Delirium Bibliography

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

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

You may base your search on as many search terms as you like. A search term can be a keyword, an author's name, all or part of an article's title, or any word or phrase that you might expect to find in an article's abstract. You may then indicate whether you would like to limit the search to one or more options.

The results are prioritized so that entries including all search terms will be listed first, but you can indicate whether to then sort by title (the default), by author, by journal name or by publication year.

You may further restrict to a topic category. Note: If you do not enter any search terms, the results will include all of the entries for the selected topic category.

More information about each entry on this page is available by moving the mouse over the green information symbols.

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

Total Results: 2732

  • ICU delirium - a diagnostic and therapeutic challenge in the intensive care unit. 2018 Kotfis, K. Marra, A. Ely, E. W.. Anaesthesiol Intensive Ther, 50:2 (160-7)
    • Title

      ICU delirium - a diagnostic and therapeutic challenge in the intensive care unit.

    • Authors
      Kotfis, K. Marra, A. Ely, E. W.
    • Year
      2018
    • Journal
      Anaesthesiol Intensive Ther
    • URL
    • Abstract
      ICU delirium is a common medical problem occurring in patients admitted to the intensive care units (ICUs). Studies have shown that ICU delirium is associated with increased mortality, prolonged hospitalization, prolonged mechanical ventilation, costs and the occurrence of cognitive disoders after discharge from ICU. The tools available for ICU delirium screening and diagnosis are validated tests available for all members if the medical team (physicians, nurses, physiotherapists). Their use for routine patient assessment is recommended by international medical and scientific societies. They have been implemented as Pain, Agitation, Delirium (PAD) Guidelines by the Society of Critical Care Medicine. Apart from monitoring, a strategy of prevention and treatment is recommended, based on non-pharmacological approach (restoration of senses, early mobilization, physiotherapy, improvement in sleep hygiene and family involvement) as well as pharmacological treatment (typical and atypical antipsychotics and dexmedetomidine). In this article, we present the risk factors of ICU delirium, available tools for monitoring, as well as options for prevention and treatment of delirium that can be used to improve care over critically ill patients.
    • PubMed ID
  • Melatonin and Sleep in Preventing Hospitalized Delirium: A Randomized Clinical Trial. 2018 Jaiswal, S. J. McCarthy, T. J. Wineinger, N. E. Kang, D. Y. Song, J. Garcia, S. van Niekerk, C. J. Lu, C. Y. Loeks, M. Owens, R. L.. American Journal of Medicine,
    • Title

      Melatonin and Sleep in Preventing Hospitalized Delirium: A Randomized Clinical Trial.

    • Authors
      Jaiswal, S. J. McCarthy, T. J. Wineinger, N. E. Kang, D. Y. Song, J. Garcia, S. van Niekerk, C. J. Lu, C. Y. Loeks, M. Owens, R. L.
    • Year
      2018
    • Journal
      American Journal of Medicine
    • URL
    • Abstract
      Purpose: Studies suggest that melatonin may prevent delirium, a condition of acute brain dysfunction occurring in 20%-30% of hospitalized older adults that is associated with increased morbidity and mortality. We examined the effect of melatonin on delirium prevention in hospitalized older adults while measuring sleep parameters as a possible underlying mechanism. Methods: This was a randomized clinical trial measuring the impact of 3mg of melatonin nightly on incident delirium and both objective and subjective sleep in inpatients age ≥65years, admitted to internal medicine wards (non-intensive care units). Delirium incidence was measured by bedside nurses using the confusion assessment method. Objective sleep measurements (nighttime sleep duration, total sleep time per 24hours, and sleep fragmentation as determined by average sleep bout length) were obtained via actigraphy. Subjective sleep quality was measured using the Richards Campbell Sleep Questionnaire. Results: Delirium occurred in 22.2% (8/36) of subjects who received melatonin vs in 9.1% (3/33) who received placebo (P =.19). Melatonin did not significantly change objective or subjective sleep measurements. Nighttime sleep duration and total sleep time did not differ between subjects who became delirious vs those who did not, but delirious subjects had more sleep fragmentation (sleep bout length 7.0 ± 3.0vs 9.5 ± 5.3 min; P =.03). Conclusions: Melatonin given as a nightly dose of 3mg did not prevent delirium in non-intensive care unit hospitalized patients or improve subjective or objective sleep.
    • PubMed ID
  • Intraoperative ketamine administration to prevent delirium or postoperative cognitive dysfunction: A systematic review and meta-analysis. 2018 Hovaguimian, F. Tschopp, C. Beck-Schimmer, B. Puhan, M.. Acta Anaesthesiol Scand,
    • Title

      Intraoperative ketamine administration to prevent delirium or postoperative cognitive dysfunction: A systematic review and meta-analysis.

