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: 3042

  • Influence of early elective tracheostomy on the incidence of postoperative complications in patients undergoing head and neck surgery. 2019 Meier, J. Wunschel, M. Angermann, A. Ettl, T. Metterlein, T. Klingelhöffer, C. Reichert, T. E. Ritzka, M.. BMC Anesthesiology, 19:1
    • Title

      Influence of early elective tracheostomy on the incidence of postoperative complications in patients undergoing head and neck surgery.

    • Authors
      Meier, J. Wunschel, M. Angermann, A. Ettl, T. Metterlein, T. Klingelhöffer, C. Reichert, T. E. Ritzka, M.
    • Year
      2019
    • Journal
      BMC Anesthesiology
    • URL
    • Abstract
      Background: The incidence of postoperative complications after head and neck surgery is high. This study evaluated the influence of early elective tracheostomy on the incidence of postoperative pneumonia and delirium. Methods: We reviewed the data of all patients who had undergone removal of an oropharyngeal tumor and microsurgical tissue transfer at our department in a two year period. Pearson's Chi-squared test and the Fischer's exact t-test were then used to measure the influence of patients' preexisting conditions and risk factors and of early elective tracheostomy on the incidence of postoperative complications. Results: In total, 47 cases were analyzed. Patients with an endotracheal tube were ventilated for a longer time (3.4 days vs. 1.5 days) and were transferred to the regular ward later (after 6.9 days vs. 4.7 days) than patients with tracheostomy. Only 1 (2.1%) of the patients with a tracheostomy developed pneumonia in contrast to 5 intubated patients (10.6%) and only 2 patients with a tracheostomy developed postoperative delirium (9.5%) in contrast to 8 intubated patients (30.8%). Conclusion: Early primary tracheostomy in patients undergoing resection of oropharyngeal cancer seems to have numerous benefits, such as lower complication rates with regard to pneumonia and postoperative delirium and shorter duration of both mechanical ventilation and intensive care unit (ICU) stays. Further studies have to evaluate if these benefits also influence morbidity and mortality rates.
    • PubMed ID
  • Pharmacological Prevention of Postoperative Delirium: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. 2019 Liu, Y. Li, X. J. Liang, Y. Kang, Y.. Evidence-Based Complementary and Alternative Medicine,
    • Title

      Pharmacological Prevention of Postoperative Delirium: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    • Authors
      Liu, Y. Li, X. J. Liang, Y. Kang, Y.
    • Year
      2019
    • Journal
      Evidence-Based Complementary and Alternative Medicine
    • URL
    • Abstract
      Background. The high prevalence of delirium among postoperative patients has increased morbidity and mortality. The kind of drug that can effectively reduce the incidence of delirium has become the focus of discussion in recent years. However, a consensus in this respect has yet to be reached. Methods. Randomized controlled trials (RCTs) were retrieved from the PubMed, Cochrane Library, ClinicalTrials.gov, and Embase databases from their inception through October 12, 2018. We included RCTs of pharmacological prevention for postoperative delirium in adults (at least 18 years), and the Cochrane risk of bias tool was used to evaluate the methodological quality of trials. The primary outcomes were the risk ratios (RRs) of incidence of postoperative delirium, and the secondary outcomes were the RRs of mortality and adverse events in the intervention and control groups. Results. Thirty-eight trials, which comprised 20302 patients and 18 different drugs, were included in the analysis. Of the 38 studies, 17 were rated as low risk with respect to methodological quality. Dexmedetomidine administration (RR 0.58, 95%CI 0.44-0.76, P<0.01) was associated with a significantly lower incidence of postoperative delirium than the control conditions. However, the findings from the studies with a low risk of bias did not show a significant difference in this beneficial effect (RR 0.64, 95%CI 0.39-1.04, P=0.07). The antipsychotic drugs olanzapine (RR 0.44, 95%CI 0.30- 0.65, P<0.01) and risperidone (RR 0.42, 95%CI 0.19-0.92, P=0.03) had promising effects, but there was a lack of sufficient evidence to obtain a definitive conclusion. The beneficial effect of other drugs, including haloperidol, methylprednisolone, dexamethasone, gabapentin, ketamine, cyproheptadine, donepezil, hypertonic saline, melatonin, nimodipine, ondansetron, pregabalin, rivastigmine, TJ-54, and tryptophan, was not proven on the basis of present evidence. Conclusion. Among the pharmacological prophylactic measures for postoperative delirium, dexmedetomidine, olanzapine, and risperidone showed higher efficacy than other drugs. However, more high-quality evidence is needed to confirm these results.
    • PubMed ID
  • Delirium: Medical Students’ Knowledge and Effectiveness of Different Teaching Methods. 2019 Baessler, F. Ciprianidis, A. Rizvi, A. Z. Weidlich, J. Wagner, F. L. Klein, S. B. Baumann, T. C. Nikendei, C. Schultz, J. H.. Am J Geriatr Psychiatry,
    • Title

