENA lo largo del tiempo, al delirium se lo ha conocido por diversos nombres: falla cerebral aguda, síndrome cerebral orgánico agudo, síndrome confusional o psicosis postquirúrgica. No obstante, el término preferido en la actualidad es delirium (de latín delirare, que significa "arar fuera del surco"). El delirium, como síndrome, es un conjunto de signos y síntomas de inicio agudo caracterizado por deterioro cognitivo fluctuante, con enturbiamiento de la conciencia y capacidad disminuida de mantener y cambiar la atención de un punto a otro.Numerosos estudios han demostrado que los pacientes que desarrollan delirium tienen un riesgo aumentado de resultados adversos tanto durante la hospitalización como tras el alta. Este riesgo es independiente de cualquier comorbilidad existente, de la severidad de la enfermedad, la edad u otras variables asociadas. Asimismo, el delirium está asociado a un incremento en la mortalidad, aumento del tiempo de hospitalización y desarrollo de disfunciones cognitivas posteriores al alta.Este artículo de revisión presenta una actualización acerca de la fisiopatología del delirium, de las herramientas de reconocimiento del cuadro y de su tratamiento. Todas estas informaciones resultan útiles en el manejo diario de este tipo de pacientes, tanto por médicos internistas como por médicos psiquiatras. Palabras claves:ABSTRACT Over time, delirium has been known by several names: acute brain failure, acute organic brain syndrome, confusional syndrome, or post-surgical psychosis. However, the currently preferred term is delirium (from the Latin term delirare, which means "to go out of the furrow"). Delirium, as a syndrome, is a set of signs and symptoms of acute onset characterized by fluctuating cognitive impairment, clouding of consciousness and diminished ability to maintain and shift attention from one point to another. Numerous studies have shown that patients who develop delirium have an increased risk of adverse outcomes both during hospitalization and after discharge. This risk is independent of any existing comorbidity, severity of disease, age or other associated variables. Likewise, delirium is associated with an increase in mortality, delirio, trastornos neurocognitivos, síndrome confusional, delirio -fisiopatología, delirio -tratamiento farmacológico

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“…Factors that have been associated with an increased risk of postoperative delirium include advancing age, sensory deprivation (visual or hearing impairment), sleep deprivation, social isolation, physical restraint, use of bladder catheter, iatrogenic adverse events, polypharmacy, use of psychoactive drugs, comorbidities, severe illness (especially infection, fracture, or stroke), cognitive impairment, temperature abnormality (fever or hypothermia), dehydration, malnutrition, and low serum albumin [9].…”

Section: Current Research On Postoperative Deliriummentioning

confidence: 99%

Postoperative Cognitive Disorders

Price¹,

Tanner²,

Monk³

2011

Neuroscientific Foundations of Anesthesiology

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Purpose of review-The elderly are the fastest growing segment of the population and undergo 25-30% of all surgical procedures. Postoperative cognitive problems are common in older patients following major surgery. The socioeconomic implications of these cognitive disorders are profound; cognitive decline is associated with a loss of independence, a reduction in the quality of life, and death. This review will focus on the two most common cognitive problems following surgery: postoperative delirium and postoperative cognitive dysfunction (POCD).Recent findings-For years, preoperative geriatric consultation/screening was the only intervention proven to decrease postoperative delirium. There are, however, several recent publications indicating that preoperative and postoperative pharmacological and medical (hydration, oxygenation) management can reduce postoperative delirium. Spinal anesthesia with minimal propofol sedation has been shown to decrease the incidence of postoperative delirium in hip-fracture patients. Likewise, dexmedetomidine sedation in mechanically ventilated patients in the ICU is associated with less postoperative delirium and shorter ventilator times. Preoperative levels of education and brain function (cognitive reserve) may predict patients at risk for postoperative cognitive problems. Reduced white matter integrity is reported to place patients at a higher risk for both postoperative delirium and POCD.Summary-The etiology of postoperative cognitive problems is unknown, but there is emerging evidence that decreased preoperative cognitive function contributes to the development of postoperative delirium and POCD. There is growing concern that inhalation anesthetics may be neurotoxic to the aging brain, but there are no human data evaluating this hypothesis to date. Randomized controlled trials evaluating interventions to improve long-term cognitive outcomes in elderly patients are urgently needed.

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Interventions for preventing delirium in hospitalised patients

Cited by 66 publications

References 29 publications

Postoperative Delirium After Colorectal Surgery in Older Patients

Postoperative Delirium After Colorectal Surgery in Older Patients

Delirium: an update for internists and psychiatrists

Postoperative Cognitive Disorders

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