    • Authors
      Hovaguimian, F. Tschopp, C. Beck-Schimmer, B. Puhan, M.
    • Year
      2018
    • Journal
      Acta Anaesthesiol Scand
    • URL
    • Abstract
      BACKGROUND: Postoperative cognitive complications are associated with substantial morbidity and mortality. Ketamine has been suggested to have neuroprotective effects in various settings. This systematic review evaluates the effects of intraoperative ketamine administration on postoperative delirium and postoperative cognitive dysfunction (POCD). METHODS: Medline, Embase and Central were searched to 4 March 2018 without date or language restrictions. We considered randomised controlled trials (RCTs) comparing intraoperative ketamine administration versus no intervention in adults undergoing surgery under general anaesthesia. Primary outcomes were postoperative delirium and POCD. Non-cognitive adverse events, mortality and length of stay were considered as secondary outcomes. Data were independently extracted. The quality of the evidence (GRADE approach) was assessed following recommendations from the Cochrane collaboration. Risk ratios were calculated for binary outcomes, mean differences for continuous outcomes. We planned to explore the effects of age, specific anaesthesia regimen, depth of anaesthesia and intraoperative haemodynamic events through subgroup analyses. RESULTS: Six RCTs were included. The incidence of postoperative delirium did not differ between groups (4 trials, 557 patients, RR 0.83, 95% CI [0.25, 2.80]), but patients receiving ketamine seemed at lower risk of POCD (3 trials, 163 patients, RR 0.34, 95% CI [0.15, 0.73]). However, both analyses presented limitations. Therefore, the quality of the evidence (GRADE) was deemed low (postoperative delirium) and very low (POCD). CONCLUSION: The effect of ketamine on postoperative delirium remains unclear but its administration may offer some protection towards POCD. Large, well-designed randomised trials are urgently needed to further clarify the efficacy of ketamine on neurocognitive outcomes.
    • PubMed ID
  • The use of clonidine in elderly patients with delirium; pharmacokinetics and hemodynamic responses. 2018 Hov, K. R. Neerland, B. E. Andersen, A. M. Undseth, O. Wyller, V. B. MacLullich, A. M. J. Skovlund, E. Qvigstad, E. Wyller, T. B.. BMC Pharmacol Toxicol, 19:1 (29)
    • Title

      The use of clonidine in elderly patients with delirium; pharmacokinetics and hemodynamic responses.

    • Authors
      Hov, K. R. Neerland, B. E. Andersen, A. M. Undseth, O. Wyller, V. B. MacLullich, A. M. J. Skovlund, E. Qvigstad, E. Wyller, T. B.
    • Year
      2018
    • Journal
      BMC Pharmacol Toxicol
    • URL
    • Abstract
      BACKGROUND: The Oslo Study of Clonidine in Elderly Patients with Delirium (LUCID) is an RCT investigating the effect of clonidine in medical patients > 65 years with delirium. To assess the dosage regimen and safety measures of this study protocol, we measured the plasma concentrations and hemodynamic effects of clonidine in the first 20 patients. METHODS: Patients were randomised to clonidine (n = 10) or placebo (n = 10). The treatment group was given a loading dose (75mug every 3rd hour up to a maximum of 4 doses) to reach steady state, and further 75mug twice daily until delirium free for 2 days, discharge or a maximum of 7 days. Blood pressure (BP) and heart rate (HR) were measured just before every dose. If the systolic BP was < 100 mmHg or HR < 50 beats per minute the next dose was omitted. Plasma concentrations of clonidine were measured 3 h after each drug intake on day 1, just before intake (day 2 and at steady state day 4-6) and 3 h after intake at steady state (Cmax). Our estimated pre-specified plasma concentration target range was 0.3-0.7mug/L. RESULTS: 3 h after the first dose of 75mug clonidine, plasma concentration levels rose to median 0.35 (range 0.24-0.40)mug/L. Median trough concentration (C0) at day 2 was 0.70 (0.47-0.96)mug/L. At steady state, median C0 was 0.47 (0.36-0.76)mug/L, rising to Cmax 0.74 (0.56-0.95)mug/L 3 h post dose. A significant haemodynamic change from baseline was only found at a few time-points during the loading doses within the clonidine group. There was however extensive individual BP and HR variation in both the clonidine and placebo groups, and when comparing the change scores (delta values) between the clonidine and the placebo groups, there were no significant differences. CONCLUSIONS: The plasma concentration of clonidine was at the higher end of the estimated therapeutic range. Hemodynamic changes during clonidine treatment were as expected, with trends towards lower blood pressure and heart rate in patients treated with clonidine, but with dose adjustments based on SBP this protocol appears safe. TRIAL REGISTRATION: ClinicalTrials.gov NCT01956604 , 09.25.2013. EudraCT Number: 2013-000815-26, 03.18.2013. Enrolment of first participant: 04.24.2014.
    • PubMed ID
  • Delirium's Arousal Subtypes and Their Relationship with 6-Month Functional Status and Cognition. 2018 Han, J. H. Hayhurst, C. J. Chandrasekhar, R. Hughes, C. G. Vasilevskis, E. E. Wilson, J. E. Schnelle, J. F. Dittus, R. S. Ely, E. W.. Psychosomatics,
    • Title

