Tag Archives: Delirium

Modifiable Risk Factors for Delirium in Critically Ill Trauma Patients: A Multicenter Prospective Study (Kolli)

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Duceppe MA, Williamson DR, Elliott A, Para M, Poirier MC, Delisle MS, Deckelbaum D, Razek T, Desjardins M, Bertrand JC, Bernard F, Rico P, Burry L, Frenette AJ, Perreault M. Modifiable Risk Factors for Delirium in Critically Ill Trauma Patients: A Multicenter Prospective Study. J Intensive Care Med. 2019 Apr;34(4):330-336. PMID: 28335673.

OBJECTIVE: Intensive care unit (ICU)-acquired delirium has been associated with increased morbidity and mortality. Prevention strategies including modification of delirium risk factors are emphasized by practice guidelines. No study has specifically evaluated modifiable delirium risk factors in trauma ICU patients. Our goal was to evaluate modifiable risk factors for delirium among trauma patients admitted to the ICU.

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Delirium in a Tertiary PICU: Risk Factors and Outcomes (Kolli)

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Dervan LA, Di Gennaro JL, Farris RWD, Watson RS. Delirium in a Tertiary PICU:
Risk Factors and Outcomes. Pediatr Crit Care Med. 2020 Jan;21(1):21-32. PMID: 31568239.

OBJECTIVES: To determine risk factors and outcomes associated with delirium in PICU patients.

DESIGN: Retrospective cohort study.

SETTING: Thirty-two-bed PICU within a tertiary care academic children’s hospital.

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Delirium in Critically Ill Children: An International Point Prevalence Study. (Carroll)

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Traube C, Silver G, Reeder RW, et al. Delirium in Critically Ill Children: An International Point Prevalence Study. Crit Care Med. 2017 Apr; 45(4) :584-590.

OBJECTIVES: To determine prevalence of delirium in critically ill children and explore associated risk factors.

DESIGN: Multi-institutional point prevalence study.

SETTING: Twenty-five pediatric critical care units in the United States, the Netherlands, New Zealand, Australia, and Saudi Arabia.

PATIENTS: All children admitted to the pediatric critical care units on designated study days (n = 994).

INTERVENTION: Children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the bedside nurse. Demographic and treatment-related variables were collected.

MEASUREMENTS AND MAIN RESULTS: Primary study outcome measure was prevalence of delirium. In 159 children, a final determination of mental status could not be ascertained. Of the 835 remaining subjects, 25% screened positive for delirium, 13% were classified as comatose, and 62% were delirium-free and coma-free. Delirium prevalence rates varied significantly with reason for ICU admission, with highest delirium rates found in children admitted with an infectious or inflammatory disorder. For children who were in the PICU for 6 or more days, delirium prevalence rate was 38%. In a multivariate model, risk factors independently associated with development of delirium included age less than 2 years, mechanical ventilation, benzodiazepines, narcotics, use of physical restraints, and exposure to vasopressors and antiepileptics.

CONCLUSIONS: Delirium is a prevalent complication of critical illness in children, with identifiable risk factors. Further multi-institutional, longitudinal studies are required to investigate effect of delirium on long-term outcomes and possible preventive and treatment measures. Universal delirium screening is practical and can be implemented in pediatric critical care units.

Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospital… (Betters)

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Barnes-Daly MA, Phillips G, Ely EW. Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients. Crit Care Med. 2017 Feb; 45(2):171-178.

OBJECTIVES: To track compliance by an interprofessional team with the Awakening and Breathing Coordination, Choice of drugs, Delirium monitoring and management, Early mobility, and Family engagement (ABCDEF) bundle in implementing the Pain, Agitation, and Delirium guidelines. The aim was to study the association between ABCDEF bundle compliance and outcomes including hospital survival and delirium-free and coma-free days in community hospitals.

DESIGN: A prospective cohort quality improvement initiative involving ICU patients.

SETTING: Seven community hospitals within California’s Sutter Health System.

PATIENTS: Ventilated and nonventilated general medical and surgical ICU patients enrolled between January 1, 2014, and December 31, 2014.

MEASUREMENTS AND MAIN RESULTS: Total and partial bundle compliance were measured daily. Random effects regression was used to determine the association between ABCDEF bundle compliance accounting for total compliance (all or none) or for partial compliance (“dose” or number of bundle elements used) and outcomes of hospital survival and delirium-free and coma-free days, after adjusting for age, severity of illness, and presence of mechanical ventilation. Of 6,064 patients, a total of 586 (9.7%) died before hospital discharge. For every 10% increase in total bundle compliance, patients had a 7% higher odds of hospital survival (odds ratio, 1.07; 95% CI, 1.04-1.11; p < 0.001). Likewise, for every 10% increase in partial bundle compliance, patients had a 15% higher hospital survival (odds ratio, 1.15; 95% CI, 1.09-1.22; p < 0.001). These results were even more striking (12% and 23% higher odds of survival per 10% increase in bundle compliance, respectively, p < 0.001) in a sensitivity analysis removing ICU patients identified as receiving palliative care. Patients experienced more days alive and free of delirium and coma with both total bundle compliance (incident rate ratio, 1.02; 95% CI, 1.01-1.04; p = 0.004) and partial bundle compliance (incident rate ratio, 1.15; 95% CI, 1.09-1.22; p < 0.001).

CONCLUSIONS: The evidence-based ABCDEF bundle was successfully implemented in seven community hospital ICUs using an interprofessional team model to operationalize the Pain, Agitation, and Delirium guidelines. Higher bundle compliance was independently associated with improved survival and more days free of delirium and coma after adjusting for age, severity of illness, and presence of mechanical ventilation.