Delirium Bibliography

The searchable delirium bibliography page is one of our most popular features, allowing you to quickly gain access to the literature on delirium and acute care of older persons.  The HELP team keeps it updated for you on a monthly basis!  Feel free to search by author, title, keywords. It is primarily intended for clinicians and researchers interested in exploring these topics.

Each article is indexed by keywords taken from MEDLINE and other relevant databases.

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Please note that Pub Med Central (PMC) full text links are provided wherever available.  However, due to copyright restrictions, only abstracts can be provided for articles not available in PMC.

Total Results: 2405

  • Incidence of delirium after cardiac surgery: protocol for the DELIRIUM-CS Canada cross-sectional cohort study. 2017 DELIRIUM-CS Investigators, Canadian Cardiovascular Critical Care Society Investigator Group and the Canadian Critical Care Trials Group. CMAJ Open, 5:3
    • Title

      Incidence of delirium after cardiac surgery: protocol for the DELIRIUM-CS Canada cross-sectional cohort study.

    • Authors
      DELIRIUM-CS Investigators, Canadian Cardiovascular Critical Care Society Investigator Group and the Canadian Critical Care Trials Group
    • Year
      2017
    • Journal
      CMAJ Open
    • URL
    • Abstract
      BACKGROUND: Delirium is a recognized complication of cardiac surgery and is the focus of increasing attention owing to its negative effect on postoperative outcomes. However, little is known about the actual incidence of delirium following cardiac surgery, with published rates ranging widely, from 3%-78%. We describe the protocol for the DELIRIUM-CS Canada study, which will use validated and easily implementable bedside tools to determine the incidence of postoperative delirium in a contemporary cardiac surgery population. We hypothesize that delirium, identified through a systematic and standardized screening protocol, is a highly prevalent, though variable, condition following cardiac surgery. METHODS: The DELIRIUM-CS Canada study is a multicentre cross-sectional cohort study. Over a 3-month period, all patients undergoing major cardiac surgical procedures at 10 participating centres will be screened for postoperative delirium by means of the Intensive Care Delirium Screening Checklist or the Confusion Assessment Method for the Intensive Care Unit. Delirium screening will be conducted for 7 days following the date of surgery or until the initial discharge from the intensive care unit. In addition to reporting an overall rate of delirium, we will report unadjusted and adjusted incidence rates of delirium by institution and for the entire cohort. Risk adjustment will be performed with the use of multivariate regression modelling techniques. INTERPRETATION: The results of this study will provide valuable insight into the true burden of delirium among patients having undergone a major cardiac surgical procedure in the current era. This is the first step in creating a multifaceted delirium prevention/treatment clinical pathway for patients undergoing cardiac surgery. Trial registration: ClinicalTrials.gov, no. NCT02206880.
    • PubMed ID
  • Preoperative C-Reactive Protein as a Risk Factor for Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Surgery for Colon Carcinoma. 2017 Xiang, Dong Xing, Hailin Tai, Huiyu Xie, Guozhu. BioMed Research International, (1-6)
    • Title

      Preoperative C-Reactive Protein as a Risk Factor for Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Surgery for Colon Carcinoma.

    • Authors
      Xiang, Dong Xing, Hailin Tai, Huiyu Xie, Guozhu
    • Year
      2017
    • Journal
      BioMed Research International
    • URL
    • Abstract
      Background. Postoperative delirium (POD) is a very common complication in operative disciplines, especially in those elderly patients after cardiac surgery. This study aimed to investigate the relationship between C-reactive protein (CRP) and POD in elderly patients undergoing laparoscopic surgery for colon carcinoma. Methods. 160 elderly patients scheduled to undergo selective laparoscopic surgery for colon carcinoma were prospectively recruited in this present study. The preoperative demographic and medical characteristics, intraoperative variables, and postoperative complications were all recorded in detail. POD assessment was performed once a day for the first 3 days and at 7th day after surgery, respectively. CRP concentrations preoperatively and on postoperative days 1, 2, and 3 were measured by using human enzyme linked immunosorbent assay (ELISA). Results. Of all the 160 enrolled patients, 39 had suffered POD with a POD incidence of 24.4% within the first week after the operation. The univariate analysis and multiple logistic regression analysis suggested preoperative CRP concentrations as the only independent predicator for POD in patients undergoing laparoscopic surgery for colon carcinoma (OR: 5.87; 95% CI: 2.22–11.4; P=0.018). Conclusions. This present study highlighted the predictive role of preoperative CRP concentrations for POD in elderly patients undergoing laparoscopic surgery for colon carcinoma.
    • PubMed ID
  • Responding to Ten Common Delirium Misconceptions With Best Evidence: An Educational Review for Clinicians. 2017 Oldham, M. A. Flanagan, N. M. Khan, A. Boukrina, O. Marcantonio, E. R.. J Neuropsychiatry Clin Neurosci,
    • Title

      Responding to Ten Common Delirium Misconceptions With Best Evidence: An Educational Review for Clinicians.