      Delirium's Arousal Subtypes and Their Relationship with 6-Month Functional Status and Cognition.

    • Authors
      Han, J. H. Hayhurst, C. J. Chandrasekhar, R. Hughes, C. G. Vasilevskis, E. E. Wilson, J. E. Schnelle, J. F. Dittus, R. S. Ely, E. W.
    • Year
      2018
    • Journal
      Psychosomatics
    • URL
    • Abstract
      Background: We sought to determine how delirium subtyped by arousal affected 6-month function and cognition in acutely ill older patients. Methods: This was secondary analysis of a prospective cohort study which enrolled hospitalized patients ≥65 years old. Delirium and arousal were ascertained daily in the emergency department and the first 7 days of hospitalization using the modified Brief Confusion Assessment Method and Richmond Agitation Sedation Scale, respectively. For each day, patients were categorized as having no delirium, delirium with normal arousal, delirium with decreased arousal, or delirium with increased arousal. Preillness and 6-month functional status were determined using the Older American Resources and Services activities of daily living scale which ranges from 0 (completely dependent) to 28 (completely independent). Preillness and 6-month cognition were determined using the Informant Questionnaire on Cognitive Decline in the Elderly which ranges from 1 (markedly improved cognition) to 5 (severe cognitive impairment). Multiple linear regression was performed adjusted for preillness Older American Resources and Services activities of daily living and Informant Questionnaire on Cognitive Decline in the Elderly and other relevant confounders. Results: In 228 older patients, delirium with normal arousal was the only subtype independently associated with poorer 6-month function and cognition. For every day spent in this subtype, the 6-month Older American Resources and Services activities of daily living decreased by 0.84 points (95% confidence interval: −1.59 to −0.09) and the patient's 6-month Informant Questionnaire on Cognitive Decline in the Elderly significantly increased by 0.14 points (95% confidence interval: 0.06–0.23). Conclusions: Delirium with normal arousal, as opposed to delirium with decreased or increased arousal, was the only arousal subtype significantly associated with worsening 6-month function and cognition. Subtyping delirium by arousal may have important prognostic value.
    • PubMed ID
  • Intraoperative electroencephalogram suppression at lower volatile anaesthetic concentrations predicts postoperative delirium occurring in the intensive care unit. 2018 Fritz, B. A. Maybrier, H. R. Avidan, M. S.. British Journal of Anaesthesia, 121:1 (241-8)
    • Title

      Intraoperative electroencephalogram suppression at lower volatile anaesthetic concentrations predicts postoperative delirium occurring in the intensive care unit.

    • Authors
      Fritz, B. A. Maybrier, H. R. Avidan, M. S.
    • Year
      2018
    • Journal
      British Journal of Anaesthesia
    • URL
    • Abstract
      Background: Postoperative delirium is a common complication associated with increased morbidity and mortality. A recently-reported association between intraoperative electroencephalogram suppression and postoperative delirium might be mediated in some patients by a heightened sensitivity to volatile anaesthetics. Methods: This retrospective cohort study included 618 elective surgery patients with planned intensive care unit admission, who also received intraoperative electroencephalogram monitoring and had delirium assessments documented in the medical record. Sensitivity to volatile anaesthetics was assessed using a mixed effects model predicting the likelihood of electroencephalogram suppression at each time point based on the current end-tidal anaesthetic concentration. Patients with a random intercept above the population median (electroencephalogram suppression at lower anaesthetic concentrations) were classified as having heightened sensitivity to volatile anaesthetics. Delirium was defined as a positive Confusion Assessment Method for the Intensive Care Unit assessment anytime in the first five postoperative days. Results: Postoperative delirium was observed in 162 of 618 patients (26%). Patients who experienced electroencephalogram suppression at lower volatile anaesthetic concentrations had a higher incidence of postoperative delirium [109/309 (35%)] than other patients [53/309 (17%)] [unadjusted odds ratio 2.63; 95% confidence interval (CI), 1.81–3.84, P<0.001]. This association remained significant after adjusting for patient characteristics, surgical variables, and duration of electroencephalogram suppression (adjusted odds ratio 2.13; 95% CI 1.24–3.65, P=0.006). Conclusions: These data support the hypothesis that patients with electroencephalogram suppression at lower volatile anaesthetic concentrations have an increased incidence of postoperative delirium. Such patients appear to exhibit a phenotype of anaesthetic sensitivity, which might predispose them to adverse cognitive outcomes.
    • PubMed ID
  • Efficacy of perioperative dexmedetomidine on postoperative delirium: systematic review and meta-analysis with trial sequential analysis of randomised controlled trials. 2018 Duan, X. Coburn, M. Rossaint, R. Sanders, R. D. Waesberghe, J. V. Kowark, A.. British Journal of Anaesthesia,
    • Title