      Delirium: Medical Students’ Knowledge and Effectiveness of Different Teaching Methods.

    • Authors
      Baessler, F. Ciprianidis, A. Rizvi, A. Z. Weidlich, J. Wagner, F. L. Klein, S. B. Baumann, T. C. Nikendei, C. Schultz, J. H.
    • Year
      2019
    • Journal
      Am J Geriatr Psychiatry
    • URL
    • Abstract
      Objective: Medical schools are often blamed for inadequately training doctors on delirium. This study assesses the knowledge of medical students regarding delirium and evaluates different teaching methods for comparing learning outcomes. Methods: A video, a handout, and a video+handout were used as three different teaching methods. Students were randomly assigned to three groups and pre- and postintervention knowledge gains were compared. Interventions were held between 2015 and 2018 at the University of Heidelberg Medical School in Germany. Seventy-eight (video intervention 33; handout 26; video+handout 19) sixth-year medical students participated. Participants learned about delirium with the help of a video, a handout, and both a video+handout at the start of one-hour lectures dedicated to teaching about delirium. Pre- and postintervention questionnaires, comprising five multiple-choice questions and a self-estimated grade of knowledge about delirium, were used. Variables calculated were objective and subjective knowledge, recall, and accuracy of self-assessment. Microsoft Excel and analysis of covariance were used to analyze data. Results: Knowledge gains for all interventions were large (d>0.8) irrespective of gender. Post hoc comparison showed video and video+handout methods were more effective with high recall for video (92.8%). Students rated their knowledge as satisfactory, although they scored 11.4 out of 20. Preintervention knowledge level was correctly estimated by 31% of students, and postintervention by 40.3% students. Conclusion: Teaching about delirium to medical students with a video resulted in better knowledge transfer and recall. Most medical students, particularly men, overestimated their knowledge about delirium.
    • PubMed ID
  • Low Plasma Cholinesterase Activity is Associated With Postoperative Delirium After Noncardiac Surgery in Elderly Patients: AProspective Observational Study. 2019 Zhao, B. Ni, Y. Tian, X.. Psychosomatics, 60:2 (190-6)
    • Title

      Low Plasma Cholinesterase Activity is Associated With Postoperative Delirium After Noncardiac Surgery in Elderly Patients: AProspective Observational Study.

    • Authors
      Zhao, B. Ni, Y. Tian, X.
    • Year
      2019
    • Journal
      Psychosomatics
    • URL
    • Abstract
      Background: Postoperative delirium (POD) commonly occurs in elderly patients after noncardiac surgery, resulting in increased morbidity and greater risk of death. However, its pathophysiology is currently unknown. Cholinergic dysfunction has been implicated in delirium pathophysiology, and low plasma cholinesterase activity has been reported as a risk marker of POD. Objective: Therefore, the aim of this study was to investigate the link between plasma cholinesterase activity and POD in elderly Han Chinese patients after noncardiac surgery. Method: From January 2014 to January 2016, a cohort of 206 patients aged ≥ 60years who underwent noncardiac surgery and were transferred to the surgical intensive care unit were enrolled. POD was assessed using the Confusion Assessment Method for Intensive Care Unit. Clinical data including sex, age, general comorbidities, alcohol consumption, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and type of surgery were recorded. Blood was drawn postoperatively to measure cholinesterase activity. Using multiple logistic regression analyses, the associations between cholinesterase activity and POD were examined, adjusting for potential confounding variables. Results: Delirium incidence was 22.3%. POD was associated with cholinesterase activity, age, and APACHE II score. In multiple logistic regression analyses, lower acetylcholinesterase and butyrylcholinesterase activity were independent risk factors for POD. Conclusion: Plasma cholinesterase activity may be a candidate biomarker for POD after noncardiac surgery in the elderly Chinese Han population.
    • PubMed ID
  • Interventions for preventing delirium in older people in institutional long-term care. 2019 Woodhouse, R. Burton, J. K. Rana, N. Pang, Y. L. Lister, J. E. Siddiqi, N.. Cochrane Database of Systematic Reviews, (CD009537)
    • Title

