Delirium Bibliography

**The Delirium Bibliography is moving!**

 

We're excited to announce that the Delirium Bibliography has been moved to the Network for Investigation of Delirium: Unifying Scientists (NIDUS) website! The new bibliography includes well over 3,000 references on delirium and acute care for elders in addition to new references on pediatric delirium, as well. Articles in the new bibliography are still indexed by keywords taken from MEDLINE and other relevant databases, and they can be easily browsed with a search function. Questions? Email margaretwebb@hsl.harvard.edu

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: 3263

  • Frailty and hospital outcomes within a low socioeconomic population. 2019 Clark, S. Shaw, C. Padayachee, A. Howard, S. Hay, K. Frakking, T. T.. QJM, 112:12 (907-913)
    • Title

      Frailty and hospital outcomes within a low socioeconomic population.

    • Authors
      Clark, S. Shaw, C. Padayachee, A. Howard, S. Hay, K. Frakking, T. T.
    • Year
      2019
    • Journal
      QJM
    • URL
    • Abstract
      BACKGROUND: Clinical frailty scales (CFS) predict hospital-related outcomes. Frailty is more common in areas of higher socioeconomic disadvantage, but no studies exclusively report on the impact of CFS on hospital-related outcomes in areas of known socioeconomic disadvantage. AIMS: To evaluate the association of the CFS with hospital-related outcomes. DESIGN: Retrospective observational study in a community hospital within a disadvantaged area in Australia (Social Economic Index for Areas = 0.1%). METHODS: The CFS was used in the emergency department (ED) for people aged >/= 75 years. Frailty was defined as a score of >/=4. Associations between the CFS and mortality, admission rates, ED presentations and length of stay (LOS) were analysed using regression analyses. RESULTS: Between 11 July 2017 and 31 March 2018, there were 5151 ED presentations involving 3258 patients aged >/= 75 years. Frail persons were significantly more likely to be older, represent to the ED and have delirium compared with non-frail persons. CFS was independently associated with 28-day mortality, with odds of mortality increasing by 1.5 times per unit increase in CFS (95% CI: 1.3-1.7). Frail persons with CFS 4-6 were more likely to be admitted (OR: 1.2; 95% CI: 1.0-1.5), have higher geometric mean LOS (1.43; 95% CI 1.15-1.77 days) and higher rates of ED presentations (IRR: 1.12; 95% CI 1.04-1.21) compared with non-frail persons. CONCLUSIONS: The CFS predicts community hospital-related outcomes in frail persons within a socioeconomic disadvantage area. Future intervention and allocation of resources could consider focusing on CFS 4-6 as a priority for frail persons within a community hospital setting.
    • PubMed ID
  • Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis. 2019 Chen, D. X. Yang, L. Ding, L. Li, S. Y. Qi, Y. N. Li, Q.. Medicine, 98:49 (e18220)
    • Title

      Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis.