      Efficacy of perioperative dexmedetomidine on postoperative delirium: systematic review and meta-analysis with trial sequential analysis of randomised controlled trials.

    • Authors
      Duan, X. Coburn, M. Rossaint, R. Sanders, R. D. Waesberghe, J. V. Kowark, A.
    • Year
      2018
    • Journal
      British Journal of Anaesthesia
    • URL
    • Abstract
      Background: Dexmedetomidine's influence on postoperative delirium (POD) in adult surgical patients remains controversial. We aimed to analyse whether dexmedetomidine could decrease POD incidence in this population and to address the dependency on dexmedetomidine administration timing and patients' age. Methods: We used random-effects modelled meta-analysis, trial sequential analysis, and followed Cochrane methodology with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). PubMed and Cochrane library were searched up to July 2017 for randomised controlled trials that analysed POD incidence of adult surgical patients (age ≥18 yr) after dexmedetomidine administration. Results: Eighteen studies (comprising 3309 patients) were included and showed decreased risk of POD with dexmedetomidine for entire adult surgical population [odds ratio (OR) 0.35; 95% confidence interval (CI) 0.24–0.51)], with firm evidence from trial sequential analysis. Pre-specified subgroup analyses confirmed this result with firm evidence for cardiac and non-cardiac surgical patients, (OR 0.41; 95% CI 0.26–0.63) and (OR 0.33; 95% CI 0.18–0.59), respectively. We also revealed firm evidence for a reduction of POD, if dexmedetomidine is administered during postoperative period (OR 0.30; 95% CI 0.21–0.44), in patients aged <65 yr (OR 0.19; 95% CI 0.10–0.36) or ≥65 yr (OR 0.44; 95% CI 0.30–0.65). Evidence for dexmedetomidine's influence on secondary outcomes (in-hospital mortality, intensive care unit- and hospital length of stay, bradycardia, and hypotension) is thus far insufficient to draw any conclusion. Conclusion: Dexmedetomidine may reduce POD incidence for adult cardiac and non-cardiac surgical patients. The optimal dose and timing of dexmedetomidine and influence on other outcomes or particular patient populations with risk factors warrants further studies. Clinical trial registration: PROSPERO: CRD42017072380.
    • PubMed ID
  • Long-term sequelae of acute respiratory distress syndrome caused by severe community-acquired pneumonia: Delirium-associated cognitive impairment and post-traumatic stress disorder. 2018 Denke, C. Balzer, F. Menk, M. Szur, S. Brosinsky, G. Tafelski, S. Wernecke, K. D. Deja, M.. J Int Med Res, 46:6 (2265-83)
    • Title

      Long-term sequelae of acute respiratory distress syndrome caused by severe community-acquired pneumonia: Delirium-associated cognitive impairment and post-traumatic stress disorder.

    • Authors
      Denke, C. Balzer, F. Menk, M. Szur, S. Brosinsky, G. Tafelski, S. Wernecke, K. D. Deja, M.
    • Year
      2018
    • Journal
      J Int Med Res
    • URL
    • Abstract
      Objective Delirium in critically ill patients is considered a risk factor for various long-term consequences. We evaluated delirium and associated long-term outcomes in patients with acute respiratory distress syndrome with non-H1N1 and H1N1- associated severe community-acquired pneumonia (sCAP) who had been recommended to take antiviral drugs associated with delirious symptoms as adverse effects. Methods Of 64 patients, 42 survivors (H1N1, 15; non-H1N1, 27) were analyzed regarding the relationship between medication and the duration of delirium in the intensive care unit. During follow-up (n = 23), we assessed cognitive abilities, post-traumatic stress disorder (PTSD), physical capacity, and health-related quality of life (HRQoL). Results The incidence of delirium was 88%. There was no difference in the incidence and duration of delirium between patients with H1N1 and non-H1N1 infection. The haloperidol and opioid doses were associated with a longer delirium duration. The delirium duration was correlated with reduced cognitive performance in motor skills, memory function, and learning efficiency. Patients with PTSD (16%) had a significantly longer delirium duration and low mental HRQoL. Conclusions H1N1 infection and corresponding antiviral medication had no impact on delirium. The duration of delirium in these patients was associated with impairments in various outcome parameters, illustrating the burden of sCAP.
    • PubMed ID
  • A Performing Arts Intervention Improves Cognitive Dysfunction in 50 Hospitalized Older Adults. 2018 Danila, M. I. Melnick, J. A. Mudano, A. Flood, K. Booth, K. Kirklin, K. Saag, K. G.. Innov Aging, 2:2
    • Title

