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.

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Total Results: 2619

  • Postoperative delirium, learning, and anesthetic neurotoxicity: Some perspectives and directions. 2018 Mutch, W. A. El-Gabalawy, R. M. Graham, M. R.. Frontiers in Neurology,
    • Title

      Postoperative delirium, learning, and anesthetic neurotoxicity: Some perspectives and directions.

    • Authors
      Mutch, W. A. El-Gabalawy, R. M. Graham, M. R.
    • Year
      2018
    • Journal
      Frontiers in Neurology
    • URL
    • Abstract
      Evidence of anesthetic neurotoxicity is unequivocal when studied in animal models. These findings have translated poorly to the clinical domain when equated to postoperative delirium (POD) in adults and postoperative cognitive dysfunction (POCD) in either children or the elderly. In this perspective, we examine various reasons for the differences between animal modeling of neurotoxicity and the clinical situation of POD and POCD and make suggestions as to potential directions for ongoing research. We hypothesize that the animal anesthetic neurotoxicity models are limited, in part, due to failed scaling correction of physiological time. We posit that important insights into POCD in children and adults may be gleaned from studies in adults examining alterations in perioperative management designed to limit POD. In this way, POD may be more useful as the proxy for POCD rather than neuronal dropout or behavioral abnormalities that have been used in animal models but which may not be proxies for the human condition. We argue that it is time to move beyond animal models of neurotoxicity to directly examine these problems in well-conducted clinical trials with comprehensive preoperative neuropsychometric and psychiatric testing, high fidelity intraoperative monitoring of physiological parameters during the anesthetic course and postoperative assessment of subthreshold and full classification of POD. In this manner, we can "model ourselves" to better understand these important and poorly understood conditions.
    • PubMed ID
  • Designing a nurse-delivered delirium bundle: What intensive care unit staff, survivors, and their families think? 2018 Bannon, L. McGaughey, J. Clarke, M. McAuley, D. F. Blackwood, B.. Aust Crit Care,
    • Title

      Designing a nurse-delivered delirium bundle: What intensive care unit staff, survivors, and their families think?

    • Authors
      Bannon, L. McGaughey, J. Clarke, M. McAuley, D. F. Blackwood, B.
    • Year
      2018
    • Journal
      Aust Crit Care
    • URL
    • Abstract
      BACKGROUND: Implementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation. OBJECTIVE: The objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation. METHODS: Nine focus group interviews were conducted with ICU staff (n = 68) in 12 UK ICUs. Three focus group interviews were conducted with ICU survivors (n = 12) and their family members (n = 2). Interviews were digitally recorded, transcribed, and thematically analysed using the Braun and Clarke framework. RESULTS: Overall, staff, survivors, and their families agreed the bundle was acceptable. Facilitating factors for delivering the bundle were staff and relatives' education about potential benefits and encouraging family presence. Facilitating factors for sedation minimisation were evening ward rounds, using non-verbal pain scores, and targeting sedation scores. Barriers identified by staff were inadequate resources, poor education, relatives' anxiety, safety concerns, and ICU culture. Concerns were raised about patient confidentiality when displaying orientation materials and managing resources for early mobility. Survivors cited that flexible visiting and re-establishing normality were important factors; and staff workload, lack of awareness, and poor communication were factors that needed to be considered before implementation. CONCLUSION: Generally, the bundle was deemed acceptable and deliverable. However, like any complex intervention, component adaptations will be required depending on resources available to the ICU; in particular, involvement of pharmacists in the ward round and physiotherapists in mobilising intubated patients.
    • PubMed ID
  • The 2014 updated version of the Confusion Assessment Method for the Intensive Care Unit compared to the 5th version of the Diagnostic and Statistical Manual of Mental Disorders and other current methods used by intensivists. 2018 Chanques, G. Ely, E. W. Garnier, O. Perrigault, F. Eloi, A. Carr, J. Rowan, C. M. Prades, A. de Jong, A. Moritz-Gasser, S. Molinari, N. Jaber, S.. Ann Intensive Care, 8:1 (33)
    • Title

      The 2014 updated version of the Confusion Assessment Method for the Intensive Care Unit compared to the 5th version of the Diagnostic and Statistical Manual of Mental Disorders and other current methods used by intensivists.