      Interventions for preventing delirium in older people in institutional long-term care.

    • Authors
      Woodhouse, R. Burton, J. K. Rana, N. Pang, Y. L. Lister, J. E. Siddiqi, N.
    • Year
      2019
    • Journal
      Cochrane Database of Systematic Reviews
    • URL
    • Abstract
      BACKGROUND: Delirium is a common and distressing mental disorder. It is often caused by a combination of stressor events in susceptible people, particularly older people living with frailty and dementia. Adults living in institutional long-term care (LTC) are at particularly high risk of delirium. An episode of delirium increases risks of admission to hospital, development or worsening of dementia and death. Multicomponent interventions can reduce the incidence of delirium by a third in the hospital setting. However, it is currently unclear whether interventions to prevent delirium in LTC are effective. This is an update of a Cochrane Review first published in 2014. OBJECTIVES: To assess the effectiveness of interventions for preventing delirium in older people in institutional long-term care settings. SEARCH METHODS: We searched ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group (CDCIG) 's Specialised Register of dementia trials (dementia.cochrane.org/our-trials-register), to 27 February 2019. The search was sufficiently sensitive to identify all studies relating to delirium. We ran additional separate searches in the Cochrane Central Register of Controlled Trials (CENTRAL), major healthcare databases, trial registers and grey literature sources to ensure that the search was comprehensive. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-randomised controlled trials (cluster-RCTs) of single and multicomponent, non-pharmacological and pharmacological interventions for preventing delirium in older people (aged 65 years and over) in permanent LTC residence. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Primary outcomes were prevalence, incidence and severity of delirium; and mortality. Secondary outcomes included falls, hospital admissions and other adverse events; cognitive function; new diagnoses of dementia; activities of daily living; quality of life; and cost-related outcomes. We used risk ratios (RRs) as measures of treatment effect for dichotomous outcomes, hazard ratios (HR) for time-to-event outcomes and mean difference (MD) for continuous outcomes. For each outcome, we assessed the overall certainty of the evidence using GRADE methods. MAIN RESULTS: We included three trials with 3851 participants. All three were cluster-RCTs. Two of the trials were of complex, single-component, non-pharmacological interventions and one trial was a feasibility trial of a complex, multicomponent, non-pharmacological intervention. Risk of bias ratings were mixed across the three trials. Due to the heterogeneous nature of the interventions, we did not combine the results statistically, but produced a narrative summary.It was not possible to determine the effect of a hydration-based intervention on delirium incidence (RR 0.85, 95% confidence interval (CI) 0.18 to 4.00; 1 study, 98 participants; very low-certainty evidence downgraded for risk of bias and very serious imprecision). This study did not assess delirium prevalence, severity or mortality.The introduction of a computerised system to identify medications that may contribute to delirium risk and trigger a medication review was probably associated with a reduction in delirium incidence (12-month HR 0.42, CI 0.34 to 0.51; 1 study, 7311 participant-months; moderate-certainty evidence downgraded for risk of bias) but probably had little or no effect on mortality (HR 0.88, CI 0.66 to 1.17; 1 study, 9412 participant-months; moderate-certainty evidence downgraded for imprecision), hospital admissions (HR 0.89, CI 0.72 to 1.10; 1 study, 7599 participant-months; moderate-certainty evidence downgraded for imprecision) or falls (HR 1.03, CI 0.92 to 1.15; 1 study, 2275 participant-months; low-certainty evidence downgraded for imprecision and risk of bias). Delirium prevalence and severity were not assessed.In the enhanced educational intervention study, aimed at changing practice to address key delirium risk factors, it was not possible to determine the effect of the intervention on delirium incidence (RR 0.62, 95% CI 0.16 to 2.39; 1 study, 137 resident months; very low-certainty evidence downgraded for risk of bias and serious imprecision) or delirium prevalence (RR 0.57, 95% CI 0.15 to 2.19; 1 study, 160 participants; very low-certainty evidence downgraded for risk of bias and serious imprecision). There was probably little or no effect on mortality (RR 0.82, CI 0.50 to 1.34; 1 study, 215 participants; moderate-certainty evidence downgraded for imprecision). The intervention was probably associated with a reduction in hospital admissions (RR 0.67, CI 0.57 to 0.79; 1 study, 494 participants; moderate-certainty evidence downgraded due to indirectness). AUTHORS' CONCLUSIONS: Our review identified limited evidence on interventions for preventing delirium in older people in LTC. A software-based intervention to identify medications that could contribute to delirium risk and trigger a pharmacist-led medication review, probably reduces incidence of delirium in older people in institutional LTC. This is based on one large RCT in the US and may not be practical in other countries or settings which do not have comparable information technology services available in care homes. In the educational intervention aimed at identifying risk factors for delirium and developing bespoke solutions within care homes, it was not possible to determine the effect of the intervention on delirium incidence, prevalence or mortality. This evidence is based on a small feasibility trial. Our review identified three ongoing trials of multicomponent delirium prevention interventions. We identified no trials of pharmacological agents. Future trials of multicomponent non-pharmacological delirium prevention interventions for older people in LTC are needed to help inform the provision of evidence-based care for this vulnerable group.
    • PubMed ID
  • Effect of flurbiprofen axetil on postoperative delirium for elderly patients. 2019 Wang, X. Wang, Y. Hu, Y. Wang, L. Zhao, W. Wei, L. Chen, H. Han, F.. Brain Behav, (e01290)
    • Title