      A Performing Arts Intervention Improves Cognitive Dysfunction in 50 Hospitalized Older Adults.

    • Authors
      Danila, M. I. Melnick, J. A. Mudano, A. Flood, K. Booth, K. Kirklin, K. Saag, K. G.
    • Year
      2018
    • Journal
      Innov Aging
    • URL
    • Abstract
      Background and Objectives: Arts in medicine programs have emerged as a patient-centered approach that aims to improve health-related quality of life for patients in U.S. hospitals. Storytelling and poetry/monologue recitation are forms of arts-based experiences designed to enhance healing and are delivered by an artist-in-residence. We evaluated the effect of a storytelling/poetry experience on delirium screening scores and patient satisfaction in hospitalized older adults. Research Design and Methods: We conducted an observational pre-post study with a control group in the Acute Care for the Elders (ACE) unit at an academic medical center. A convenience sample of 50 participants was recruited to participate and complete two questionnaires measuring pain, anxiety, general well-being, and distress at hospital admission and at hospital discharge. Multivariable regression models were used to compare delirium screening score (primary outcome) between the control and intervention groups and to adjust for the differences in baseline characteristics between groups. Results: At baseline participants in the intervention group were younger and had significantly lower cognitive impairment compared with those in the control group. Participants exposed to the storytelling/poetry intervention had a lower delirium screening score at hospital discharge compared with those in the control group. The result remained significant after adjusting for age, baseline cognitive impairment, and general well-being. Participants in the intervention group reported a high level of satisfaction with the interaction with the artist delivering the intervention. Discussion and Implications: An artist in residence-delivered storytelling/poetry experience was associated with a lower delirium score at discharge in this pilot study. Further larger studies in diverse inpatient settings are needed to examine whether storytelling/poetry interventions or other types of arts in medicine programs can prevent or reduce delirium in hospitalized older adults.
    • PubMed ID
  • Training students to detect delirium: An interprofessional pilot study 2018 Chambers, B. Meyer, M. Peterson, M.. Nurse Educ Today, (123-7)
    • Title

      Training students to detect delirium: An interprofessional pilot study

    • Authors
      Chambers, B. Meyer, M. Peterson, M.
    • Year
      2018
    • Journal
      Nurse Educ Today
    • URL
    • Abstract
      AIM: The purpose of this paper is to report nursing student knowledge acquisition and attitude after completing and interprofessional simulation with medical students. INTRODUCTION: The IOM has challenged healthcare educators to teach teamwork and communication skills in interprofessional settings. Interprofessional simulation provides a higher fidelity experience than simulation in silos. Simulation may be particularly useful in helping healthcare workers gain the necessary skills to care for psychiatric clients. Specifically, healthcare providers have difficulty differentiating between dementia and delirium. Recognizing this deficit, an interprofessional simulation was created using medical students in their neurology rotation and senior nursing students. METHOD: Twenty-four volunteer nursing students completed a pre-survey to assess delirium knowledge and then completed an education module about delirium. Twelve of these students participated in a simulation with medicine students. Pre and Post Kid SIM Attitude questionnaires were completed by all students participating in the simulation. After the simulations were complete, all twenty-four students were asked to complete the post-survey regarding delirium knowledge. RESULTS: While delirium knowledge scores improved in both groups, the simulation group scored higher, but the difference did not reach significance. The simulation group demonstrated a statistically significant improvement in attitudes toward simulation, interprofessional education, and teamwork post simulation compared to their pre-simulation scores. CONCLUSION: Nursing students who participated in an interprofessional simulation developed a heightened appreciation for learning communication, teamwork, situational awareness, and interprofessional roles and responsibilities. These results support the use of interprofessional simulation in healthcare education.
    • PubMed ID
Page 3 of 274 pages    < 1 2 3 4 5 >  Last ›