    • Authors
      Chanques, G. Ely, E. W. Garnier, O. Perrigault, F. Eloi, A. Carr, J. Rowan, C. M. Prades, A. de Jong, A. Moritz-Gasser, S. Molinari, N. Jaber, S.
    • Year
      2018
    • Journal
      Ann Intensive Care
    • URL
    • Abstract
      BACKGROUND: One third of patients admitted to an intensive care unit (ICU) will develop delirium. However, delirium is under-recognized by bedside clinicians without the use of delirium screening tools, such as the Intensive Care Delirium Screening Checklist (ICDSC) or the Confusion Assessment Method for the ICU (CAM-ICU). The CAM-ICU was updated in 2014 to improve its use by clinicians throughout the world. It has never been validated compared to the new reference standard, the Diagnostic and Statistical Manual of Mental Disorders 5th version (DSM-5). METHODS: We made a prospective psychometric study in a 16-bed medical-surgical ICU of a French academic hospital, to measure the diagnostic performance of the 2014 updated CAM-ICU compared to the DSM-5 as the reference standard. We included consecutive adult patients with a Richmond Agitation Sedation Scale (RASS) >/= -3, without preexisting cognitive disorders, psychosis or cerebral injury. Delirium was independently assessed by neuropsychological experts using an operationalized approach to DSM-5, by investigators using the CAM-ICU and the ICDSC, by bedside clinicians and by ICU patients. The sensitivity, specificity, positive and negative predictive values were calculated considering neuropsychologist DSM-5 assessments as the reference standard (primary endpoint). CAM-ICU inter-observer agreement, as well as that between delirium diagnosis methods and the reference standard, was summarized using kappa coefficients, which were subsequently compared using the Z-test. RESULTS: Delirium was diagnosed by experts in 38% of the 108 patients included for analysis. The CAM-ICU had a sensitivity of 83%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 91%. Compared to the reference standard, the CAM-ICU had a significantly (p < 0.05) higher agreement (kappa = 0.86 +/- 0.05) than the physicians,' residents' and nurses' diagnoses (kappa = 0.65 +/- 0.09; 0.63 +/- 0.09; 0.61 +/- 0.09, respectively), as well as the patient's own impression of feeling delirious (kappa = 0.02 +/- 0.11). Differences between the ICDSC (kappa = 0.69 +/- 0.07) and CAM-ICU were not significant (p = 0.054). The CAM-ICU demonstrated a high reliability for inter-observer agreement (kappa = 0.87 +/- 0.06). CONCLUSIONS: The 2014 updated version of the CAM-ICU is valid according to DSM-5 criteria and reliable regarding inter-observer agreement in a research setting. Delirium remains under-recognized by bedside clinicians.
    • PubMed ID
  • Effect of a 24-h extended visiting policy on delirium in critically ill patients. 2018 Westphal, G. A. Moerschberger, M. S. Vollmann, D. D. Inacio, A. C. Machado, M. C. Sperotto, G. Cavalcanti, A. B. Koenig, A.. Intensive Care Medicine,
    • Title

      Effect of a 24-h extended visiting policy on delirium in critically ill patients.

    • Authors
      Westphal, G. A. Moerschberger, M. S. Vollmann, D. D. Inacio, A. C. Machado, M. C. Sperotto, G. Cavalcanti, A. B. Koenig, A.
    • Year
      2018
    • Journal
      Intensive Care Medicine
    • URL
    • Abstract
    • PubMed ID
  • Effect of Sedation Regimen on Weaning from Mechanical Ventilation in the Intensive Care Unit. 2018 Nunes, S. L. Forsberg, S. Blomqvist, H. Berggren, L. Sorberg, M. Sarapohja, T. Wickerts, C. J.. Clin Drug Investig,
    • Title

      Effect of Sedation Regimen on Weaning from Mechanical Ventilation in the Intensive Care Unit.