    • Authors
      Chen, D. X. Yang, L. Ding, L. Li, S. Y. Qi, Y. N. Li, Q.
    • Year
      2019
    • Journal
      Medicine
    • URL
    • Abstract
      BACKGROUND: Previous meta-analyses assessing anesthetic techniques in adult patients undergoing hip fractures surgery are available. However, whether the anesthetic technique is associated with risk of mortality and complications in geriatric patients with hip fractures remains unclear. This study was conducted to assess postoperative outcomes of anesthesia technique in geriatric patients undergoing hip fracture surgery. METHODS: Cochrane Library, PubMed, EMBASE, MEDLINE, CNKI, and CBM were searched from inception up to May 25, 2018. Observational studies and randomized controlled trials (RCTs) that assessed the perioperative outcomes of technique of anesthesia (general or regional [epidural/spinal/neuraxial]) in geriatric patients (>/=60 years old) undergoing hip fracture surgery were included. Two investigators independently screened studies for inclusion and performed data extraction. Heterogeneity was assessed by the I and Chi-square tests. The odds ratio (OR) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CI) were calculated to assess the pooled data. RESULTS: Eleven retrospective and 2 RCTs were included. There was no difference in 30-day mortality (OR = 0.96; 95% CI 0.86-1.08; P = .51) between the general and regional anesthesia groups. In-hospital mortality (OR = 1.26; 95% CI 1.17-1.36; P < .001), acute respiratory failure (OR = 2.66; 95% CI 2.34-3.02; P < .001), length of hospital stay (MD = 0.33; 95% CI 0.24-0.42; P < .001), and readmission (OR = 1.09; 95% CI 1.01-1.18; P = .03) were significantly reduced in the regional anesthesia group. Pneumonia (OR = 0.99; 95% CI 0.91-1.07; P = .79), heart failure (OR = 0.97; 95% CI 0.86-1.09; P = .62), acute myocardial infraction (OR = 1.07; 95% CI 0.99-1.16; P = .10), acute renal failure (OR = 1.32; 95% CI 0.97-1.79; P = .07), cerebrovascular accident (OR = 1.08; 95% CI 0.82-1.42; P = .58), postoperative delirium (OR = 1.51; 95% CI 0.16-13.97; P = .72), and deep vein thrombosis/pulmonary embolism (OR = 1.42; 95% CI 0.84-2.38; P = .19) were similar between the two anesthetic techniques. CONCLUSION: General anesthesia is associated with increased risk of in-hospital mortality, acute respiratory failure, longer hospital stays, and higher readmission. There is evidence to suggest that regional anesthesia is associated with improved perioperative outcomes. Large RCTs are needed to explore the most optimal anesthetic techniques for geriatric patients with hip fractures before drawing final conclusions. PROSPERO REGISTRATION NUMBER: CRD42018093582.
    • PubMed ID
  • Postoperative delirium is associated with increased plasma neurofilament light. 2019 Casey, C. P. Lindroth, H. Mohanty, R. Farahbakhsh, Z. Ballweg, T. Twadell, S. Miller, S. Krause, B. Prabhakaran, V. Blennow, K. Zetterberg, H. Sanders, R. D.. Brain,
    • Title

      Postoperative delirium is associated with increased plasma neurofilament light.

    • Authors
      Casey, C. P. Lindroth, H. Mohanty, R. Farahbakhsh, Z. Ballweg, T. Twadell, S. Miller, S. Krause, B. Prabhakaran, V. Blennow, K. Zetterberg, H. Sanders, R. D.
    • Year
      2019
    • Journal
      Brain
    • URL
    • Abstract
      While delirium is associated with cognitive decline and dementia, there is limited evidence to support causality for this relationship. Clarification of how delirium may cause cognitive decline, perhaps through evidence of contemporaneous neuronal injury, would enhance plausibility for a causal relationship. Dose-dependence of neuronal injury with delirium severity would further enhance the biological plausibility for this relationship. We tested whether delirium is associated with neuronal injury in 114 surgical patients recruited to a prospective biomarker cohort study. Patients underwent perioperative testing for changes in neurofilament light, a neuronal injury biomarker, as well as a panel of 10 cytokines, with contemporaneous assessment of delirium severity and incidence. A subset of patients underwent preoperative MRI. Initially we confirmed prior reports that neurofilament light levels correlated with markers of neurodegeneration [hippocampal volume (ΔR2 = 0.129, P = 0.015)] and white matter changes including fractional anisotropy of white matter (ΔR2 = 0.417, P < 0.001) with similar effects on mean, axial and radial diffusivity) in our cohort and that surgery was associated with increasing neurofilament light from preoperative levels [mean difference (95% confidence interval, CI) = 0.240 (0.178, 0.301) log10 (pg/ml), P < 0.001], suggesting putative neuronal injury. Next, we tested the relationship with delirium. Neurofilament light rose more sharply in participants with delirium compared to non-sufferers [mean difference (95% CI) = 0.251 (0.136, 0.367) log10 (pg/ml), P < 0.001]. This relationship showed dose-dependence, such that neurofilament light rose proportionately to delirium severity (ΔR2 = 0.199, P < 0.001). Given that inflammation is considered an important driver of postoperative delirium, next we tested whether neurofilament light, as a potential marker of neurotoxicity, may contribute to the pathogenesis of delirium independent of inflammation. From a panel of 10 cytokines, the pro-inflammatory cytokine IL-8 exhibited a strong correlation with delirium severity (ΔR2 = 0.208, P < 0.001). Therefore, we tested whether the change in neurofilament light contributed to delirium severity independent of IL-8. Neurofilament light was independently associated with delirium severity after adjusting for the change in inflammation (ΔR2 = 0.040, P = 0.038). These data suggest delirium is associated with exaggerated increases in neurofilament light and that this putative neurotoxicity may contribute to the pathogenesis of delirium itself, independent of changes in inflammation.
    • PubMed ID
  • An Evaluation of Risperidone Dosing for Pediatric Delirium in Children Less Than or Equal to 2 Years of Age. 2019 Campbell, C. T. Grey, E. Munoz-Pareja, J. Manasco, K. B.. Annals of Pharmacotherapy,
    • Title

