Alawi Luetz

Charité Universitätsmedizin Berlin | Charité · Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte

To compare validity and reliability of three instruments for detection and assessment of delirium in intensive care unit (ICU) patients. Delirium in critically ill patients is associated with higher mortality, prolonged duration of ICU stay, and greater healthcare costs. Currently, there are several assessment tools available for detection of delir...

Noise is a proven cause of wakefulness and qualitative sleep disturbance in critically ill patients. A sound pressure level reduction can improve sleep quality, but there are no studies showing the feasibility of such a noise reduction in the intensive care unit (ICU) setting. Considering all available evidence, we redesigned two ICU rooms with the...

Purpose: Although delirium monitoring is recommended in international guidelines, there is lacking evidence for improved outcome due to it. We hypothesized that adherence to routine delirium monitoring would improve clinical outcome in adult critically ill patients. Material and methods: We present the results of a prospective, noninterventional...

Objectives: To evaluate test validity of the Pediatric Confusion Assessment Method for the ICU, the Pediatric Anesthesia Emergence Delirium scale, and the newly developed severity scale for the Pediatric Confusion Assessment Method for the ICU; to prospectively assess covariates and their influence on test validity of the scores. Design: Prospec...

Delirium, the most common form of acute brain dysfunction affecting up to 80% of intensive care unit (ICU) patients, has been shown to predict long-term cognitive impairment, one of the domains in "Post-ICU Syndrome" (PICS). The ICU environment affects several potentially modifiable risk factors for delirium, such as disorientation and disruption,...

Objectives Nonpharmacologic delirium management is recommended by current guidelines, but studies on the impact of ICU design are still limited. The study’s primary purpose was to determine if a multicomponent change in room design prevents ICU delirium. Second, the influence of lighting conditions on serum melatonin was assessed. Design Prospecti...

Postoperative delirium is common especially in the elderly and is associated with high rates of morbidity and mortality. Non-pharmacological multicomponent interventions are effective in reducing the incidence and to a degree the duration of postoperative delirium and are recommended in international guidelines on postoperative delirium as first li...

Circadian body and behavior rhythms serve to coordinate and maintain the physiological processes in the human body. A disruption of these rhythms frequently occurs in intensive care patients and can be the cause for the development of delirium. This review article discusses the underlying pathophysiological mechanisms and develops a chronobiologica...

Zusammenfassung Die zirkadiane Dysrhythmie betrifft die Mehrzahl der Intensivpatienten und hat weitreichende Auswirkungen auf Organfunktionen. Auf der Ebene des zentralen Nervensystems werden kognitive Exekutivfunktionen beeinträchtigt und die Entwicklung eines Delirs gefördert. Aus diesem Grund sollten mehrdimensionale, patientenindividualisierte...

The aim of this study was to synthesize quantitative research that identified ranking lists of the most severe stressors of patients in the intensive care unit, as perceived by patients, relatives, and health care professionals (HCP). We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Library from...

Background: Delirium screening instruments (DSIs) should be used to detect delirium, but they only show moderate sensitivity in patients with neurocritical illness. We explored whether, for these patients, DSI validity is impacted by patient-specific covariates. Methods: Data were prospectively collected in a single-center quality improvement proj...

Background and objectives: The use of delirium screening instruments (DSIs) is recommended in critical care practice for a timely detection of delirium. We hypothesize that the patient-related factors “level of sedation” and “mechanical ventilation” impact test validity of DSIs. Materials and Methods: This is a prospective, bi-center observational...

Background Clinical practice guidelines (CPGs) facilitate the provision of standardized, high-quality intensive care medicine. For the management of pain, agitation and delirium, several coexisting CPGs have been published. This study aims at the identification of CPGs on pain, agitation and delirium management in the intensive care unit to (a) ide...

Sleep-wake patterns are often significantly disturbed in critically ill patients. This disturbance is closely linked to secondary brain dysfunctions in these patients. Sedation not only impairs sleep quality in ICU patients but also has detrimental effects on short- and long-term outcome. In other contexts, light therapy has been proven to be effec...

