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: 2732

  • Effect of goal-directed fluid therapy on early cognitive function in elderly patients with spinal stenosis: A Case-Control Study. 2018 Zhang, N. Liang, M. Zhang, D. D. Xiao, Y. R. Li, Y. Z. Gao, Y. G. Cai, H. D. Lin, X. Z. Lin, C. Z. Zeng, K. Wu, X. D.. Int J Surg, 54:Pt A (201-5)
    • Title

      Effect of goal-directed fluid therapy on early cognitive function in elderly patients with spinal stenosis: A Case-Control Study.

    • Authors
      Zhang, N. Liang, M. Zhang, D. D. Xiao, Y. R. Li, Y. Z. Gao, Y. G. Cai, H. D. Lin, X. Z. Lin, C. Z. Zeng, K. Wu, X. D.
    • Year
      2018
    • Journal
      Int J Surg
    • URL
    • Abstract
      PURPOSE: To explore effect of goal-directed fluid therapy (GDFT) on early cognitive function in elderly patients with spinal stenosis. METHODS: 83 elderly patients with spinal stenosis were randomly classified into two groups: control group (n=40) and GDFT group (n=43). The Montreal Cognitive Assessment (MoCA) score, IL-6 and S100beta levels, hemodynamic parameters, cerebral oxygen saturation (rSO2), arterial lactic acid values, output of surgery, operation time and cases of hypotension, intraoperative complications within 7 days were recorded for all patients. RESULTS: The incidence of postoperative cognitive dysfunction (POCD) was about 21.67% in this study. The MoCA scores, inflammatory mediators, perfusion indexes (rSO2 and lactic acid)and intraoperative hemodynamics(HR, MAP, and CI)were not all the same at different time points (P<0.05). The levels of inflammatory mediators (IL-6 and S100beta) in GDFT group were lower than those in the control group (P<0.05). Total intake, amount of lactated Ringer's solution and cases of hypotension in GDFT group were significantly lower than control group (P<0.05), but amount of voluven was higher than control group(P<0.05). Compared with control group, the incidence of postoperative delirium, nausea and vomiting, and hypotension in GDFT group was lower (P<0.05). CONCLUSIONS: GDFT can maintain the stability of perioperative hemodynamics in the prone position of elderly patients with spinal stenosis, improve the balance between perfusion of tissue and organ and supply and demand of oxygen, reduce the inflammatory response, and reduce the incidence of early POCD in this type of surgery.
    • PubMed ID
  • Rehospitalization following a stay in geriatric rehabilitation wards: rates and predictive factors. 2018 Tardivel, M. Muller, F. Tortrat, D. Lechowski, L. Teillet, L.. Geriatr Psychol Neuropsychiatr Vieil,
    • Title

      Rehospitalization following a stay in geriatric rehabilitation wards: rates and predictive factors.

    • Authors
      Tardivel, M. Muller, F. Tortrat, D. Lechowski, L. Teillet, L.
    • Year
      2018
    • Journal
      Geriatr Psychol Neuropsychiatr Vieil
    • URL
    • Abstract
      Hospitalization in the elderly patients is highly associated with morbi-mortality. Geriatric post-acute and rehabilitation care wards are designed to provide care and to implement life project of elderly patients. Objective of this study was to characterize rehospitalizations after a stay in geriatric post-acute and rehabilitation care wards. METHODS: The study was retrospective, case-control, including all the patients hospitalized in the 4 geriatric post-acute and rehabilitation care wards of a hospital in Paris (France) and returned at home. Data collection was carried out on the basis of the hospitalization report and the information system of the hospital. Rehospitalizations were documented by the information system as well as by telephone interview. We compared patients according to whether they had been rehospitalized or not within 60 days after discharge. RESULTS: Out of a total of 1,063 stays during a 12 months period, 435 (41%) were discharged at home. Re-admission rate was 10.1% at 30 days and 18.4% at 90 days. Mean age of rehospitaliszed patients was 87.2 years +/- 5.3 vs 87.9 years +/- 5.8 for non-rehospitalized patients. Patients rehospitalized had more often a delirium during the prior hospitalization. CONCLUSION: Unplanned rehospitalisation is a major public health issue and should be prevented particularly after a stay in a geriatric post-acute and rehabilitation care wards.
    • PubMed ID
  • Elimination of Routine Benzodiazepine Administration for Nonprocedural Sedation in a Trauma Intensive Care Unit Is Feasible. 2018 McGinn, K. Davis, S. N. Terrry, E. Simmons, J. Brevard, S.. Am Surg, 84:6 (947-951)
    • Title

      Elimination of Routine Benzodiazepine Administration for Nonprocedural Sedation in a Trauma Intensive Care Unit Is Feasible.

