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

  • The effect of preoperative cognitive impairment and type of vascular surgery procedure on postoperative delirium with associated cost implications. 2018 Styra, R. Larsen, E. Dimas, M. A. Baston, D. Elgie-Watson, J. Flockhart, L. Lindsay, T. F.. J Vasc Surg,
    • Title

      The effect of preoperative cognitive impairment and type of vascular surgery procedure on postoperative delirium with associated cost implications.

    • Authors
      Styra, R. Larsen, E. Dimas, M. A. Baston, D. Elgie-Watson, J. Flockhart, L. Lindsay, T. F.
    • Year
      2018
    • Journal
      J Vasc Surg
    • URL
    • Abstract
      OBJECTIVE: Postoperative delirium (POD) has a high prevalence among vascular surgery patients, increasing morbidity, mortality, and length of stay. We prospectively studied preoperative risk factors for delirium that can be assessed by the surgical team to identify high-risk patients and assessed its impact on hospital costs. METHODS: There were 173 elective vascular surgery patients assessed preoperatively for cognitive function using the Montreal Cognitive Assessment (MoCA) and the Confusion Assessment Method for POD, which was verified by chart and clinical review. Demographic information, medications, and a history of substance abuse, psychiatric disorders, and previous delirium were prospectively recorded. An accompanying retrospective chart review of an additional 434 (elective and emergency) vascular surgery patients provided supplemental cost information related to sitter use and prolonged hospitalization secondary to three factors: delirium alone, dementia alone, and delirium and dementia. RESULTS: Prospective screening of 173 patients (73.4% male; age, 69.9 +/- 10.97 years) identified that 119 (68.8%) had MoCA scores <24, indicating cognitive impairment, with 7.5% having severe impairment (dementia). Patients who underwent amputation had significantly (P < .000) lower MoCA scores (17 of 30) compared with open surgery and endovascular aneurysm repair patients (23.7 of 30). The incidence of delirium was 11.6% in the elective cohort. Regression analysis identified predictors of delirium to be type of surgical procedure, including lower limb amputation (odds ratio [OR], 16.67; 95% confidence interval [CI], 3.41-71.54; P < .000) and open aortic repair (OR, 5.33; 95% CI, 1.91-14.89; P < .000); cognitive variables (dementia: OR, 5.63; 95% CI, 2.08-15.01; P < .001); MoCA scores 200 hours (8.3 days), accounting for 69.7% of sitter costs for the surgical unit; 43.7% of costs were accounted for by patients with pre-existing cognitive impairment. CONCLUSIONS: POD is predicted by type of vascular surgery procedure, impaired cognition (MoCA), and previous delirium. Costs and morbidity related to delirium are greatest for those with impaired cognitive burden. Preoperative MoCA screening can identify those at highest risk, allowing procedure modification and informed care.
    • PubMed ID
  • Rate and risk factors for a hyperactivity delirium in patients with aneurysmal subarachnoid haemorrhage. 2018 Sauvigny, T. Mohme, M. Grensemann, J. Duhrsen, L. Regelsberger, J. Kluge, S. Schmidt, N. O. Westphal, M. Czorlich, P.. Neurosurg Rev,
    • Title

      Rate and risk factors for a hyperactivity delirium in patients with aneurysmal subarachnoid haemorrhage.