    • Authors
      Oldham, M. A. Flanagan, N. M. Khan, A. Boukrina, O. Marcantonio, E. R.
    • Year
      2017
    • Journal
      J Neuropsychiatry Clin Neurosci
    • URL
    • Abstract
      Delirium (acute confusion) is a serious, common health condition, and it predicts poor outcomes, including greater rates of mortality, institutionalization, prolonged hospitalization, and cognitive impairment. Expedient diagnosis and management are critical to address modifiable delirium causes and improve both quality of care and outcomes. Moreover, more than a third of delirium is preventable. Despite the clear significance of delirium and our increasingly sophisticated understanding of the condition, the gap between evidence and practice persists. The authors provide an educational review of 10 prevalent misconceptions of delirium pertaining to recognition, etiology, natural history, and best management. The authors respond to each with best evidence. Several themes emerge, chief among which is that casual observation is seldom sufficient to detect delirium. Use of open-ended questions, regular neurocognitive testing, and validated delirium screening instruments will aid in accurately identifying cases of delirium. Delirium is typically multifactorial, with several physiological and/or pharmacological contributors. Because of its multidetermined nature and its relationship with cognitive vulnerability, delirium can persist for days to months after acute causes have resolved. Furthermore, patients often have long-term cognitive impairment after delirium rather than returning to their predelirium cognitive baseline. Finally, nonpharmacological management of delirium is first-line, both for prevention and treatment. Psychotropic drugs such as neuroleptics are not recommended for routine use in delirium. They are best reserved for treating dangerous or distressing symptoms, including severe agitation, psychosis, or emotional lability. Challenging these 10 misconceptions stands to improve patient care, quality of life, and clinical outcomes substantially.
    • PubMed ID
  • The network model of delirium. 2017 Young, J. W. S.. Med Hypotheses, (80-85)
    • Title

      The network model of delirium.

    • Authors
      Young, J. W. S.
    • Year
      2017
    • Journal
      Med Hypotheses
    • URL
    • Abstract
      The coordinated function of brain networks underlies consciousness, attention and reality testing, all of which are impaired in delirium. The default-mode network, salience network, frontoparietal control network and dorsal attention network are brain networks with integral roles in the maintenance and modulation of the aforementioned functions. Multiple lines of evidence point to their dysfunction in delirium. The convergence of neurotransmitter changes, neuroendocrine and inflammatory stressors on brain networks disrupts bottom-up and top-down attentional control. Neuroimaging and neuroanatomy correlates are potentially consistent with this hypothesis. Overall, this model appears to have significant utility in connecting the seemingly disparate precipitants of delirium while accounting for the clinical manifestations of the syndrome.
    • PubMed ID
  • Aging and Post-Intensive Care Syndrome: A Critical Need for Geriatric Psychiatry. 2017 Wang, S. Allen, D. Kheir, Y. N. Campbell, N. Khan, B.. Am J Geriatr Psychiatry,
    • Title

      Aging and Post-Intensive Care Syndrome: A Critical Need for Geriatric Psychiatry.

    • Authors
      Wang, S. Allen, D. Kheir, Y. N. Campbell, N. Khan, B.
    • Year
      2017
    • Journal
      Am J Geriatr Psychiatry
    • URL
    • Abstract
      Because of the aging of the intensive care unit (ICU) population and an improvement in survival rates after ICU hospitalization, an increasing number of older adults are suffering from long-term impairments because of critical illness, known as post-intensive care syndrome (PICS). This article focuses on PICS-related cognitive, psychological, and physical impairments and the impact of ICU hospitalization on families and caregivers. The authors also describe innovative models of care for PICS and what roles geriatric psychiatrists could play in the future of this rapidly growing population.
    • PubMed ID
  • Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study. 2017 Tiruvoipati, R. Botha, J. Fletcher, J. Gangopadhyay, H. Majumdar, M. Vij, S. Paul, E. Pilcher, D.. PLoS One, 12:7
    • Title

      Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study.