      An Evaluation of Risperidone Dosing for Pediatric Delirium in Children Less Than or Equal to 2 Years of Age.

    • Authors
      Campbell, C. T. Grey, E. Munoz-Pareja, J. Manasco, K. B.
    • Year
      2019
    • Journal
      Annals of Pharmacotherapy
    • URL
    • Abstract
      Background: Risperidone dosing and safety data are limited in patients ≤2 years of age. Objective: To describe the dosing strategies, safety, and tolerability of risperidone in infants ≤2 years of age. Methods: An institutional review board–approved retrospective study was conducted in a 24-bed pediatric intensive care unit at an academic medical center in patients ≤2 years of age receiving risperidone for the management of ICU delirium. The primary outcome was mean initial daily dose of risperidone. Secondary outcomes included mean daily dose, dosing frequency, treatment duration, and adverse effects. Results: Seventeen patients who received at least 1 dose of risperidone were included in the study. The initial daily dose ranged from 0.1 to 0.25 mg (0.01-0.04 mg/kg), with a mean of 0.17 mg (0.02 mg/kg). Most patients were initiated on once-daily dosing (76.5%) versus twice-daily dosing (17.6%). More than 80% of patients required a dose increase during therapy. Median daily doses of fentanyl, morphine, ketamine, and midazolam were decreased following initiation of risperidone. No adverse events that led to discontinuation of risperidone were reported. Conclusion and Relevance: Risperidone was found to be safe and well tolerated at daily doses of risperidone of 0.1 to 0.25 mg in 1 or 2 doses per day in patients ≤2 years old for the management of ICU delirium. To our knowledge, these results provide the largest cohort describing dosing recommendations specific for risperidone in this age group. Further investigation on the effect of antipsychotic administration on other sedation and analgesic regimens is necessary.
    • PubMed ID
  • Inpatient Rehabilitation Delirium Screening: Impact on Acute Care Transfers and Functional Outcomes. 2019 Bushi, S. Barrett, A. M. Oh-Park, M.. PM&R,
    • Title

      Inpatient Rehabilitation Delirium Screening: Impact on Acute Care Transfers and Functional Outcomes.

    • Authors
      Bushi, S. Barrett, A. M. Oh-Park, M.
    • Year
      2019
    • Journal
      PM&R
    • URL
    • Abstract
      INTRODUCTION: Delirium is well studied in the acute care setting, but there is limited understanding of its impact in the post-acute care setting, particularly in the inpatient rehabilitation facility (IRF). OBJECTIVE: To investigate the prevalence and related outcomes of delirium in the IRF setting, particularly patients' transfers to acute care hospitals. DESIGN: Retrospective cohort study SETTING: A freestanding IRF PARTICIPANTS: Patients discharged from an IRF between January 2016 and December 2016 (12 months) INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Transfer to acute care hospitals, motor and cognitive Functional Independence Measures (FIM), length of stay, discharge disposition RESULTS: A total of 1,567 patients (53.86% female, mean age 72.86 +/- 13.9) were included in the analysis. Positive scores were found among 142 (9.1%) patients on a 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM), indicating delirium on admission. Fifty-nine (3.8%) were un-scorable on 3D-CAM. Twice as many delirium patients were transferred to acute care hospitals compared to non-delirium patients (22.5% versus 10.8%, P<.001). Multi-variate logistic regression showed that, for patients with 3D-CAM positive scores, there was an increased risk of transfers to acute care hospitals at an odds ratio of 1.61 (1.03-2.53, P=.04) after adjusting for age, gender, neurological diagnosis, and motor FIM score. The delirium group also showed lower gains in motor function, increased lengths of stay, and reduced discharges to home when compared to the non-delirium group (P<.001). CONCLUSIONS: This study finds that delirium on admission to an IRF is associated with worsened outcomes related to function, length of stay, discharge status and transfer to acute care hospitals. Positive delirium screening is an independent predictor for transfer to acute care hospitals from an IRF. Early identification of delirium is recommended in order to mitigate preventable transfers. LEVEL OF EVIDENCE: III This article is protected by copyright. All rights reserved.
    • PubMed ID
  • Routine Management of Postoperative Delirium Outside the ICU: Results of an International Survey among Anaesthesiologists. 2019 Bilotta, F. Weiss, B. Neuner, B. Kramer, S. Aldecoa, C. Bettelli, G. Sanders, R. D. Delp, S. M. Spies, C. D.. Acta Anaesthesiol Scand,
    • Title