Background Sleep abnormalities and disturbances of the circadian rhythm are known to negatively affect recovery for patients in the Intensive Care Unit (ICU). Daylight is the most important stimulus to entrain circadian rhythmicity by suppression of melatonin production. Therefore, light therapy seems a promising intervention to improve patients’ o...

Delirium is a highly prevalent manifestation of acute brain dysfunction in the surgical critically ill patient and is associated with longer hospital stays, higher mortality, and poor cognitive and functional outcomes. The etiology of delirium is not yet fully understood and is probably multifactorial. Addressing modifiable risk factors including s...

Surgical patients are at high risk for developing infectious complications and postoperative delirium. Prolonged infections and delirium result in worse outcome. Granulocyte-macrophage colony-stimulating factor (GM-CSF) and influenza vaccination are known to increase HLA-DR on monocytes and improve immune reactivity. This study aimed to investigate...

Study protocol (German). (PDF)

CONSORT Flow Diagram. (DOC)

Safety data: Adverse events (AE) and Serious adverse events (SAE). (DOC)

Methods of flow cytometry and measurement of soluble mediators. (DOC)

Translation of study protocol (synopsis). (DOC)

CONSORT Checklist. (DOC)

Das Management von Schmerzen, Stress, Agitation und Delirsymptomen ist Bestandteil jeder intensivmedizinischen Behandlung und gehört zur Grundversorgung intensivpflichtiger Patienten. Ein multimodales Management trägt unabhängig von der zugrunde liegenden Erkrankung maßgeblich zum Behandlungserfolg bei. In Deutschland stellt es zudem einen Qualität...

Delirium incidence in intensive care unit (ICU) patients is high and associated with poor outcome. Identification of high-risk patients may facilitate its prevention. To develop and validate a model based on data available at ICU admission to predict delirium development during a patient's complete ICU stay and to determine the predictive value of...

Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implem...

Recent evidence revealed that sedation is related to adverse outcomes including a higher mortality. Despite this fact, patients sometimes require deep sedation for a limited period of time to control, for example, intracranial hypertension. In particular in these cases, weaning from sedation is often challenging due to emerging agitation, stress, a...

“Brain Disorders in Critical Illness”, edited by Robert Stevens, Tarek Sharshar and Wes Ely, offers an overview of critical illness brain dysfunction (delirium, coma, encephalopathy), a major problem in intensive care with potentially debilitating long-term consequences. Chapters on epidemiology, outcomes, relevant behavioral neurology and biologic...

Recalibration and determining discriminative power, internationally, of the existing delirium prediction model (PRE-DELIRIC) for intensive care patients. A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The ten predictors (age, APACHE-II, urgent and admission category, infection, coma, seda...

Introduction: Symptoms such as anxiety, confusion, disorientation and pain can be found in the majority of ICU patients, especially in those with delirium. Non-pharmacological strategies have been proven to be effective for the prevention and management of these symptoms. We developed a new concept for the design of ICU rooms. One part of this conc...

Delirium is a serious and frequent disorder in ICU patients. The aim of this study was to internationally validate the existing Prediction of Delirium ICU (PREDELIRIC) model to predict delirium in ICU patients.

Das Delir ist eine der häufigsten akuten Organdysfunktionen während einer intensivrnedizinischen Behandlung. Seine Inzidenz ist mit 50% bei nichtbeatmeten und bis zu 80% bei beatmeten Patienten sehr hoch. Im Rahmen der klinischen Routineversorgung von kritisch kranken Patienten bleibt es, insbesondere wegen der mangelhaften Implementierung valider...

Purpose: Systematic monitoring of sedation, pain and delirium in the ICU is of paramount importance in delivering adequate patient care. While the use of systematic monitoring instruments is widely agreed upon, these tools are infrequently implemented into daily ICU care. The aim of this study is to compare the effectiveness of two different train...

To date there are only a few studies published, dealing with delirium in critically ill patients. The problem with these studies is that prevalence rates of delirium could only be estimated because of the lack of validated delirium assessment tools for the paediatric intensive care unit (PICU). The paediatric Confusion Assessment Method for the Int...