    • Authors
      Nunes, S. L. Forsberg, S. Blomqvist, H. Berggren, L. Sorberg, M. Sarapohja, T. Wickerts, C. J.
    • Year
      2018
    • Journal
      Clin Drug Investig
    • URL
    • Abstract
      BACKGROUND: Intensive care unit patients undergoing mechanical ventilation have traditionally been sedated to make them comfortable and to avoid pain and anxiety. However, this may lead to prolonged mechanical ventilation and a longer length of stay. OBJECTIVE: The aim of this retrospective study was to explore whether different sedation regimens influence the course and duration of the weaning process. PATIENTS AND METHODS: Intubated adult patients (n = 152) from 15 general intensive care units in Sweden were mechanically ventilated for >/= 24 h. Patients were divided into three groups according to the sedative(s) received during the weaning period (i.e. from being assessed as 'fit for weaning' until extubation): dexmedetomidine alone (DEX group, n = 32); standard of care with midazolam and/or propofol (SOC group, n = 67); or SOC plus dexmedetomidine (SOCDEX group, n = 53). RESULTS: Patients receiving dexmedetomidine alone were weaned more rapidly than those in the other groups despite spending longer time on mechanical ventilation prior to weaning. Anxiety during weaning was present in 0, 9 and 24% patients in the DEX, SOC and SOCDEX groups, respectively. Anxiety after extubation was present in 41, 20 and 34% in the DEX, SOC and SOCDEX groups, respectively. Delirium during weaning was present in 1, 2 and 1 patient in the DEX, SOC and SOCDEX groups, respectively. Delirium at ICU discharge was present in 1, 0 and 3 patients in the DEX, SOC and SOCDEX groups, respectively. Few patients fulfilled criteria for post-traumatic stress disorder. CONCLUSION: Dexmedetomidine, used as a single sedative, may have contributed to a shorter weaning period than SOC or SOCDEX. Patients who received dexmedetomidine-only sedation tended to report better health-related quality of life than those receiving other forms of sedation.
    • PubMed ID
  • Validation of the korean version of the delirium motor subtype scale. 2018 Kim, H. Lee, M. Kwon, I. S. Kim, J. L.. Psychiatry Investigation, 15:1 (6-12)
    • Title

      Validation of the korean version of the delirium motor subtype scale.

    • Authors
      Kim, H. Lee, M. Kwon, I. S. Kim, J. L.
    • Year
      2018
    • Journal
      Psychiatry Investigation
    • URL
    • Abstract
      Objective The Delirium Motor Subtype Scale (DMSS) is a validated and reliable instrument developed from various methods previously used to assess delirium motor subtypes. It focuses on pure motor disturbances with a relative specificity for delirium. The aim of this study was to investigate the validity and reliability of a Korean version of the DMSS (K-DMSS). Methods We recruited 145 patients who were older than 60 years and had been referred for psychiatric consultation for delirium. These patients were evaluated using the K-DMSS, Liptzin & Levkoff criteria, and the Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-R98) to compare delirium motor subtypes. Results The internal consistency of the K-DMSS in assessing delirium motor subtypes was acceptable (Cronbach’s alpha=0.79). Delirium motor subtypes identified with the K-DMSS and K-DRS-R98 showed almost perfect agreement (Cohen’s Kappa=0.81), while those identified with the K-DMSS and Liptzin & Levkoff criteria showed substantial agreement (Cohen’s Kappa=0.78). Conclusion Our results suggest that the K-DMSS is a valid and reliable tool for identifying delirium subtypes.
    • PubMed ID
  • e-Screening revolution: A novel approach to developing a delirium screening tool in the intensive care unit. 2018 Eeles, E. Gunn, H. Sutt, A. L. Pinsker, D. Flaws, D. Jarrett, P. Lye, I. Fraser, J. F.. Australasian Journal on Ageing,
    • Title

      e-Screening revolution: A novel approach to developing a delirium screening tool in the intensive care unit.