    • Authors
      Sauvigny, T. Mohme, M. Grensemann, J. Duhrsen, L. Regelsberger, J. Kluge, S. Schmidt, N. O. Westphal, M. Czorlich, P.
    • Year
      2018
    • Journal
      Neurosurg Rev
    • URL
    • Abstract
      Hyperactive delirium (agitation) is a common complication in patients on intensive care units and can be assessed by the Richmond Agitation and Sedation Scale (RASS) in principle. However, the role of agitation in patients with aneurysmal subarachnoid haemorrhage (SAH) is poorly understood. We performed a retrospective analysis to identify risk factors for the development of a hyperactive delirium and its functional consequences for neurological outcome. Three hundred thirty-eight patients with SAH were screened in this study resulting in 212 patients which reached at least once a RASS of 0 and were eligible for further analysis. Clinical characteristics were analysed towards the occurrence of a hyperactive delirium. Neurological outcome at discharge and follow-up was assessed using the Glasgow Outcome Scale. Seventy-eight of 212 patients (36.8%) developed a hyperactive delirium; the duration ranged from 1 to 11 days. Multivariate regression revealed initial hydrocephalus (odds ratio (OR) 3.21 95% confidence interval (CI) [1.33-7.70]; p = 0.01), microsurgical clipping (OR 3.70 95%CI 1.71-8.01]; p = 0.001), male gender (OR 1.97 95%CI [1.05-3.85]; p = 0.047) and a higher Graeb score (OR 1.11 95%CI [1.00-1.22]; p = 0.043) to be significantly associated with the development of agitation. Medical history of psychiatric disorders, alcohol or nicotine abuse showed no correlation with agitation. Cox regression analysis revealed no significant influence of agitation towards unfavourable outcome at discharge or follow-up. We provide four independent risk factors for the development of agitation in SAH patients. Our study emphasizes the specific entity of agitation in patients with SAH and underscores its relevance in neurological patients.
    • PubMed ID
  • Delirium in Postoperative Patients Admitted to the Intensive Care Unit. 2018 Romanauski, T. R. Martin, E. E. Sprung, J. Martin, D. P. Schroeder, D. R. Weingarten, T. N.. Am Surg, 84:6 (875-880)
    • Title

      Delirium in Postoperative Patients Admitted to the Intensive Care Unit.

    • Authors
      Romanauski, T. R. Martin, E. E. Sprung, J. Martin, D. P. Schroeder, D. R. Weingarten, T. N.
    • Year
      2018
    • Journal
      Am Surg
    • URL
    • Abstract
      Postoperative delirium (POD) is common among surgical patients admitted to the intensive care unit (ICU) and is associated with increased resource utilization, morbidity, and death. Our primary aim was to compare rates of POD using administrative International Classification of Diseases, Ninth Revision, records and automated interrogation of electronic health records from Confusion Assessment Method for the ICU (CAM-ICU) screening. The secondary aim was to assess POD risk associated with patient and perioperative characteristics. Electronic health records of surgical patients admitted to the ICU during 2011 through 2014 were abstracted for POD assessment by CAM-ICU and by administrative codes, Charlson comorbidity index, surgical characteristics, and Acute Physiology, Age, Chronic Health Evaluation III scores. Of 6338 patients, CAM-ICU identified 606 (9.6%) and administrative records identified 55 (0.9%) POD cases, with agreement on 50 cases. In multivariable logistic regression based on POD identified with CAM-ICU, preexisting dementia had the strongest association with POD (odds ratio [95% confidence interval], 6.47 [3.68-11.37]; P < 0.001). Other associations found were older age, congestive heart failure, chronic pulmonary disease, increased surgical duration, emergency cases, blood transfusions, postoperative ventilation, and higher Acute Physiology, Age, Chronic Health Evaluation III scores (all P
    • PubMed ID
  • Degree of implementation of preventive strategies for post-ICU syndrome: Multi-centre, observational study in Spain. 2018 Raurell-Torreda, M. Arias-Rivera, S. Marti, J. D. Frade-Mera, M. J. Zaragoza-Garcia, I. Gallart, E. Velasco-Sanz, T. R. San Jose-Arribas, A. Blazquez-Martinez, E.. Enferm Intensiva,
    • Title

      Degree of implementation of preventive strategies for post-ICU syndrome: Multi-centre, observational study in Spain.

    • Authors
      Raurell-Torreda, M. Arias-Rivera, S. Marti, J. D. Frade-Mera, M. J. Zaragoza-Garcia, I. Gallart, E. Velasco-Sanz, T. R. San Jose-Arribas, A. Blazquez-Martinez, E.
    • Year
      2018
    • Journal
      Enferm Intensiva
    • URL
    • Abstract
      AIM: To evaluate the degree of implementation of protocols associated with the prevention of intensive-care-unit (ICU) acquired muscle weakness, and the presence of the physiotherapist in various ICU in Spain. METHOD: A descriptive, cross-sectional study performed in 86 adult ICU in Spain between March and June 2017. Neurosurgical and major burns ICU were excluded. A multiple-choice survey was used that included questions on protocols for glycaemia control, sedation, pain assessment, delirium prevention, delirium management and early mobilisation. The survey was completed using a user-protected application and password. The Student's t-test or Mann-Whitney U test and Pearson's correlation or Spearman's Rho test were used for the inferential analysis. RESULTS: Eighty-nine point five percent of the ICU had a glycaemia control protocol, with a predominating range of 110-140mg/dl. Seventy-four point four percent evaluated sedation levels, although only 36% had sedation protocols. Pain assessment was carried out on communicative patients in 73.7%, and on uncommunicative patients in only 47.5%. Only 37.2% performed daily screening to detect delirium and 31.4% of the ICU had delirium prevention protocols, 26.7% had delirium management protocols and 14% had protocols for early mobilisation. Thirty-four point nine percent requested cross consultation with the rehabilitation department. CONCLUSIONS: The implementation of the different protocols associated with the prevention of ICU-acquired muscle weakness was high in relation to glycaemia control protocols, sedation level and pain assessment in communicative patients, and was low for early mobilisation and delirium screening and prevention. Similarly, the physiotherapist was seldom present in the ICU.
    • PubMed ID
  • Surgical delay is a risk factor of delirium in hip fracture patients with mild-moderate cognitive impairment. 2018 Pioli, G. Bendini, C. Giusti, A. Pignedoli, P. Cappa, M. Iotti, E. Ferri, M. A. Bergonzini, E. Sabetta, E.. Aging Clin Exp Res,
    • Title

