Journal ArticleDOI
Delirium and its motoric subtypes: A study of 614 critically ill patients.
Josh F. Peterson,Brenda T. Pun,Robert S. Dittus,Jason W. W. Thomason,James C. Jackson,Ayumi Shintani,E. Wesley Ely +6 more
TLDR
To describe the motoric subtypes of delirium in critically ill patients and compare patients aged 65 and older with a younger cohort is compared.Abstract:
OBJECTIVES: To describe the motoric subtypes of delirium in critically ill patients and compare patients aged 65 and older with a younger cohort.
DESIGN: Prospective cohort study.
SETTING: The medical intensive care unit (MICU) of a tertiary care academic medical center.
PARTICIPANTS: Six hundred fourteen MICU patients admitted during a process improvement initiative to monitor levels of sedation and delirium.
MEASUREMENTS: MICU nursing staff assessed delirium and level of consciousness in all MICU patients at least once per 12-hour shift using the Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation-Sedation Scale. Delirium episodes were categorized as hypoactive, hyperactive, and mixed type.
RESULTS: Delirium was detected in 112 of 156 (71.8%) subjects aged 65 and older and 263 of 458 (57.4%) subjects younger than 65. Mixed type was most common (54.9%), followed by hypoactive delirium (43.5%) and purely hyperactive delirium (1.6%). Patients aged 65 and older experienced hypoactive delirium at a greater rate than younger patients (41.0% vs 21.6%, P<.001) and never experienced hyperactive delirium. Older age was strongly and independently associated with hypoactive delirium (adjusted odds ratio=3.0, 95% confidence interval=1.7–5.3), compared with no delirium in a model that adjusted for other important determinants of delirium including severity of illness, sedative medication use, and ventilation status.
CONCLUSION: Older age is a strong predictor of hypoactive delirium in MICU patients, and this motoric subtype of delirium may be missed in the absence of active monitoring.read more
Citations
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Journal ArticleDOI
Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit
Juliana Barr,Gilles L. Fraser,Kathleen Puntillo,E. Wesley Ely,Céline Gélinas,Joseph F. Dasta,Judy E. Davidson,John W. Devlin,John P. Kress,Aaron M. Joffe,Douglas B. Coursin,Daniel Herr,Avery Tung,Bryce R.H. Robinson,Dorrie K. Fontaine,Michael A. E. Ramsay,Richard R. Riker,Curtis N. Sessler,Brenda T. Pun,Yoanna Skrobik,Roman Jaeschke +20 more
TL;DR: These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.
Journal ArticleDOI
Postoperative delirium in the elderly: risk factors and outcomes.
Thomas N. Robinson,Christopher D. Raeburn,Zung Vu Tran,Erik M. Angles,Lisa A. Brenner,Marc Moss +5 more
TL;DR: Outcomes, including an increased rate of 6 month mortality, were worse in patients who developed postoperative delirium, and pre-existing cognitive dysfunction was the strongest predictor of the development of postoperativeDelirium.
Journal ArticleDOI
Delirium in the intensive care unit
TL;DR: Little evidence exists regarding the prevention and treatment of delirium in the ICU, but multicomponent interventions reduce the incidence of delIRium in non-ICU studies.
Journal ArticleDOI
Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial.
Xian Su,Zhao-Ting Meng,Xin-Hai Wu,Fan Cui,Hong-Liang Li,Dong-Xin Wang,Xi Zhu,Sai-Nan Zhu,Mervyn Maze,Daqing Ma +9 more
TL;DR: For patients aged over 65 years who are admitted to the intensive care unit after non-cardiac surgery, prophylactic low-dose dexmedetomidine significantly decreases the occurrence of delirium during the first 7 days after surgery.
Journal ArticleDOI
Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients
Pratik P. Pandharipande,Bryan A. Cotton,Ayumi Shintani,Jennifer L. Thompson,Brenda T. Pun,John A. Morris,Robert S. Dittus,E. Wesley Ely +7 more
TL;DR: Exposure to midazolam is an independent and potentially modifiable risk factor for the transitioning to delirium in surgical and trauma ICU patients, keeping with other recent data on benzodiazepines.
References
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