      Routine Management of Postoperative Delirium Outside the ICU: Results of an International Survey among Anaesthesiologists.

    • Authors
      Bilotta, F. Weiss, B. Neuner, B. Kramer, S. Aldecoa, C. Bettelli, G. Sanders, R. D. Delp, S. M. Spies, C. D.
    • Year
      2019
    • Journal
      Acta Anaesthesiol Scand
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium is a severe brain dysfunction. Although data indicates a high relevance, no survey has investigated the routine practice to monitor delirium outside the ICU setting after surgery. Prior to publishing of the new ESA guidelines on postoperative delirium, a international survey was conducted to assess current practice. METHODS: ESA-endorsed online survey; Trial Registration: NCT-identifier: 02513537 RESULTS: In total 566 respondents from 62 countries accessed, and 564 (99.6%) completed the survey (completion-rate). Overall 385 (68%) of the respondents reported that delirium is either "very relevant" or "relevant" for their daily clinical practice. Thirty-eight (7%) of the respondents routinely monitor for delirium in > 50% of all patients. Asked on the monitoring time point more than half (n=308, 55%) indicated to screen before or at recovery-room discharge, 235 (42%) up to the first postoperative day, 143 (25%) up to three days, and 77 (14%) up to five postoperative days. Although there is a lack of long-term monitoring, nearly all respondents (n=530, 94%) reported to treat delirium. Availability of EEG/EMG-based monitoring to assess the depth of anaesthesia was high in the study group (n=547, 97%) and was used by more than one third of the respondents to reduce risk of burst suppression (n=189, 34%). CONCLUSION: Although delirium is perceived as a relevant condition among anaesthesiologists, there is a high demand for implementing monitoring strategies after publishing of the POD-Guideline. The survey shows that tools necessary for POD-Guideline implementation are available in the centers represented by the respondents.
    • PubMed ID
  • Impact of delirium on short-term outcomes in hip fracture patients under a program of approach to delirium. 2019 Bielza, R. Zambrana, F. Fernandez de la Puente, E. Sanjurjo, J. Andreu, C. Thuissard, I. J. Gomez Cerezo, J.. Geriatr Gerontol Int,
    • Title

      Impact of delirium on short-term outcomes in hip fracture patients under a program of approach to delirium.

    • Authors
      Bielza, R. Zambrana, F. Fernandez de la Puente, E. Sanjurjo, J. Andreu, C. Thuissard, I. J. Gomez Cerezo, J.
    • Year
      2019
    • Journal
      Geriatr Gerontol Int
    • URL
    • Abstract
      AIM: We aimed to investigate the impact of delirium on short-term outcomes in hip fracture patients. Special attention was given to patients with delirium and dementia. METHODS: A prospective observational cohort study was carried out in hip fracture patients aged >/=70 years who were admitted to a hospital unit where a multicomponents approach to delirium is established for all patients. Our population was split into delirium (n = 212) and non-delirium cohort (n = 171) according to the Confusion Assessment Method. Patients with a previous diagnosis of dementia in an outpatient appointment were also assessed within the delirium cohort. The utility of the rehabilitation was measured with the Absolute Functional Gain index. RESULTS: A total of 383 patients were entered into the study. The median age was 86 years, and most patients were women (78.8%). Delirium patients were older, presented a lower previous Barthel Index (BI), had higher rates of dementia and came more frequently from nursing homes. Comparative analysis did not show differences in mortality, complications, length of stay or walking ability between the cohorts. However, lower BI on discharge, lower Absolute Functional Gain and the presence of nosocomial infections were found more frequently in the delirium cohort. In multivariate analysis, only the BI on discharge (P = 0.010) was lower in delirium patients. Within the delirium cohort, those suffering from dementia had worse BI on discharge (P = 0.017) and lower Absolute Functional Gain (P = 0.019). CONCLUSIONS: Delirium was not associated with mortality, walking ability, length of stay and clinical complications in hip fracture patients. BI on discharge was the only short-term outcome affected. In the delirium cohort, those suffering from dementia showed worse rehabilitation results. Geriatr Gerontol Int 2019; **: **-**.
    • PubMed ID
  • Effect of the Tailored, Family-Involved Hospital Elder Life Program on Postoperative Delirium and Function in Older Adults: A Randomized Clinical Trial. 2019 Wang, Y. Y. Yue, J. R. Xie, D. M. Carter, P. Li, Q. L. Gartaganis, S. L. Chen, J. Inouye, S. K.. JAMA Intern Med,
    • Title

