The intensive care delirium research agenda: a multinational, interprofessional perspective

Abstract

Delirium, a prevalent organ dysfunctions in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically, to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy and the neurosciences, sought to address five questions: What is the current standard of care in managing ICU delirium?What have been the major recent advances in delirium research and care?What are the common delirium beliefs that have been challenged by recent trials?What are the remaining areas of uncertainty in delirium research?What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium; identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda.

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

“…Delirium can be disturbing for affected patients and relatives and is associated with worse outcome, and much higher ICU and hospital LOS and costs (276). Many research gaps exist in this area (277). In this guideline, we address six actionable questions and five descriptive questions (see prioritized topic list in Supplemental…”

Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta‐analysis

“…This surgical complication is characterized by a transient global disturbance in attention, consciousness and cognition 1 . POD has been associated with increased morbidity and mortality, prolonged hospital stay and additional healthcare expenses 2,3 . While POD has been reported to affect 11%‐51% of surgical patients, 4 its pathophysiology has not been fully understood.…”

Agents intervening against delirium in the intensive care unit (AID‐ICU) – Protocol for a randomised placebo‐controlled trial of haloperidol in patients with delirium in the ICU

“…In ICU, delirium research core outcome sets (COS) have been called upon, but at the moment none exist . Outcome measures in ICU delirium research are challenged by the fluctuating delirium status over time, the inability to screen comatose patients, the discontinued delirium assessment after ICU discharge and a high mortality in ICU patients.…”

“…A composite outcome of death and delirium status — “delirium‐free days” has been used in previous studies, however this measure does not address the status of coma. This has led to another prevalent outcome measure “delirium and coma free days.” Other outcome measures encountered in ICU delirium research include ICU or hospital LOS, days on mechanical ventilation, delirium resolution and mortality …”