      Surgical delay is a risk factor of delirium in hip fracture patients with mild-moderate cognitive impairment.

    • Authors
      Pioli, G. Bendini, C. Giusti, A. Pignedoli, P. Cappa, M. Iotti, E. Ferri, M. A. Bergonzini, E. Sabetta, E.
    • Year
      2018
    • Journal
      Aging Clin Exp Res
    • URL
    • Abstract
      AIM: To investigate the relationship between onset of delirium and time to surgery in hip fracture (HF) patients with a different degree of cognitive impairment. METHODS: Retrospective analysis of a prospective database of 939 older adults, aged >/= 75 years admitted with a fragility HF. Subjects underwent a Comprehensive Geriatric Assessment on admission, evaluating health status, prefracture functional status in basic and instrumental activities of daily living, and walking ability. According to the Short Portable Mental Status Questionnaire score, patients were stratified into three categories: cognitively healthy (0-2 errors), mildly to moderately impaired (3-7 errors) and severely impaired (8-10 errors). Time to surgery (from admission) was expressed as days. The occurrence of delirium was ascertained daily by Confusion Assessment Method. RESULTS: Two hundred ninety-two (31.1%) patients experienced delirium during in-hospital stay. They were older, with a higher degree of comorbidity and functional impairment compared to patients without delirium. In multivariate analysis, surgical delay resulted a significant independent risk factor for delirium (HR 1.11, 95% CI 1.01-1.24), along with age, prefracture functional disability and cognitive impairment. When the analysis was performed accounting for the cognitive categories, surgical delay demonstrated to increase the risk of delirium only in the subcategory of mildly to moderately impaired patients, while no significant effect was demonstrated in patients cognitively healthy or severely impaired. CONCLUSIONS: The study supports the concept that older adults with HF should undergo surgery quickly. Patients with mild-to-moderate cognitive impairment should be primarily considered as the best target for interventions aiming to reduce time to surgery.
    • PubMed ID
  • Predictors of Delirium Development in Older Medical Inpatients: Readily Identifiable Factors at Admission. 2018 O’Regan, Niamh A. Fitzgerald, James Adamis, Dimitrios Molloy, David William Meagher, David Timmons, Suzanne Montero-Odasso, Manuel. Journal of Alzheimer's Disease, 64:3 (775-785)
    • Title

      Predictors of Delirium Development in Older Medical Inpatients: Readily Identifiable Factors at Admission.