      Effect of the Tailored, Family-Involved Hospital Elder Life Program on Postoperative Delirium and Function in Older Adults: A Randomized Clinical Trial.

    • Authors
      Wang, Y. Y. Yue, J. R. Xie, D. M. Carter, P. Li, Q. L. Gartaganis, S. L. Chen, J. Inouye, S. K.
    • Year
      2019
    • Journal
      JAMA Intern Med
    • URL
    • Abstract
      Importance: Postoperative delirium (POD) is a common condition for older adults, contributing to their functional decline. Objective: To investigate the effectiveness of the Tailored, Family-Involved Hospital Elder Life Program (t-HELP) for preventing POD and functional decline in older patients after a noncardiac surgical procedure. Design, Setting, and Participants: A 2-arm, parallel-group, single-blind, cluster randomized clinical trial was conducted from August 24, 2015, to February 28, 2016, on 6 surgical floors (gastric, colorectal, pancreatic, biliary, thoracic, and thyroid) of West China Hospital in Chengdu, China. Eligible participants (n = 281) admitted to each of the 6 surgical floors were randomized into a nursing unit providing t-HELP (intervention group) or a nursing unit providing usual care (control group). All randomized patients were included in the intention-to-treat analyses for the primary outcome of POD incidence. Statistical analysis was performed from April 3, 2016, to December 30, 2017. Interventions: In addition to receiving usual care, all participants in the intervention group received the t-HELP protocols, which addressed each patient's risk factor profile. Besides nursing professionals, family members and paid caregivers were involved in the delivery of many of the program interventions. Main Outcomes and Measures: The primary outcome was the incidence of POD, evaluated with the Confusion Assessment Method. Secondary outcomes included the pattern of functional and cognitive changes (activities of daily living [ADLs], instrumental activities of daily living [IADLs], Short Portable Mental Status Questionnaire [SPMSQ]) from hospital admission to 30 days after discharge, and the length of hospital stay (LOS). Results: Of the 475 patients screened for eligibility, 281 (171 [60.9%] male, mean [SD] age 74.7 [5.2] years) were enrolled and randomized to receive t-HELP (n = 152) or usual care (n = 129). Postoperative delirium occurred in 4 participants (2.6%) in the intervention group and in 25 (19.4%) in the control group, with a relative risk of 0.14 (95% CI, 0.05-0.38). The number needed to treat to prevent 1 case of POD was 5.9 (95% CI, 4.2-11.1). Participants in the intervention group compared with the control group showed less decline in physical function (median [interquartile range] for ADLs: -5 [-10 to 0] vs -20 [-30 to -10]; P < .001; for IADLs: -2 [-2 to 0] vs -4 [-4 to -2]; P < .001) and cognitive function (for the SPMSQ level: 1 [0.8%] vs 8 [7.0%]; P = .009) at discharge, as well as shorter mean (SD) LOS (12.15 [3.78] days vs 16.41 [4.69] days; P < .001). Conclusions and Relevance: The findings suggest that t-HELP, with family involvement at its core, is effective in reducing POD for older patients, maintaining or improving their physical and cognitive functions, and shortening the LOS. The results of this t-HELP trial may improve generalizability and increase the implementation of this program. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR-POR-15006944.
    • PubMed ID
  • Automated tracking of level of consciousness and delirium in critical illness using deep learning. 2019 Sun, H. Kimchi, E. Akeju, O. Nagaraj, S. B. McClain, L. M. Zhou, D. W. Boyle, E. Zheng, W. L. Ge, W. Westover, M. B.. NPJ Digital Medicine, 2:1
    • Title

      Automated tracking of level of consciousness and delirium in critical illness using deep learning.