      Effect of flurbiprofen axetil on postoperative delirium for elderly patients.

    • Authors
      Wang, X. Wang, Y. Hu, Y. Wang, L. Zhao, W. Wei, L. Chen, H. Han, F.
    • Year
      2019
    • Journal
      Brain Behav
    • URL
    • Abstract
      OBJECTIVES: Proinflammatory cytokines triggered by surgery and postoperative pain are major causes of postoperative delirium (POD). This study investigated the effects of flurbiprofen axetil on POD when used for postoperative analgesia after major noncardiac surgery in elderly patients. METHODS: Patients over 65 years old were randomly divided into two groups: the sufentanil group (S group), in which 150 mug of sufentanil was used in the patient-controlled analgesia (PCA) pump for 3 days; the sufentanil combined with flurbiprofen axetil group (SF group), in which 150 mug of sufentanil was combined with 300 mg of flurbiprofen axetil in the PCA pump for 3 days. The Confusion Assessment Method scale was used for POD evaluation. The pain intensity, side effects, and risk factors (age, gender, surgical position, and category of surgery) for POD were evaluated. RESULTS: Ultimately, 140 patients were included. The overall incidence of POD was not significantly different between the S and SF groups. The incidence of POD was significantly lower in the SF group than in the S group among patients over 70 years (5.1% vs. 20.7%, p = 0.045, odds ratio = 0.146, 95% confidence interval = 0.020-1.041). The incidence of POD was no difference in patients classified by the category of surgery, surgical position, or gender between groups. Sufentanil and flurbiprofen axetil in the PCA pump was completely used within 72 hr. The pain intensity, consumed sufentanil dosage of the PCA, and the side effects was not different between groups. CONCLUSIONS: Flurbiprofen axetil might reduce POD in patients over 70 years undergoing major noncardiac surgery.
    • PubMed ID
  • Clinical and prognostic implications of delirium in elderly patients with non–ST-segment elevation acute coronary syndromes. 2019 Vives-Borrás, M. Martínez-Sellés, M. Ariza-Solé, A. Vidán, M. T. Formiga, F. Bueno, H. Sanchís, J. Alegre, O. Durán-Cambra, A. López-Palop, R. Abu-Assi, E. Sionis, A.. Journal of Geriatric Cardiology, 16:2 (121-8)
    • Title

      Clinical and prognostic implications of delirium in elderly patients with non–ST-segment elevation acute coronary syndromes.