    • Authors
      O’Regan, Niamh A. Fitzgerald, James Adamis, Dimitrios Molloy, David William Meagher, David Timmons, Suzanne Montero-Odasso, Manuel
    • Year
      2018
    • Journal
      Journal of Alzheimer's Disease
    • URL
    • Abstract
      Background: Identifying patients at high risk of delirium is crucial to facilitate prevention. Although dementia is the most consistent risk factor across populations, it remains under-diagnosed. Hence understanding other markers of delirium vulnerability on admission is important.Objective: We aimed to identify predictors of incident delirium development in older medical inpatients that were readily identifiable at presentation to the emergency department.Methods: Medical inpatients of ≥70 years were assessed on admission for delirium using the Revised Delirium Rating Scale (DRS-R98) and those with prevalent delirium were excluded. Consenting non-delirious patients were then assessed daily using the DRS-R98. Data pertaining to multiple baseline delirium risk factors were collected, including pre-morbid dementia. Multivariable logistic regression was used to examine which factors predicted the development of incident delirium.Results: Of 555 patients approached, 184 (33.1%) had prevalent delirium. Following other exclusions, 191 were included in the study and 61 developed incident delirium. Predictors of incident delirium on multivariable analysis, controlling for confounders, were dementia (OR 2.54, 95% CI 1.01-6.43, p = 0.048); Barthel Index score (OR 1.15 for each unit decrease in score, 95% CI 1.06-1.25, p = 0.001), and Modified Cumulative Illness Rating Scale score (OR 1.13 for each unit increase in score, 95% CI 1.05-1.22, p = 0.001).Conclusion: Dementia is a well-known risk factor for delirium; however, it too is under-recognized and on admission can be missed. Conversely, the Barthel Index is a simple and widely used measure of functional ability that may prove useful in stratifying those at risk of in-hospital delirium on admission.
    • PubMed ID
  • Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis. 2018 MacKenzie, K. K. Britt-Spells, A. M. Sands, L. P. Leung, J. M.. Anesthesiology,
    • Title

      Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis.

    • Authors
      MacKenzie, K. K. Britt-Spells, A. M. Sands, L. P. Leung, J. M.
    • Year
      2018
    • Journal
      Anesthesiology
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction. METHODS: A systematic search for randomized controlled trials was conducted using Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, and Google search using the keywords processed electroencephalogram, Bispectral Index, postoperative delirium, postoperative cognitive dysfunction. Screening and data extraction were conducted by two independent reviewers, and risk of bias was assessed. Postoperative delirium combined-effect estimates calculated with a fixed-effects model were expressed as odds ratios with 95% CIs. RESULTS: Thirteen of 369 search results met inclusion criteria. Postoperative cognitive dysfunction data were excluded in meta-analysis because of heterogeneity of outcome measurements; results were discussed descriptively. Five studies were included in the quantitative postoperative delirium analysis, with data pooled from 2,654 patients. The risk of bias was low in three studies and unclear for the other two. The use of processed electroencephalogram-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium (odds ratio = 0.62; P < 0.001; 95% CI, 0.51 to 0.76). CONCLUSIONS: Processed electroencephalogram-guided anesthesia was associated with a decrease in postoperative delirium. The mechanism explaining this association, however, is yet to be determined. The data are insufficient to assess the relationship between processed electroencephalogram monitoring and postoperative cognitive dysfunction.
    • PubMed ID
  • The influence of oxygen delivery during cardiopulmonary bypass on the incidence of delirium in CABG patients; a retrospective study 2018 Leenders, J. Overdevest, E. van Straten, B. Golab, H.. Perfusion,
    • Title

      The influence of oxygen delivery during cardiopulmonary bypass on the incidence of delirium in CABG patients; a retrospective study

    • Authors
      Leenders, J. Overdevest, E. van Straten, B. Golab, H.
    • Year
      2018
    • Journal
      Perfusion
    • URL
    • Abstract
      INTRODUCTION: Postoperative delirium is the most common neurological complication of cardiac surgery. Hypoxia has been shown to increase the risk of postoperative delirium. The possibility to continuously monitor oxygen delivery (DO2) during cardiopulmonary bypass (CPB) offers an adequate approximation of the oxygen status in a patient. This study investigates the role of oxygen delivery during cardiopulmonary bypass in the incidence of postoperative delirium. METHODS: Three hundred and fifty-seven adult patients who underwent normothermic coronary artery bypass grafting (CABG) surgery were included in this retrospective study. The nadir indexed DO2 (DO2i) value on bypass, the total time under the critical DO2i level and the area under the curve (AUC) for critical DO2i were determined. Delirium was identified by the postoperative administration of haloperidol. RESULTS: The mean nadir DO2i significantly differed, comparing the group of patients with postoperative delirium to the group without. Multivariate analysis only identified age, pre-existing cognitive impairment, preoperative kidney dysfunction and cross-clamp time as independent risk factors for delirium. The results also indicated that patients of older age were more sensitive to a declined DO2i. CONCLUSION: A low DO2i during cardiopulmonary bypass is significantly associated with the incidence of postoperative delirium in CABG patients. However, the role of DO2 as an independent predictor of delirium could not be proven.
    • PubMed ID
  • Safety of brotizolam in hospitalized patients. 2018 Lavon, O. Bejel, S.. European Journal of Clinical Pharmacology, 74:7 (939-943)
    • Title

      Safety of brotizolam in hospitalized patients.

