The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients

Abstract

Delirium in the surgical/trauma ICU cohort is independently associated with more days requiring MV, longer ICU length of stay, and longer hospital length of stay. Additionally, greater amounts of lorazepam and fentanyl were administered to patients with delirium.

Impact of a Delirium Screening Tool and Multifaceted Education on Nurses’ Knowledge of Delirium and Ability to Evaluate It Correctly

“…The low rate of delirium detected in our study (13%, 12 of 90 assessments) deserves mention because it is substantially lower than the rate detected in other STICU studies. 2,3,4,8,18 This can be explained, in part, by our use of a screening tool (ie, the ICDSC) that has a lower reported sensitivity than the tool used in other published studies (ie, CAM-ICU) and our inclusion of patients with conditions where delirium cannot be evaluated (eg, severe traumatic brain injury). 39 Additionally, we did not have a requirement for mechanical ventilation and thus, unlike other studies in this population, our patients may have had a lower baseline risk for delirium.…”

“…[1][2][3][4] Given that delirium is associated with increased mortality, a longer duration of mechanical ventilation, and the potential for serious sequelae after leaving the ICU (eg, dementia and prolonged neuropsychological impairment), current practice guidelines recommend that patients be routinely screened by using a validated delirium screening tool such as the Intensive Care Delirium Screening Checklist (ICDSC). [5][6][7][8][9][10][11][12][13][14][15][16] However, despite an increasing awareness among ICU clinicians regarding the sequelae of delirium and the ever-increasing use of protocols for delirium screening efforts in ICUs, most patients admitted to ICUs are not routinely screened for delirium. [17][18][19][20][21][22][23] Common barriers to delirium screening with a validated tool reported by clinicians include the perceptions that the tool takes too long to complete, that use of a tool does not enhance clinicians' ability to recognize delirium, and that assessment tools are too complex to use.…”

“…[24][25][26][27] Pharmacists play a key role in optimizing the care of patients in the ICU and may be well suited to spearhead ICU delirium detection and education efforts, given pharmacists' daily presence in the ICU, their experience in optimizing sedation therapy, and their involvement with delirium recognition and prevention efforts. 8,17,23,28 Although a number of reports describe delirium screening efforts in medical or mixed medical-surgical ICUs, few studies have described the implementation of delirium screening efforts in STICUs. 17,18,[24][25][26][27]29,30 Furthermore, although results of studies on the impact of using a validated delirium screening tool, accompanied by education surrounding its use, on the ability of ICU nurses to recognize delirium have been published, the relative impact of each of these interventions on the knowledge of nurses about delirium and their ability to evaluate delirium remains unknown.…”

Screening and Management of Delirium in Critically Ill Patients

“…5,6,14,26 The pain, agitation, and delirium guidelines state that benzodiazepine use may be a risk factor for delirium development. 10 It is prudent to avoid administering benzodiazepines as first-line sedatives or in excessively high doses to critically ill patients due to the potential delirious effects of these medications.…”

“…2,[4][5][6][7][8] Unfortunately, the pathophysiology of this syndrome is not well understood. Proposed mechanisms for pathogenesis include neuroinflammation and neurotransmitter imbalances.…”