Latest & greatest articles for delirium

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Top results for delirium

1. Effect of Targeting Mean Arterial Pressure During Cardiopulmonary Bypass by Monitoring Cerebral Autoregulation on Postsurgical Delirium Among Older Patients: A Nested Randomized Clinical Trial

Effect of Targeting Mean Arterial Pressure During Cardiopulmonary Bypass by Monitoring Cerebral Autoregulation on Postsurgical Delirium Among Older Patients: A Nested Randomized Clinical Trial Delirium occurs in up to 52% of patients after cardiac surgery and may result from changes in cerebral perfusion. Using intraoperative cerebral autoregulation monitoring to individualize and optimize cerebral perfusion may be a useful strategy to reduce the incidence of delirium after cardiac surgery.To (...) determine whether targeting mean arterial pressure during cardiopulmonary bypass (CPB) using cerebral autoregulation monitoring reduces the incidence of delirium compared with usual care.This randomized clinical trial nested within a larger trial enrolled patients older than 55 years who underwent nonemergency cardiac surgery at a single US academic medical center between October 11, 2012, and May 10, 2016, and had a high risk for neurologic complications. Patients, physicians, and outcome assessors

2019 EvidenceUpdates

2. Interventions for preventing delirium in older people in institutional long-term care. (PubMed)

Interventions for preventing delirium in older people in institutional long-term care. Delirium is a common and distressing mental disorder. It is often caused by a combination of stressor events in susceptible people, particularly older people living with frailty and dementia. Adults living in institutional long-term care (LTC) are at particularly high risk of delirium. An episode of delirium increases risks of admission to hospital, development or worsening of dementia and death (...) . Multicomponent interventions can reduce the incidence of delirium by a third in the hospital setting. However, it is currently unclear whether interventions to prevent delirium in LTC are effective. This is an update of a Cochrane Review first published in 2014.To assess the effectiveness of interventions for preventing delirium in older people in institutional long-term care settings.We searched ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group (CDCIG) 's Specialised

2019 Cochrane

3. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. (PubMed)

Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. Postoperative delirium is common following cardiac surgery and may be affected by choice of analgesic and sedative.To evaluate the effect of postoperative intravenous (IV) acetaminophen (paracetamol) vs placebo combined with IV propofol vs dexmedetomidine on postoperative delirium among older (...) with dexmedetomidine or propofol starting at chest closure and continued for up to 6 hours (acetaminophen and dexmedetomidine: n = 29; placebo and dexmedetomidine: n = 30; acetaminophen and propofol: n = 31; placebo and propofol: n = 30).The primary outcome was incidence of postoperative in-hospital delirium by the Confusion Assessment Method. Secondary outcomes included delirium duration, cognitive decline, breakthrough analgesia within the first 48 hours, and ICU and hospital length of stay.Among 121 patients

2019 JAMA

4. Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. (PubMed)

Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium.To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium.Randomized clinical trial of 1232 adults aged 60 years (...) and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis. Recruitment was from January 2015 to May 2018, with follow-up until July 2018.Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery and positive vs negative recent fall history) to receive EEG-guided anesthetic administration (n = 614) or usual anesthetic care (n = 618).The primary outcome was incident delirium during postoperative days 1 through 5. Intraoperative measures

2019 JAMA

5. A systematic review of interventions to facilitate extubation in patients difficult-to-wean due to delirium, agitation, or anxiety and a meta-analysis of the effect of dexmedetomidine

A systematic review of interventions to facilitate extubation in patients difficult-to-wean due to delirium, agitation, or anxiety and a meta-analysis of the effect of dexmedetomidine Delirium, agitation, and anxiety may hinder weaning from mechanical ventilation and lead to increased morbidity and healthcare costs. The most appropriate clinical approach to weaning in these contexts remains unclear and challenging to clinicians. The objective of this systematic review was to identify effective (...) and safe interventions to wean patients that are difficult-to-wean from mechanical ventilation due to delirium, agitation, or anxiety.A systematic review was performed using MEDLINE, EMBASE, and PubMed. Studies evaluating mechanically ventilated patients deemed difficult-to-wean due to delirium, agitation, or anxiety, and comparing the effects of an intervention with a comparator arm were sought. Time-to-extubation was the primary outcome while the secondary outcome was intensive care unit (ICU) length