    • Authors
      Tiruvoipati, R. Botha, J. Fletcher, J. Gangopadhyay, H. Majumdar, M. Vij, S. Paul, E. Pilcher, D.
    • Year
      2017
    • Journal
      PLoS One
    • URL
    • Abstract
      BACKGROUND: Some patients experience a delayed discharge from the intensive care unit (ICU) where the intended and actual discharge times do not coincide. The clinical implications of this remain unclear. OBJECTIVE: To determine the incidence and duration of delayed ICU discharge, identify the reasons for delay and evaluate the clinical consequences. METHODS: Prospective multi-centre observational study involving five ICUs over a 3-month period. Delay in discharge was defined as >6 hours from the planned discharge time. The primary outcome measure was hospital length stay after ICU discharge decision. Secondary outcome measures included ICU discharge after-hours, incidence of delirium, survival to hospital discharge, discharge destination, the incidence of ICU acquired infections, revocation of ICU discharge decision, unplanned readmissions to ICU within 72 hours, review of patients admitting team after ICU discharge decision. RESULTS: A total of 955 out of 1118 patients discharged were included in analysis. 49.9% of the patients discharge was delayed. The most common reason (74%) for delay in discharge was non-availability of ward bed. The median duration of the delay was 24 hours. On univariable analysis, the duration of hospital stay from the time of ICU discharge decision was significantly higher in patients who had ICU discharge delay (Median days-5 vs 6; p = 0.003). After-hours discharge was higher in patients whose discharge was delayed (34% Vs 10%; p<0.001). There was no statistically significant difference in the other secondary outcomes analysed. Multivariable analysis adjusting for known confounders revealed delayed ICU discharge was independently associated with increased hospital length of stay. CONCLUSION: Half of all ICU patients experienced a delay in ICU discharge. Delayed discharge was associated with increased hospital length of stay.
    • PubMed ID
  • How can we identify patients with delirium in the emergency department?: A review of available screening and diagnostic tools. 2017 Tamune, H. Yasugi, D.. Am J Emerg Med, 35:9 (1332-4)
    • Title

      How can we identify patients with delirium in the emergency department?: A review of available screening and diagnostic tools.

    • Authors
      Tamune, H. Yasugi, D.
    • Year
      2017
    • Journal
      Am J Emerg Med
    • URL
    • Abstract
      Delirium is a widespread and serious but under-recognized problem. Increasing evidence argues that emergency health care providers need to assess the mental status of the patient as the "sixth vital sign". A simple, sensitive, time-efficient, and cost-effective tool is needed to identify delirium in patients in the emergency department (ED); however, a stand-alone measurement has not yet been established despite previous studies partly because the differential diagnosis of dementia and delirium superimposed on dementia (DSD) is too difficult to achieve using a single indicator. To fill up the gap, multiple aspects of a case should be assessed including inattention and arousal. For instance, we proposed the 100 countdown test as an effective means of detecting inattention. Further dedicated studies are warranted to shed light on the pathophysiology and better management of dementia, delirium and/or "altered mental status". We reviewed herein the clinical questions and controversies concerning delirium in an ED setting.
    • PubMed ID
  • Symptom profile as assessed on delirium rating scale-revised-98 of delirium in respiratory intensive care unit: A study from India. 2017 Sharma, A. Malhotra, S. Grover, S. Jindal, S. K.. Lung India, 34:5 (434-40)
    • Title

      Symptom profile as assessed on delirium rating scale-revised-98 of delirium in respiratory intensive care unit: A study from India.