    • Authors
      Eeles, E. Gunn, H. Sutt, A. L. Pinsker, D. Flaws, D. Jarrett, P. Lye, I. Fraser, J. F.
    • Year
      2018
    • Journal
      Australasian Journal on Ageing
    • URL
    • Abstract
      OBJECTIVES: Delirium is common in the intensive care unit (ICU), often affecting older patients. A bedside electronic tool has the potential to revolutionise delirium screening. Our group describe a novel approach to the design and development of delirium screening questions for the express purpose of use within an electronic device. Preliminary results are presented. METHODS: Our group designed a series of tests which targeted the clinical criteria for delirium according to Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) criteria against predefined requirements, including applicability to older patients. RESULTS: Candidate questions, including tests of attention and awareness, were devised and then refined by an expert multidisciplinary group, including geriatricians. A scoring scheme was constructed, with testing to failure an indicator of delirium. The device was tested in healthy controls, aged 20-80 years, who were recorded as being without delirium. CONCLUSION: e-Screening for delirium requires a novel approach to instrument design but may revolutionise recognition of delirium in ICU.
    • PubMed ID
  • Sedation Intensity in the First 48 Hours of Mechanical Ventilation and 180-Day Mortality: A Multinational Prospective Longitudinal Cohort Study. 2018 Shehabi, Y. Bellomo, R. Kadiman, S. Ti, L. K. Howe, B. Reade, M. C. Khoo, T. M. Alias, A. Wong, Y. L. Mukhopadhyay, A. McArthur, C. Seppelt, I. Webb, S. A. Green, M. Bailey, M. J.. Crit Care Med,
    • Title

      Sedation Intensity in the First 48 Hours of Mechanical Ventilation and 180-Day Mortality: A Multinational Prospective Longitudinal Cohort Study.

    • Authors
      Shehabi, Y. Bellomo, R. Kadiman, S. Ti, L. K. Howe, B. Reade, M. C. Khoo, T. M. Alias, A. Wong, Y. L. Mukhopadhyay, A. McArthur, C. Seppelt, I. Webb, S. A. Green, M. Bailey, M. J.
    • Year
      2018
    • Journal
      Crit Care Med
    • URL
    • Abstract
      OBJECTIVES: In the absence of a universal definition of light or deep sedation, the level of sedation that conveys favorable outcomes is unknown. We quantified the relationship between escalating intensity of sedation in the first 48 hours of mechanical ventilation and 180-day survival, time to extubation, and delirium. DESIGN: Harmonized data from prospective multicenter international longitudinal cohort studies SETTING:: Diverse mix of ICUs. PATIENTS: Critically ill patients expected to be ventilated for longer than 24 hours. INTERVENTIONS: Richmond Agitation Sedation Scale and pain were assessed every 4 hours. Delirium and mobilization were assessed daily using the Confusion Assessment Method of ICU and a standardized mobility assessment, respectively. MEASUREMENTS AND MAIN RESULTS: Sedation intensity was assessed using a Sedation Index, calculated as the sum of negative Richmond Agitation Sedation Scale measurements divided by the total number of assessments. We used multivariable Cox proportional hazard models to adjust for relevant covariates. We performed subgroup and sensitivity analysis accounting for immortal time bias using the same variables within 120 and 168 hours. The main outcome was 180-day survival. We assessed 703 patients in 42 ICUs with a mean (SD) Acute Physiology and Chronic Health Evaluation II score of 22.2 (8.5) with 180-day mortality of 32.3% (227). The median (interquartile range) ventilation time was 4.54 days (2.47-8.43 d). Delirium occurred in 273 (38.8%) of patients. Sedation intensity, in an escalating dose-dependent relationship, independently predicted increased risk of death (hazard ratio [95% CI], 1.29 [1.15-1.46]; p < 0.001, delirium hazard ratio [95% CI], 1.25 [1.10-1.43]), p value equals to 0.001 and reduced chance of early extubation hazard ratio (95% CI) 0.80 (0.73-0.87), p value of less than 0.001. Agitation level independently predicted subsequent delirium hazard ratio [95% CI], of 1.25 (1.04-1.49), p value equals to 0.02. Delirium or mobilization episodes within 168 hours, adjusted for sedation intensity, were not associated with survival. CONCLUSIONS: Sedation intensity independently, in an ascending relationship, predicted increased risk of death, delirium, and delayed time to extubation. These observations suggest that keeping sedation level equivalent to a Richmond Agitation Sedation Scale 0 is a clinically desirable goal.
    • PubMed ID
  • Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): a re-evaluation of the threshold for delirium. 2018 Boettger, S. Garcia Nunez, D. Meyer, R. Richter, A. Rudiger, A. Schubert, M. Jenewein, J.. Swiss Medical Weekly,
    • Title

      Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): a re-evaluation of the threshold for delirium.