    • Authors
      Vives-Borrás, M. Martínez-Sellés, M. Ariza-Solé, A. Vidán, M. T. Formiga, F. Bueno, H. Sanchís, J. Alegre, O. Durán-Cambra, A. López-Palop, R. Abu-Assi, E. Sionis, A.
    • Year
      2019
    • Journal
      Journal of Geriatric Cardiology
    • URL
    • Abstract
      Background Elderly patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) may present delirium but its clinical relevance is unknown. This study aimed at determining the clinical associated factors, and prognostic implications of delirium in old-aged patients admitted for NSTE-ACS. Methods LONGEVO-SCA is a prospective multicenter registry including unselected patients with NSTE-ACS aged 80 years. Clinical variables and a complete geriatric evaluation were assessed during hospitalization. The association between delirium and 6-month mortality was assessed by a Cox regression model weighted for a propensity score including the potential confounding variables. We also analysed its association with 6-month bleeding and cognitive or functional decline. Results Among 527 patients included, thirty-seven (7%) patients presented delirium during the hospitalization. Delirium was more frequent in patients with dementia or depression and in those from nursing homes (27.0% vs. 3.1%, 24.3% vs. 11.6%, and 11.1% vs. 2.2%, respectively; all P < 0.05). Delirium was significantly associated with in-hospital infections (27.0% vs. 5.3%, P < 0.001) and usage of diuretics (70.3% vs. 49.8%, P = 0.02). Patients with delirium had longer hospitalizations [median 8.5 (5.5-14) vs. 6.0 (4.0-10) days, P = 0.02] and higher incidence of 6-month bleeding and mortality (32.3% vs. 10.0% and 24.3% vs. 10.8%, respectively; both P < 0.05) but similar cognitive or functional decline. Delirium was independently associated with 6-month mortality (HR = 1.47, 95% CI: 1.02-2.13, P = 0.04) and 6-month bleeding events (OR = 2.87; 95% CI: 1.98-4.16, P < 0.01). Conclusions In-hospital delirium in elderly patients with NSTE-ACS is associated with some preventable risk factors and it is an independent predictor of 6-month mortality.
    • PubMed ID
  • Brain network disintegration as a final common pathway for delirium: a systematic review and qualitative meta-analysis. 2019 van Montfort, S. J. T. van Dellen, E. Stam, C. J. Ahmad, A. H. Mentink, L. J. Kraan, C. W. Zalesky, A. Slooter, A. J. C.. Neuroimage Clin,
    • Title

      Brain network disintegration as a final common pathway for delirium: a systematic review and qualitative meta-analysis.

    • Authors
      van Montfort, S. J. T. van Dellen, E. Stam, C. J. Ahmad, A. H. Mentink, L. J. Kraan, C. W. Zalesky, A. Slooter, A. J. C.
    • Year
      2019
    • Journal
      Neuroimage Clin
    • URL
    • Abstract
      Delirium is an acute neuropsychiatric syndrome characterized by altered levels of attention and awareness with cognitive deficits. It is most prevalent in elderly hospitalized patients and related to poor outcomes. Predisposing risk factors, such as older age, determine the baseline vulnerability for delirium, while precipitating factors, such as use of sedatives, trigger the syndrome. Risk factors are heterogeneous and the underlying biological mechanisms leading to vulnerability for delirium are poorly understood. We tested the hypothesis that delirium and its risk factors are associated with consistent brain network changes. We performed a systematic review and qualitative meta-analysis and included 126 brain network publications on delirium and its risk factors. Findings were evaluated after an assessment of methodological quality, providing N=99 studies of good or excellent quality on predisposing risk factors, N=10 on precipitation risk factors and N=7 on delirium. Delirium was consistently associated with functional network disruptions, including lower EEG connectivity strength and decreased fMRI network integration. Risk factors for delirium were associated with lower structural connectivity strength and less efficient structural network organization. Decreased connectivity strength and efficiency appear to characterize structural brain networks of patients at risk for delirium, possibly impairing the functional network, while functional network disintegration seems to be a final common pathway for the syndrome.
    • PubMed ID
  • Predictive Factors of Postoperative Delirium in Patients After Pancreaticoduodenectomy. 2019 Tomimaru, Y. Park, S. A. Shibata, A. Miyagawa, S. Noguchi, K. Noura, S. Imamura, H. Shirakawa, T. Dono, K.. J Gastrointest Surg,
    • Title