2019 EvidenceUpdates

6. Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit: A Rapid Review

Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit: A Rapid Review ICU pain, agitation, delirium, sedation and mobilisation CPGs: A Rapid Review 1 Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit: A Rapid Review Citation Corey Joseph & Angela Melder. April 2018. Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care (...) unit: A Rapid Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia. Contact cce@monashhealth.org Executive Summary Background The Program Medical Director for Critical Care has requested a review of clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit (ICU) to inform future implementation of a new clinical practice guideline in the ICU. Objectives The objective of this review was to review and summarise current

2019 Monash Health Evidence Reviews

7. Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit

Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit Benzodiazepines and anticholinergics are risk factors for delirium in the intensive care unit (ICU). We tested the impact of a deprescribing intervention on short-term delirium outcomes.Multisite randomized clinical trial.ICUs of three large hospitals.Two hundred adults aged 18 years or older and admitted to an ICU with delirium, according to the Richmond Agitation-Sedation Scale (...) and the Confusion Assessment Method for the ICU (CAM-ICU). Participants had a contraindication to haloperidol (seizure disorder or prolonged QT interval) or preference against haloperidol as a treatment for delirium, and were excluded for serious mental illness, stroke, pregnancy, or alcohol withdrawal. Participants were randomized to a deprescribing intervention or usual care. The intervention included electronic alerts combined with pharmacist support to deprescribe anticholinergics

2019 EvidenceUpdates

8. Delirium is common among adults receiving palliative care and could be better recognised

Delirium is common among adults receiving palliative care and could be better recognised Delirium recognition in palliative care Discover Portal Discover Portal Delirium is common among adults receiving palliative care and could be better recognised Published on 20 November 2018 doi: Between a quarter and two-thirds of adults admitted to specialist palliative care units experience delirium, or acute confusion. The findings come from a mixed methods project which included a systematic review (...) of the number of people living with delirium. Estimates are mostly applicable to older adults with advanced cancer. The project also included interviews with nurses in Australian palliative care units to look at delirium assessment and use of screening tools. The findings highlighted that systems which formally diagnose delirium were not commonly used. Delirium guidelines made little reference to palliative care. The qualitative findings may also have relevance to the UK, though systems will differ

2019 NIHR Dissemination Centre

9. Comprehensive assessment may reduce risk of delirium after hip fracture

Comprehensive assessment may reduce risk of delirium after hip fracture Comprehensive assessment may reduce risk of delirium after hip fracture Discover Portal Discover Portal Comprehensive assessment may reduce risk of delirium after hip fracture Published on 29 August 2017 doi: Comprehensive geriatric assessment reduced the risk of delirium by 20% in patients having hip fracture surgery. Forty-three percent developed delirium on average compared with 53% who didn’t receive these assessments (...) . The assessment of the older persons’ medical condition was typically undertaken by a team of healthcare professionals who assessed functional ability, living circumstances and risk factors in order to develop a tailored plan for prevention and treatment of delirium after surgery. This review identified four trials in people having surgery for hip fracture. Two assessed teams where geriatricians visited patients on orthopaedic wards. The other trials reported ward assessments where patients were already being

2019 NIHR Dissemination Centre

10. Benzodiazepines may increase length of stay and chance of delirium in intensive care

Benzodiazepines may increase length of stay and chance of delirium in intensive care Benzodiazepines may increase length of stay and chance of delirium in intensive care Discover Portal Discover Portal Benzodiazepines may increase length of stay and chance of delirium in intensive care Published on 18 December 2018 doi: Benzodiazepines given during mechanical ventilation in intensive care could increase the risk of a longer hospital stay and delirium compared to other sedatives. A range (...) discharged from intensive care. Results suggest benzodiazepines prolong the length of stay in intensive care compared with propofol and increase the risk of delirium compared with dexmedetomidine. Share your views on the research. Why was this study needed? Most mechanically ventilated patients receive sedatives to keep them comfortable and to facilitate treatment. Inappropriate sedation can prolong the patient’s reliance on mechanical ventilation, increase the risk of infections, such as pneumonia