    • Authors
      McGinn, K. Davis, S. N. Terrry, E. Simmons, J. Brevard, S.
    • Year
      2018
    • Journal
      Am Surg
    • URL
    • Abstract
      Current guidelines on the management of pain, agitation, and delirium in the intensive care unit (ICU) recommend a non-benzodiazepine (BDZ)-based approach to sedation. Management of agitation can be challenging in multitrauma patients but is imperative to facilitate patient recovery. Given the current guideline recommendations, a protocol to eliminate BDZ administration and maintain light levels of sedation was adopted in our ICU. The purpose of this analysis was to demonstrate that it is feasible to safely eliminate BDZ administration in a trauma ICU. This was a single-center, retrospective, observational analysis at a Level I trauma center. Adult patients (>18 years old) admitted to the Trauma Critical Care service from March 2015 to August 2015 were included. The primary outcome recorded was the use and duration of nonprocedural BDZs which was defined as BDZ not given within one hour of a procedure or test. A total of 64 patients met the inclusion criteria. The average Injury Severity Score was 18.7. A total of 14 patients (21.9%) received BDZ for a nonprocedure-related indication. Of those patients, all (100%) received less than three as-needed doses of BDZs during their ICU stay. In mechanically ventilated patients, continuous sedation or analgesia was not continued for more than 1.3 days. Only five patients (7.8%) received continuous BDZ. Limiting sedation is feasible in critically ill polytrauma patients. Protocols to standardize sedation strategies should be implemented in the ICU to avoid unnecessary sedation.
    • PubMed ID
  • Can Chaotic Analysis of Electroencephalogram Aid the Diagnosis of Encephalopathy? 2018 Jacob, J. E. Cherian, A. Gopakumar, K. Iype, T. Yohannan, D. G. Divya, K. P.. Neurology Research International,
    • Title

      Can Chaotic Analysis of Electroencephalogram Aid the Diagnosis of Encephalopathy?

    • Authors
      Jacob, J. E. Cherian, A. Gopakumar, K. Iype, T. Yohannan, D. G. Divya, K. P.
    • Year
      2018
    • Journal
      Neurology Research International
    • URL
    • Abstract
      Chaotic analysis is a relatively novel area in the study of physiological signals. Chaotic features of electroencephalogram have been analyzed in various disease states like epilepsy, Alzheimer's disease, sleep disorders, and depression. All these diseases have primary involvement of the brain. Our study examines the chaotic parameters in metabolic encephalopathy, where the brain functions are involved secondary to a metabolic disturbance. Our analysis clearly showed significant lower values for chaotic parameters, correlation dimension, and largest Lyapunov exponent for EEG in patients with metabolic encephalopathy compared to normal EEG. The chaotic features of EEG have been shown in previous studies to be an indicator of the complexity of brain dynamics. The smaller values of chaotic features for encephalopathy suggest that normal complexity of brain function is reduced in encephalopathy. To the best knowledge of the authors, no similar work has been reported on metabolic encephalopathy. This finding may be useful to understand the neurobiological phenomena in encephalopathy. These chaotic features are then utilized as feature sets for Support Vector Machine classifier to identify cases of encephalopathy from normal healthy subjects yielding high values of accuracy. Thus, we infer that chaotic measures are EEG parameters sensitive to functional alterations of the brain, caused by encephalopathy.
    • PubMed ID
  • Hospital outcomes of older people with cognitive impairment: An integrative review. 2018 Fogg, C. Griffiths, P. Meredith, P. Bridges, J.. Int J Geriatr Psychiatry,
    • Title

      Hospital outcomes of older people with cognitive impairment: An integrative review.

    • Authors
      Fogg, C. Griffiths, P. Meredith, P. Bridges, J.
    • Year
      2018
    • Journal
      Int J Geriatr Psychiatry
    • URL
    • Abstract
      OBJECTIVES: To summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group. METHODS: Integrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods. RESULTS: One hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all-cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described. CONCLUSIONS: Older people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes.
    • PubMed ID
  • Physostigmine is superior to non-antidote therapy in the management of antimuscarinic delirium: a prospective study from a regional poison center. 2018 Boley, S. P. Olives, T. D. Bangh, S. A. Fahrner, S. Cole, J. B.. Clin Toxicol, (1-6)
    • Title

      Physostigmine is superior to non-antidote therapy in the management of antimuscarinic delirium: a prospective study from a regional poison center.