      Predictive Factors of Postoperative Delirium in Patients After Pancreaticoduodenectomy.

    • Authors
      Tomimaru, Y. Park, S. A. Shibata, A. Miyagawa, S. Noguchi, K. Noura, S. Imamura, H. Shirakawa, T. Dono, K.
    • Year
      2019
    • Journal
      J Gastrointest Surg
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium is a common serious complication after various types of surgery. However, the incidence and predictive factors associated with delirium after pancreaticoduodenectomy (PD) have not been investigated. Thus, this study aimed to investigate the incidence and predictive factors of postoperative delirium in patients who underwent PD. METHODS: This study included 155 consecutive patients who underwent PD. Patients with and without postoperative delirium were compared to identify differential patient characteristics. Multivariate regression analysis was used to statistically identify independent predictive factors significantly associated with the development of postoperative delirium. RESULTS: Postoperative delirium developed in 27 (22.4%) of 155 patients. The majority of incidents occurred on postoperative day 2, and the mean delirium duration was 4.6 +/- 4.8 days. Patients with postoperative delirium had an older age and a previous history of benzodiazepine use. A multivariate analysis revealed that the development of delirium was significantly correlated with these two factors. Receiver-operator characteristics (ROC) curve analysis of the two factors yielded an area under the ROC curve of 0.823 (0.750-0.896), suggesting good discrimination power. CONCLUSIONS: This study reports on the incidence of postoperative delirium after PD. Furthermore, we identified age and use of benzodiazepines as significant predictive factors for developing delirium after PD. These results contribute to the prediction and treatment of postoperative delirium.
    • PubMed ID
  • Bach to the Basics: Implementation and Impact of a Postoperative, Inpatient Personalized Music Program for Older Adults. 2019 Sharda, N. Mattoon, E. Matters, L. Prewitt, J. McDonald, S. Sloane, R. Cassas, C. White, H.. J Perianesth Nurs, 34:2 (347-353)
    • Title

      Bach to the Basics: Implementation and Impact of a Postoperative, Inpatient Personalized Music Program for Older Adults.

    • Authors
      Sharda, N. Mattoon, E. Matters, L. Prewitt, J. McDonald, S. Sloane, R. Cassas, C. White, H.
    • Year
      2019
    • Journal
      J Perianesth Nurs
    • URL
    • Abstract
      PURPOSE: Music as an intervention to mitigate pain and anxiety has been well studied in the perioperative period. We present a quality improvement (QI) report describing implementation and evaluation of a postoperative, inpatient personalized music program for older adults undergoing elective surgeries. DESIGN: We embedded this program in an existing interdisciplinary perioperative care program, with an outpatient and an inpatient component, at an academic institution. METHODS: We describe our initial QI steps, highlight critical lessons learned from this behavioral intervention, and discuss high yield areas to focus on future implementation efforts. FINDINGS: Rapid cycle improvement was an effective method to monitor QI measures. Participants in our program perceived improved mood and pain control, were satisfied with their experience, and had lower rates of incident delirium. CONCLUSIONS: This program offers perioperative teams, especially frontline nursing staff, an inexpensive, patient-centered tool to optimize postoperative pain and anxiety. We believe that it can be easily replicated at a variety of hospital systems.
    • PubMed ID
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