    • Authors
      Sun, H. Kimchi, E. Akeju, O. Nagaraj, S. B. McClain, L. M. Zhou, D. W. Boyle, E. Zheng, W. L. Ge, W. Westover, M. B.
    • Year
      2019
    • Journal
      NPJ Digital Medicine
    • URL
    • Abstract
      Over- and under-sedation are common in the ICU, and contribute to poor ICU outcomes including delirium. Behavioral assessments, such as Richmond Agitation-Sedation Scale (RASS) for monitoring levels of sedation and Confusion Assessment Method for the ICU (CAM-ICU) for detecting signs of delirium, are often used. As an alternative, brain monitoring with electroencephalography (EEG) has been proposed in the operating room, but is challenging to implement in ICU due to the differences between critical illness and elective surgery, as well as the duration of sedation. Here we present a deep learning model based on a combination of convolutional and recurrent neural networks that automatically tracks both the level of consciousness and delirium using frontal EEG signals in the ICU. For level of consciousness, the system achieves a median accuracy of 70% when allowing prediction to be within one RASS level difference across all patients, which is comparable or higher than the median technician–nurse agreement at 59%. For delirium, the system achieves an AUC of 0.80 with 69% sensitivity and 83% specificity at the optimal operating point. The results show it is feasible to continuously track level of consciousness and delirium in the ICU.
    • PubMed ID
  • Impact of natural light exposure on delirium burden in adult patients receiving invasive mechanical ventilation in the ICU: a prospective study. 2019 Smonig, R. Magalhaes, E. Bouadma, L. Andremont, O. de Montmollin, E. Essardy, F. Mourvillier, B. Lebut, J. Dupuis, C. Neuville, M. Lermuzeaux, M. Timsit, J. F. Sonneville, R.. Ann Intensive Care, 9:1 (120)
    • Title

      Impact of natural light exposure on delirium burden in adult patients receiving invasive mechanical ventilation in the ICU: a prospective study.

    • Authors
      Smonig, R. Magalhaes, E. Bouadma, L. Andremont, O. de Montmollin, E. Essardy, F. Mourvillier, B. Lebut, J. Dupuis, C. Neuville, M. Lermuzeaux, M. Timsit, J. F. Sonneville, R.
    • Year
      2019
    • Journal
      Ann Intensive Care
    • URL
    • Abstract
      OBJECTIVE: To determine whether potential exposure to natural light via windows is associated with reduced delirium burden in critically ill patients admitted to the ICU in a single room. DESIGN: Prospective single-center study. SETTING: Medical ICU of a university hospital, Paris, France. PATIENTS: Adult patients receiving invasive mechanical ventilation. METHODS: Consecutive patients admitted to a single room with (LIGHT group) or without (DARK group) exposure to natural light via windows were evaluated for delirium. The primary endpoint was the incidence of delirium. Main secondary endpoints included incidence of severe agitation intervened with antipsychotics and incidence of hallucinations. RESULTS: A total of 195 patients were included (LIGHT group: n = 110; DARK group: n = 85). The incidence of delirium was similar in the LIGHT group and the DARK group (64% vs. 71%; relative risk (RR) 0.89, 95% CI 0.73-1.09). Compared with the DARK group, patients from the LIGHT group were less likely to be intervened with antipsychotics for agitation episodes (13% vs. 25%; RR 0.52, 95% CI 0.27-0.98) and had less frequent hallucinations (11% vs. 22%; RR 0.49, 95% CI 0.24-0.98). In multivariate logistic regression analysis, natural light exposure was independently associated with a reduced risk of agitation episodes intervened with antipsychotics (adjusted odds ratio = 0.39; 95% CI 0.17-0.88). CONCLUSION: Admission to a single room with potential exposure to natural light via windows was not associated with reduced delirium burden, as compared to admission to a single room without windows. However, natural light exposure was associated with a reduced risk of agitation episodes and hallucinations.
    • PubMed ID
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