    • Authors
      Boley, S. P. Olives, T. D. Bangh, S. A. Fahrner, S. Cole, J. B.
    • Year
      2018
    • Journal
      Clin Toxicol
    • URL
    • Abstract
      CONTEXT: Poison centers (PCs) frequently manage patients with antimuscarinic delirium. However, controversy surrounds the antidotal use of physostigmine for its treatment. The aim of this study was to prospectively investigate physostigmine versus non-antidote therapy for the management of antimuscarinic delirium in a single regional PC. METHODS: This was a prospective observational analysis of patients diagnosed with antimuscarinic delirium and treated in consultation with a regional PC. Certified Specialists in Poison Information (CSPIs) use a clinical guideline to recommend the use of physostigmine. Using a previously derived altered mental status score, we quantified the rate of delirium improvement with physostigmine compared to non-antidote therapy two hours after initial patient identification. We also recorded adverse events (defined a priori as bradycardia, vomiting, seizures) and resource utilization (intubation and physical restraint). RESULTS: We identified 245 patients and included 154 in the analysis. The most common exposure classes were antihistamines (68%), analgesics (19%), and antipsychotics (19%). CSPIs recommended physostigmine in 81% (125) of cases and the treatment team administered it in 37% (57) of these. We observed delirium control in 79% of patients who received physostigmine versus 36% of those who did not. The odds of delirium control were six times greater for patients receiving physostigmine than for patients treated with non-antidote therapy (OR 6.6). Adverse events were rare and did not differ significantly between the groups. Physostigmine was not associated with changes in the incidence of intubation or restraint. CONCLUSIONS: This study provides further evidence of both the safety and efficacy of physostigmine in the treatment of antimuscarinic delirium.
    • PubMed ID
  • Cholinesterase inhibitors for the treatment of delirium in non-ICU settings. 2018 Yu, A. Wu, S. Zhang, Z. Dening, T. Zhao, S. Pinner, G. Xia, J. Yang, D.. Cochrane Database of Systematic Reviews,
    • Title

      Cholinesterase inhibitors for the treatment of delirium in non-ICU settings.

    • Authors
      Yu, A. Wu, S. Zhang, Z. Dening, T. Zhao, S. Pinner, G. Xia, J. Yang, D.
    • Year
      2018
    • Journal
      Cochrane Database of Systematic Reviews
    • URL
    • Abstract
      BACKGROUND: Delirium is a common clinical syndrome defined as alterations in attention with an additional disturbance in cognition or perception, which develop over a short period of time and tend to fluctuate during the course of the episode. Delirium is commonly treated in hospitals or community settings and is often associated with multiple adverse outcomes such as increased cost, morbidity, and even mortality. The first-line intervention involves a multicomponent non-pharmacological approach that includes ensuring effective communication and reorientation in addition to providing reassurance or a suitable care environment. There are currently no drugs approved specifically for the treatment of delirium. Clinically, however, various medications are employed to provide symptomatic relief, such as antipsychotic medications and cholinesterase inhibitors, among others. OBJECTIVES: To evaluate the effectiveness and safety of cholinesterase inhibitors for treating people with established delirium in a non-intensive care unit (ICU) setting. SEARCH METHODS: We searched ALOIS, which is the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, on 26 October 2017. We also cross-checked the reference lists of included studies to identify any potentially eligible trials. SELECTION CRITERIA: We included randomised controlled trials, published or unpublished, reported in English or Chinese, which compared cholinesterase inhibitors to placebo or other drugs intended to treat people with established delirium in a non-ICU setting. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. The primary outcomes were duration of delirium, severity of delirium, and adverse events. The secondary outcomes were use of rescue medications, persistent cognitive impairment, length of hospitalisation, institutionalisation, mortality, cost of intervention, leaving the study early, and quality of life. For dichotomous outcomes, we calculated the risk ratio (RR) with 95% confidence intervals (CIs); for continuous outcomes we calculated the mean difference (MD) with 95% CIs. We assessed the quality of evidence using GRADE to generate a 'Summary of findings' table. MAIN RESULTS: We included one study involving 15 participants from the UK. The included participants were diagnosed with delirium based on the Confusion Assessment Method (CAM) criteria. Eight males and seven females were included, with a mean age of 82.5 years. Seven of the 15 participants had comorbid dementia at baseline. The risk of bias was low in all domains.The study compared rivastigmine with placebo. We did not find any clear differences between the two groups in terms of duration of delirium (MD -3.6, 95% CI -15.6 to 8.4), adverse events (nausea, RR 0.30, 95% CI 0.01 to 6.29), use of rescue medications (RR 0.13, 95% CI 0.01 to 2.1), mortality (RR 0.10, 95% CI 0.01 to 1.56), and leaving the study early (RR 0.88, 95% CI 0.07 to 11.54). Evidence was not available regarding the severity of delirium, persistent cognitive impairment, length of hospitalisation, cost of intervention, or other predefined secondary outcomes.The quality of evidence is low due to the very small sample size. AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the use of cholinesterase inhibitors for the treatment of delirium in non-ICU settings. No clear benefits or harms associated with cholinesterase inhibitors were observed when compared with placebo due to the lack of data. More trials are required.
    • PubMed ID
  • Perioperative dexmedetomidine reduces delirium after cardiac surgery: A meta-analysis of randomized controlled trials 2018 Wu, M. Liang, Y. Dai, Z. Wang, S.. J Clin Anesth, (33-42)
    • Title