    • Authors
      Sharma, A. Malhotra, S. Grover, S. Jindal, S. K.
    • Year
      2017
    • Journal
      Lung India
    • URL
    • Abstract
      AIM: This study aimed to evaluate the phenomenology of delirium in patients admitted in a Respiratory Intensive Care Unit (RICU). METHODS: Consecutive patients admitted to RICU were screened for delirium using Richmond Agitation-Sedation Scale (RASS), Confusion Assessment Method for ICU (CAM-ICU) assessment tool and those found positive for delirium were evaluated by a psychiatrist to confirm the diagnosis. Those with a diagnosis of delirium as per the psychiatrist were evaluated on Delirium Rating Scale-Revised-98 (DRS-R-98) to study phenomenology. RESULTS: All the 75 patients fulfilled the criteria of "acute onset of symptoms" and "presence of an underlying physical disorder" as per the DRS-R-98. Commonly seen symptoms of delirium included disturbances in attention (100%), thought process abnormality (100%), fluctuation in symptoms (97.33%) disturbance in, sleep-wake cycle, language disturbance (94.7%), disorientation (81.33%), and short-term memory impairments (73.33%). No patient had delusions and very few (5.3%) reported perceptual disturbances. According to RASS subtyping, hypoactive delirium was the most common subtype (n = 34; 45.33%), followed by hyperactive subtype (n = 28; 37.33%) and a few patients had mixed subtype of delirium (n = 13; 17.33%). Factor structure of DRS-R-98 symptoms yielded 3 factors (Factor-1: cognitive factor; Factor-2: motoric factor; Factor-3; thought, language, and fluctuation factor). CONCLUSION: The phenomenology of delirium in ICU patients is similar to non-ICU patients, but hypoactive delirium is the most common subtype.
    • PubMed ID
  • Burst-suppression ratio underestimates absolute duration of electroencephalogram suppression compared with visual analysis of intraoperative electroencephalogram. 2017 Muhlhofer, W. G. Zak, R. Kamal, T. Rizvi, B. Sands, L. P. Yuan, M. Zhang, X. Leung, J. M.. Br J Anaesth, 118:5 (755-61)
    • Title

      Burst-suppression ratio underestimates absolute duration of electroencephalogram suppression compared with visual analysis of intraoperative electroencephalogram.

    • Authors
      Muhlhofer, W. G. Zak, R. Kamal, T. Rizvi, B. Sands, L. P. Yuan, M. Zhang, X. Leung, J. M.
    • Year
      2017
    • Journal
      Br J Anaesth
    • URL
    • Abstract
      Background: Machine-generated indices based on quantitative electroencephalography (EEG), such as the patient state index (PSI™) and burst-suppression ratio (BSR), are increasingly being used to monitor intraoperative depth of anaesthesia in the endeavour to improve postoperative neurological outcomes, such as postoperative delirium (POD). However, the accuracy of the BSR compared with direct visualization of the EEG trace with regard to the prediction of POD has not been evaluated previously.Methods: Forty-one consecutive patients undergoing non-cardiac, non-intracranial surgery with general anaesthesia wore a SedLine ® monitor during surgery and were assessed after surgery for the presence of delirium with the Confusion Assessment Method. The intraoperative EEG was scanned for absolute minutes of EEG suppression and correlated with the incidence of POD. The BSR and PSI™ were compared between patients with and without POD.Results: Visual analysis of the EEG by neurologists and the SedLine ® -generated BSR provided a significantly different distribution of estimated minutes of EEG suppression ( P =0.037). The Sedline ® system markedly underestimated the amount of EEG suppression. The number of minutes of suppression assessed by visual analysis of the EEG was significantly associated with POD ( P =0.039), whereas the minutes based on the BSR generated by SedLine ® were not associated with POD ( P =0.275).Conclusions: Our findings suggest that SedLine ® (machine)-generated indices might underestimate the minutes of EEG suppression, thereby reducing the sensitivity for detecting patients at risk for POD. Thus, the monitoring of machine-generated BSR and PSI™ might benefit from the addition of a visual tracing of the EEG to achieve a more accurate and real-time guidance of anaesthesia depth monitoring and the ultimate goal, to reduce the risk of POD.
    • PubMed ID
  • Post-anaesthesia care unit delirium: incidence, risk factors and associated adverse outcomes. 2017 Hernandez, B. A. Lindroth, H. Rowley, P. Boncyk, C. Raz, A. Gaskell, A. Garcia, P. S. Sleigh, J. Sanders, R. D.. Br J Anaesth, 119:2 (288-90)
    • Title

      Post-anaesthesia care unit delirium: incidence, risk factors and associated adverse outcomes.

    • Authors
      Hernandez, B. A. Lindroth, H. Rowley, P. Boncyk, C. Raz, A. Gaskell, A. Garcia, P. S. Sleigh, J. Sanders, R. D.
    • Year
      2017
    • Journal
      Br J Anaesth
    • URL
    • Abstract
    • PubMed ID
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