    • Authors
      Boettger, S. Garcia Nunez, D. Meyer, R. Richter, A. Rudiger, A. Schubert, M. Jenewein, J.
    • Year
      2018
    • Journal
      Swiss Medical Weekly
    • URL
    • Abstract
      BACKGROUND: With its high incidence and subsequent adverse consequences in the intensive care setting, several instruments have been developed to screen for and detect delirium. One of the more commonly used is the Intensive Care Delirium Screening Checklist (ICDSC); however, the optimal cut-off score indicating delirium has been debated. METHODS: In this prospective cohort study, the ICDSC threshold for delirium set at >/=3, >/=4, or >/=5 was compared with the DSM-IV-TR-determined diagnosis of delirium (used as standard), and with the Confusion Assessment Method for the ICU (CAM-ICU), with respect to their concurrent validity. RESULTS: In total, 289 patients were assessed, including 122 with delirium. The cut-off score of >/=4 had several shortcomings: although 90% of patients with delirium were correctly classified, 23% remained undetected. The agreement with the DSM-IV-TR diagnosis of delirium was only moderate (Cohen's kappa 0.59) and the sensitivity was only 62%. In contrast, when the cut-off was >/=3, 83% of patients with delirium were correctly classified and only 14.5% remained undetected. The agreement with DSM-IV-TR was substantial (Cohen's kappa 0.68) and the sensitivity increased to 83%. The benefit of setting the cut-off at >/=5 was not convincing: although 90% of patients with delirium were correctly classified, 30% remained undetected. The concurrent validity was only moderate (Cohen's kappa 0.44), and the sensitivity reached only 44%. Changing the ICDSC cut-off score did not strengthen the moderate agreement with the CAM-ICU (Cohen's kappa 0.45-0.56). CONCLUSION: In clinical routine, decreasing the ICDSC threshold for delirium to >/=3 increased the accuracy in detecting delirium at the cost of over-identification and is therefore recommended as the optimal threshold. Increasing the cut-off score to >/=5 decreased the concurrent validity and sensitivity; in addition, the under-detection of delirium was substantial.
    • PubMed ID
  • Risk Factors of Postoperative Delirium in the Intensive Care Unit After Liver Transplantation. 2018 Lee, H. Oh, S. Y. Yu, J. H. Kim, J. Yoon, S. Ryu, H. G.. World J Surg,
    • Title

      Risk Factors of Postoperative Delirium in the Intensive Care Unit After Liver Transplantation.

    • Authors
      Lee, H. Oh, S. Y. Yu, J. H. Kim, J. Yoon, S. Ryu, H. G.
    • Year
      2018
    • Journal
      World J Surg
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium after liver transplantation is relatively common, especially due to preexisting conditions such as hepatic encephalopathy. Most studies of delirium after liver transplantation were based on ICU practices using deep hypnosedation. Therefore, risk factors and consequences of postoperative delirium after liver transplantation were evaluated in the light sedation era. METHODS: A total of 253 liver transplantation patients were evaluated for postoperative delirium. Clinical outcomes including mortality were compared between patients who suffered delirium and those who did not. Risk factors for postoperative delirium were analyzed with subgroup analysis depending on MELD scores and type of liver transplantation. RESULTS: Post-liver transplant delirium developed in 17% of the patients, 88% of which occurred within the first postoperative day. Alcoholic liver cirrhosis, class C Child-Pugh score, higher MELD scores, higher proportion of deceased donor liver transplantation, and reintubation were more frequent in patients who developed delirium, but there was no difference in mortality. Higher preoperative MELD group (15-24 vs. <15; OR 4.10, 95% Cl [1.67-10.09], P = 0.002, >/=25 vs. <15; OR 5.59, 95% CI [2.06-15.19], P < 0.01), higher APACHE II scores (OR 5.59, 95% CI [2.06-15.19], P < 0.01), and reintubation (OR 6.46, 95% CI [2.10-19.88], P < 0.01) were identified as significant risk factors for postoperative delirium. CONCLUSION: Postoperative delirium after liver transplantation was associated with worse clinical outcomes. MELD scores greater than 15 were predictive of postoperative delirium in both living and deceased donor liver transplantation.
    • PubMed ID
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