      Perioperative dexmedetomidine reduces delirium after cardiac surgery: A meta-analysis of randomized controlled trials

    • Authors
      Wu, M. Liang, Y. Dai, Z. Wang, S.
    • Year
      2018
    • Journal
      J Clin Anesth
    • URL
    • Abstract
      STUDY OBJECTIVE: To evaluate the efficiency of dexmedetomidine on the incidence of delirium in patients after cardiac surgery. DESIGN: Meta-analysis of randomized controlled trials. SETTING: Operating room and Intensive Care Unit (ICU). PATIENTS: Ten trials with a total of 1387 patients undergoing cardiac surgery met the inclusion criteria. INTERVENTION: Randomized controlled trials (RCTs) comparing the effect of dexmedetomidine versus non-treatment of dexmedetomidine (normal saline (NS), propofol and other anesthetic drugs) on delirium in patients undergoing cardiac surgery were retrieved from PubMed/Medline, Embase, the Cochrane Library and Web of science. The primary outcome was the incidence of delirium. The secondary outcomes were the rate of bradycardia and hypotension, the duration of mechanical ventilation and the length of ICU and hospital stay. MAIN RESULTS: Compared with the control group, Dexmedetomidine significantly decreased the incidence of postoperative delirium, (risk ratio 0.46; 95% confidence intervals, 0.34 to 0.62; P<0.00001), while the incidence of bradycardia was increased in dexmedetomidine group (risk ratio 1.86; 95% confidence intervals, 1.16 to 2.99; P=0.01). There was no significant difference between groups with regarding to the occurrence of hypotension (risk ratio 0.90; 95% confidence intervals, 0.59 to 1.38; P=0.63), the duration of mechanical ventilation (Mean Difference 0.21; 95% confidence intervals, -0.70 to 1.12; P=0.65), and the length of ICU (Standard Mean Difference-0.07; 95% confidence intervals, -0.19 to 0.06; P=0.3) and hospital stay (Mean Difference-0.13; 95% confidence intervals, -0.56 to 0.30; P=0.56). CONCLUSION: Perioperative dexmedetomidine administration decreased the incidence of delirium in patients after cardiac surgery, but might increase the rate of bradycardia. Furthermore, we did not observe significant differences in the incidence of hypotension, the duration of mechanical ventilation and length of ICU and hospital stay between groups. Future studies are needed to ascertain the effect of dexmedetomidine on the incidence of delirium after coronary artery bypass grafting (CABG) and in patient with cognitive disorder at baseline, whether intraoperative dexmedetomidine infusion could reduce postoperative delirium and the optimal dose of dexmedetomidine.
    • PubMed ID
  • Diabetes and Glucose Dysregulation and Transition to Delirium in ICU Patients. 2018 van Keulen, K. Knol, W. Belitser, S. V. van der Linden, P. D. Heerdink, E. R. Egberts, T. C. G. Slooter, A. J. C.. Crit Care Med,
    • Title

      Diabetes and Glucose Dysregulation and Transition to Delirium in ICU Patients.