2019 NIHR Dissemination Centre

11. Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review

Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review Measurement of delirium severity has been recognized as highly important for tracking prognosis, monitoring response to treatment, and estimating burden of care for patients both during and after hospitalization. Rather than simply rating delirium as present or absent, the ability to quantify its severity would enable development and monitoring of more effective treatment approaches for the condition.To present (...) a comprehensive review of delirium severity instruments, conduct a methodologic quality rating of the original validation study of the most commonly used instruments, and select a group of top-rated instruments.This systematic review was conducted using literature from Embase, PsycINFO, PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature, from January 1, 1974, through March 31, 2017, with the key words delirium, severity, tests, measures, and intensity. Inclusion criteria were

2019 EvidenceUpdates

12. The Effect of a Parental Visitation Program on Emergence Delirium Among Postoperative Children in the PACU. (PubMed)

The Effect of a Parental Visitation Program on Emergence Delirium Among Postoperative Children in the PACU. The purpose of this study was to examine the effects of parental presence on the incidence of emergence delirium (ED) of children in the postanesthesia care unit (PACU).A quasi-experimental pretest and post-test study with nonequivalent and nonsynchronized control groups.About 93 children aged 3 to 6 years undergoing general anesthesia for tonsillectomy were divided into two groups (...) : parental presence and absence. ED was recorded using the Pediatric Anesthesia Emergence Delirium Scale at 0, 10, 20, and 30 minutes after PACU admission.ED score at each time point in the experimental group was lower than the control group, but not statistically significant. ED score in the experimental group significantly decreased over time (F = 6.98; P = .010).Parental visitation programs could be effective on the degree of ED in children in the PACU setting. This result may contribute

2019 Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses

13. Acute Mental Status Change, Delirium, and New Onset Psychosis

Acute Mental Status Change, Delirium, and New Onset Psychosis New 2018 ACR Appropriateness Criteria ® 1 Acute Mental Status Change American College of Radiology ACR Appropriateness Criteria ® Acute Mental Status Change, Delirium, and New Onset Psychosis Variant 1: Acute mental status change. Increased risk for intracranial bleeding (ie, anticoagulant use, coagulopathy), hypertensive emergency, or clinical suspicion for intracranial infection, mass, or elevated intracranial pressure. Initial (...) CT head without IV contrast Usually Appropriate ??? CT head without and with IV contrast May Be Appropriate ??? CT head with IV contrast Usually Not Appropriate ??? Variant 5: New onset delirium. Initial imaging. Procedure Appropriateness Category Relative Radiation Level CT head without IV contrast Usually Appropriate ??? MRI head without and with IV contrast May Be Appropriate (Disagreement) O MRI head without IV contrast May Be Appropriate (Disagreement) O CT head without and with IV contrast

2019 American College of Radiology

14. Medications used for the treatment of delirium: a systematic review

Medications used for the treatment of delirium: a systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g

2019 PROSPERO

15. The effect of the ABCDEF bundle on delirium, functional outcomes and quality of life in critically ill patients - a systematic literature review protocol

The effect of the ABCDEF bundle on delirium, functional outcomes and quality of life in critically ill patients - a systematic literature review protocol Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content

2019 PROSPERO

16. Effectiveness and safety evaluation of dexmedetomidine for the prevention of delirium in elderly patients: a meta-analysis of randomized controlled trials

Effectiveness and safety evaluation of dexmedetomidine for the prevention of delirium in elderly patients: a meta-analysis of randomized controlled trials Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content

2019 PROSPERO

17. Duration of general anesthesia and the risk of delirium and POCD ( postoperative cognitive dysfunction): a dose-response meta-analyse

Duration of general anesthesia and the risk of delirium and POCD ( postoperative cognitive dysfunction): a dose-response meta-analyse Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record

2019 PROSPERO

18. Penehyclidine hydrochloride premedication and post-operative cognitive dysfunction or delirium: a systematic review and meta-analysis

Penehyclidine hydrochloride premedication and post-operative cognitive dysfunction or delirium: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record

2019 PROSPERO

19. The effects of melatonin and melatonin agonists on delirium in hospitalized patients: a systematic review and meta-analysis

The effects of melatonin and melatonin agonists on delirium in hospitalized patients: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any

2019 PROSPERO

20. Providing care for patients with dementia and delirium in the acute hospital setting: a protocol for a systematic review

Providing care for patients with dementia and delirium in the acute hospital setting: a protocol for a systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any

2019 PROSPERO