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Tanios MA, Epstein SK, Teres D: Are we ready to monitor for delirium in the intensive care unit

Critical Care Medicine (Impact Factor: 6.15). 02/2004; 32(1):295-6. DOI: 10.1097/01.CCM.0000099342.97517.62
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    • "Given the incidence and adverse effect on outcomes associated with delirium, it has been suggested that patients be given prophylaxis or treated for delirium [19-21]. Any underlying cause of delirium such as infection should be identified and managed. "
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    ABSTRACT: Delirium in the intensive care unit (ICU) is associated with increased morbidity and mortality. Using an assessment tool has been shown to improve the ability of clinicians in the ICU to detect delirium. The confusion assessment method for the ICU (CAM-ICU) is a validated delirium-screening tool for critically ill intubated patients. The aim of this project was to establish the feasibility of routine delirium screening using the CAM-ICU and to identify the incidence of delirium in a UK critical care unit. Routine CAM-ICU monitoring was implemented in a mixed critical care unit in January 2007 following a two-month educational and promotional campaign. Guidelines for the management of delirium were introduced. During a two-month prospective audit in September and October 2007, the daily CAM-ICU was recorded by the bedside nurse for consecutive level 2 and level 3 patients admitted to the mixed medical/surgical critical care ward in a district general hospital. This was repeated in January 2008. Patient outcome was recorded. The records of an additional cohort of ventilated patients were reviewed retrospectively to determine compliance with routine CAM-ICU assessments. Seventy-one patients were included in the observational cohort, with 60 patients in the retrospective cohort. In the prospective group it was not possible to assess for delirium with the CAM-ICU in nine patients due to persistent coma or inability to understand simple instructions. Excluding elective post-operative patients, the incidence of delirium was 45% in patients who could be assessed; in the 27 ventilated patients who could be assessed it was 63%. From the retrospective data compliance with the CAM-ICU assessment was 92%. The incidence of delirium in this retrospective group of ventilated patients who could be assessed was 65%. We have demonstrated that delirium screening is feasible in a UK ICU population. The high incidence of delirium and the impact on outcomes in this UK cohort of patients is in line with previous reports.
    Critical care (London, England) 03/2009; 13(1):R16. DOI:10.1186/cc7714
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    • "The professional literature is now focusing on the long-term sequelae of the ICU admission, with delirium sometimes linked to post-traumatic stress disorder (Jones et al., 2001; Rotondi et al., 2002; Rundshagen et al., 2002; Schelling et al., 1998). Through teaching and staff orientation we must change the attitude of ICU health professionals away from a preoccupation with the physical aspects of the ICU patient, however, important these may be (Tanios et al., 2004). We must learn to think of the patient in a holistic manner and to provide dignity during daily care such as bed baths and heed the need for privacy when possible. "
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    ABSTRACT: Delirium is an acute, reversible disorder of attention and cognition and may be viewed as cerebral dysfunction similar to the failure of any other organ. The development of delirium is associated with increased morbidity and mortality, extended length-of-stay in the intensive care unit and longer time spent sedated and ventilated. Nearly every clinical, pharmacological and environmental factor present and necessary in the ICU setting has the potential to cause delirium. Since all of these factors cannot be removed, it is paramount to increase the awareness amongst health care professionals so as to minimise under-recognition and encourage future research into factors that may improve the long-term outcome for ICU patients. There is a need for user-friendly, validated assessment tools for the intubated and ventilated ICU patient, which can be applied at the time of ICU admission without the need for lengthy psychiatric assessment. Nursing professionals are at the forefront of those who are able to provide holistic care through meaningful conversation and empathetic touch. A 6-month Quality Improvement (QI) project screening patients for signs of delirium provided a foundation for discussion. All patients admitted to ICU for more than 72 h, with a hospital length-of-stay less than 96 h prior to ICU admission were screened. Patients admitted following neurological insults or with pre-existing altered mental state were excluded. The QI project showed the incidence of delirium to be 40% of the total sample (n = 73) in a mixed medical/surgical and elective/emergency patient population.
    Intensive and Critical Care Nursing 09/2004; 20(4):206-13. DOI:10.1016/j.iccn.2004.04.003
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    ABSTRACT: Traditionally, intensive care unit (ICU) delirium was viewed as benign and was under-diagnosed in the absence of ICU-appropriate screening tools. Research suggests that up to half of all ICU patients experiencing delirium will continue to do so after discharge to the ward, and half of those experiencing delirium in the ward will die within 1 year of delirium diagnosis. ICU-specific screening tools are now available. The purpose of this study was to identify the incidence of delirium in ICU and explore its associations to clinical factors and outcomes. A secondary aim was to evaluate the usefulness of the intensive care delirium screening checklist (ICDSC). A total of 185 patients in six ICUs in Australia and New Zealand were screened for delirium using the ICDSC over two 12-hour periods per day for the duration of their ICU admission. Some 84 patients (45%) developed delirium. Development of delirium was associated with increased severity of illness (acute physiology and chronic health evaluation--APACHE II--and sequential organ failure assessment--SOFA), ICU length of stay (LOS), and use of psycho-active drugs. Delirious patients showed no statistically significant difference in ICU and hospital mortality rates, nor prolonged hospital LOS. The ICDSC was found to be user-friendly. The incidence of delirium, observed characteristics and outcomes for patients admitted to Australian and New Zealand ICUs for > 36 hours without any history of altered mental state fell in the mid-range and were generally consistent with previous literature. An ICU-specific delirium assessment, such as the ICDSC, should be included in routine ICU observations to minimise under-diagnosis of this serious phenomenon.
    Australian Critical Care 02/2005; 18(1):6, 8-9, 11-4 passim. DOI:10.1016/S1036-7314(05)80019-0 · 1.27 Impact Factor
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