Delirium is a severe but frequent organ dysfunction in intensive care units (ICU) affecting nearly 80% of mechanically ventilated patients and up to 50% of non-ventilated patients. Although guidelines for diagnosis and treatment of delirium exist it often remains underdiagnosed due to the lack of implementation of these guidelines. Therefore, the c...

Guidelines for weaning from sedation and weaning from ventilator gained increasing interest in recent years. This includes patients with acute respiratory distress syndrome, as well as other mechanically ventilated patients. This review will give an overview of the current literature and practice guidelines in ventilator and sedation weaning. Sedat...

Monitoring and protocolized management for analgesia, sedation and delirium are key indicators for an evidence-based treatment of critically ill patients. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%). From 2006-2...

Brain dysfunction is a major clinical problem in intensive care, with potentially debilitating long-term consequences for post-ICU patients of any age. The resulting extended length of stay in the ICU and post-discharge cognitive dysfunction are now recognized as major healthcare burdens. This comprehensive clinical text provides intensivists and n...

Delirium in the intensive care unit (ICU) is a serious complication associated with a poor outcome in critically ill patients. In this prospective observational study of the effect of a delay in delirium therapy on mortality rate, 418 ICU patients were regularly assessed using the Delirium Detection Score (DDS). The departmental standard required t...

A secondary exploratory analysis of data from an observational study was used to study the influence of the opioid used for intraoperative anaesthesia on the incidence of post-operative delirium. Patients who had been admitted to the recovery room following elective general anaesthesia were divided into those who had received fentanyl or remifentan...

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Postoperative delirium is associated with adverse outcome. The aim of this study was to find a valid and easy-to-use tool to screen for postoperative delirium on the surgical ward. Data were collected from 88 patients who underwent elective surgery. Delirium screening was performed daily until the sixth postoperative day using the Confusion Assessm...

Das postoperative Delir stellt sowohl im Aufwachraum als auch auf der Intensivstation die haufigste psychiatrische Erkrankung dar. Insbesondere bei beatmeten Patienten sind Pravalenzraten von uber 80% beschrieben. Patienten die wahrend ihrer Behandlung im Krankenhaus an einem Delir erkranken, haben ein 3-fach erhohtes Risiko, in den folgenden 6 Mon...

The reported incidence of delirium in critically ill patients ranges widely - from 11% to 87%. Both in the recovery room as well as in the intensive care unit postoperative delirium is the most common psychiatric disease. Patients with ICU delirium have a significant higher 6-month mortality rate. Recent studies could show that the use of a validat...

Illicit substance use (ISU) is a worldwide burden, and its prevalence in surgical patients has not been well investigated. Co-consumption of legal substances, such as alcohol and tobacco, complicates the perioperative management and is frequently underestimated during routine preoperative assessment. The aim of this study was to compare the anesthe...

Most therapeutic options for postoperative delirium are only symptom oriented; therefore, the best approach remains prevention. The aim of this study was to identify predisposing and precipitating factors for early postoperative delirium. A total of 1002 patients were screened for delirium in an observational, cohort study. Nine hundred and ten pat...

Although Delirium is the most common psychiatric disease in ICU settings, it is recognized late or not at all in up to 84 % of all cases. Translation of the ICDSC, in accordance with ISPOR guidelines and validation by conducting a screening of 68 ICU patients. The translation process was authorized by the original author. The final German translati...

This prospective randomized pilot study compared the influence of fentanyl-based versus remifentanil-based anaesthesia on cytokine responses and expression of the suppressor of cytokine signalling (SOCS)-3 gene following coronary artery bypass graft surgery. Forty patients were assigned to receive anaesthesia with either intravenous remifentanil (0...

Delirium is often seen in the recovery room and is a predictor for postoperative delirium on the ward. However, monitoring to detect delirium in the recovery room as a basic prerequisite for early intervention is rarely used. The aim of this study was to identify a valid and easy-to-use test for early screening of delirium in the recovery room. One...

Both in the recovery room as well as in the intensive care unit post-operative delirium is the most common psychiatric disease. The post-operative delirium is stated in literature to occur in 15 % to 50 % of patients, whereby up to 80 % of patients requiring intensive care with artificial respiration develop a delirium. The delirium correlates with...