    • Authors
      van Keulen, K. Knol, W. Belitser, S. V. van der Linden, P. D. Heerdink, E. R. Egberts, T. C. G. Slooter, A. J. C.
    • Year
      2018
    • Journal
      Crit Care Med
    • URL
    • Abstract
      OBJECTIVES: To investigate whether diabetes and glucose dysregulation (hyperglycemia and/or hypoglycemia) are associated with ICU delirium. DESIGN: Prospective cohort study. SETTING: Thirty-two-bed mixed intensive care in a tertiary care center. PATIENTS: Critically ill patients admitted to the ICU with transitions of mental status from awake and nondelirious to delirious or remaining awake and nondelirious on the next day. Patients admitted because of a neurologic illness were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The study population consisted of 2,745 patients with 1,720 transitions from awake and nondelirious to delirious and 11,421 nontransitions remaining awake and nondelirious. Generalized mixed effects models with logit link function were performed to study the association between diabetes mellitus, glucose dysregulation, and delirium, adjusting for potential confounders. Diabetes was not associated with delirium (odds ratio adjusted, 0.93; 95% CI, 0.73-1.18). In all patients, the occurrence of hyperglycemia (odds ratio adjusted, 1.35; 95% CI, 1.15-1.59) and the occurrence of both hyperglycemia and hypoglycemia on the same day (odds ratio adjusted, 1.65; 95% CI, 1.12-2.28) compared with normoglycemia were associated with transition to delirium. Hypoglycemia was not associated with transition to delirium (odds ratio adjusted, 1.86; 95% CI, 0.73-3.71). In patients without diabetes, the occurrence of hyperglycemia (odds ratio adjusted, 1.41; 95% CI, 1.16-1.68) and the occurrence of both hyperglycemia and hypoglycemia on the same day (odds ratio adjusted, 1.87; 95% CI, 1.07-2.89) were associated with transition to delirium. In patients with diabetes, glucose dysregulation was not associated with ICU delirium. CONCLUSIONS: Diabetes mellitus was not associated with the development of ICU delirium. For hypoglycemia, only a nonsignificant odds ratio for ICU delirium could be noted. Hyperglycemia and the occurrence of hyperglycemia and hypoglycemia on the same day were associated with ICU delirium but only in patients without diabetes. Our study supports the institution of measures to prevent glucose dysregulation in nondiabetic ICU patients and contributes to the understanding of the determinants of delirium.
    • PubMed ID
  • Factors associated with delirium in critical patients in a health institution in Bucaramanga, Colombia. 2018 Torres-Contreras, C. C. Paez-Esteban, A. N. Hinestrosa-Diaz Del Castillo, A. Rincon-Romero, M. K. Amaris-Vega, A. Martinez-Patino, J. P.. Enferm Intensiva,
    • Title

      Factors associated with delirium in critical patients in a health institution in Bucaramanga, Colombia.

    • Authors
      Torres-Contreras, C. C. Paez-Esteban, A. N. Hinestrosa-Diaz Del Castillo, A. Rincon-Romero, M. K. Amaris-Vega, A. Martinez-Patino, J. P.
    • Year
      2018
    • Journal
      Enferm Intensiva
    • URL
    • Abstract
      OBJECTIVE: To determine the incidence and the factors associated with delirium in intensive care unit patients. METHODS: A cohort study conducted on 134 patients in the intensive care unit at a clinic in Bucaramanga, Colombia., who were recruited in the first 24hours following admission and on whom the Richmond Agitation-Sedation Scale (RASS), PRE-DELIRIC version in Spanish, and Confusion Assessment method for Intensive Care Unit (CAM-ICU) were applied; the outcome was evaluated through daily monitoring with CAM-ICU. RESULTS: The incidence of delirium was 20.2%, the predominating type was hypoactive at 66.7%, followed by the hyperactive type at 7.4% and mixed at 25.9%. Fifty-two percent of the patients with delirium died. In the bivariate analysis, the use of sedatives (Relative Risk(RR) 2.4, 95% confidence interval (95% CI) = 1.2-4.5), infection (RR = 2. 8, 95% CI=1.3-5.9), metabolic acidosis (RR = 4 3, 95% CI=2.3-8.0), mechanical ventilation (RR = 4 6, 95% CI=2.0-10.6), aged over 60 years (RR = 2 3, 95% CI=1.09-5.3) and APACHE score greater than 14 (RR = 3. 0) (95% CI=1.1-8.2) were identified as risk factors for delirium. The multivariate analysis only found a relationship with infection (RR = 3 8, 95% CI=1.6-9.1) and being aged over 60 years (RR = 3 2, 95% CI 1.2-8.3). CONCLUSIONS: delirium is frequent in patients in the intensive care unit, especially the hypoactive type. Half of the patients with delirium died. The main risk factors for delirium are infection and being over 60 years age, therefore, delirium prevention activities should focus on these critical patients.
    • PubMed ID
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