    • Authors
      Lavon, O. Bejel, S.
    • Year
      2018
    • Journal
      European Journal of Clinical Pharmacology
    • URL
    • Abstract
      Purpose: The objective of this study was to evaluate the safety of brotizolam in hospitalized patients. Methods: A single-center, comparative retrospective cohort analysis of patients hospitalized in internal medicine wards. Patients treated with brotizolam were compared to patients not treated with any benzodiazepines during hospitalization. Primary outcome was any of the following safety events: mechanical ventilation, delirium, and falls. Results: Six hundred patients were included after exclusion in the final analysis; 300 treated with brotizolam (treatment) and 300 not treated with any benzodiazepines (comparator). The brotizolam-treated patients were older with more comorbidities and psychotropic medications. After adjustment using multivariate logistic regression analysis with propensity score, the primary outcomes occurred at significantly higher rates in treated patients than in untreated patients (17 vs. 2 events; OR = 7.33). Any psychotropic medication administered during hospitalization was found by logistic regression to be the main independent risk factor for the studied safety outcomes while age, comorbidities, and the cause of hospitalization were not. Conclusions: Treatment with brotizolam during hospitalization in internal medicine wards is linked to a higher risk of respiratory deterioration, delirium, and falls. Use of psychotropic medications during hospitalization is the main independent risk factor of safety outcomes. Further research is needed to fully evaluate the risks and benefits of sleep induction medications in hospitals.
    • PubMed ID
  • Early delirium after cardiac surgery: An analysis of incidence and risk factors in elderly (≥65 years) and very elderly (≥80 years) patients. 2018 Kotfis, K. Szylińska, A. Listewnik, M. Strzelbicka, M. Brykczyński, M. Rotter, I. Żukowski, M.. Clinical Interventions in Aging, (1061-1070)
    • Title

      Early delirium after cardiac surgery: An analysis of incidence and risk factors in elderly (≥65 years) and very elderly (≥80 years) patients.

    • Authors
      Kotfis, K. Szylińska, A. Listewnik, M. Strzelbicka, M. Brykczyński, M. Rotter, I. Żukowski, M.
    • Year
      2018
    • Journal
      Clinical Interventions in Aging
    • URL
    • Abstract
      Introduction: Postoperative delirium is a common complication of cardiac surgery associated with increased mortality, morbidity, and long-term cognitive dysfunction. The aim of this study was to identify incidence and risk factors of delirium in elderly (≥65 years) and very elderly (≥80 years) patients undergoing major cardiac surgery. Materials and methods: We performed a retrospective cohort analysis of prospectively collected data from a register of the cardiac surgery department of a tertiary referral university hospital between 2014 and 2016. Analysis was performed in two groups, ≥65 years and ≥80 years. Results: We analyzed 1,797 patients ≥65 years, including 230 (7.24%) patients ≥80 years. Delirium was diagnosed in 21.4% (384/1,797) of patients above 65 years, and in 33.5% (77/230) of octogenarians. Early mortality did not differ between patients with and without delirium. Intensive care unit (ICU) stay (p<0.001), hospital stay (p<0.001), and intubation time (p=0.002) were significantly longer in patients undergoing cardiac surgery ≥65 years with delirium. According to multivariable analysis, ≥65 years, age (odds ratio [OR] 1.036, p=0.002), low ejection fraction (OR 1.634, p=0.035), diabetes (1.346, p=0.019), and extracardiac arteriopathy (OR 1.564, p=0.007) were found to be independent predictors of post-cardiac surgery delirium. Postoperative risk factors for developing delirium ≥65 years were atrial fibrillation (1.563, p=0.001), postoperative pneumonia (OR 1.896, p=0.022), elevated postoperative creatinine (OR 1.384, p=0.004), and prolonged hospitalization (OR 1.019, p=0.009). Conclusion: Patients above 65 years of age with postoperative delirium have poorer outcome and are more likely to have prolonged hospitalization and ICU stay, and longer intubation times, but 30-day mortality is not increased. In our study, eight independent risk factors for development of post-cardiac surgery delirium were age, low ejection fraction, diabetes, extracardiac arteriopathy, postoperative atrial fibrillation, pneumonia, elevated creatinine, and prolonged hospitalization time.
    • PubMed ID
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