Latest & greatest articles for delirium

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Top results for delirium

1. Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review of Evidence-Based Guidelines

Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review of Evidence-Based Guidelines Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review of Evidence-Based Guidelines | CADTH.ca Find the information you need Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review of Evidence-Based Guidelines Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review (...) of Evidence-Based Guidelines Last updated: July 19, 2019 Project Number: RC1159-000 Product Line: Research Type: Devices and Systems Report Type: Summary with Critical Appraisal Result type: Report Question What are the evidence based guidelines to prevent falls for older adults requiring wheelchairs in institutionalized care? What are the evidence based guidelines to prevent falls for adult patients with delirium in institutionalized care? Key Message One evidence-based guideline was included

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

2. Pharmacological interventions for the treatment of delirium in critically ill adults. (PubMed)

Pharmacological interventions for the treatment of delirium in critically ill adults. Although delirium is typically an acute reversible cognitive impairment, its presence is associated with devastating impact on both short-term and long-term outcomes for critically ill patients. Advances in our understanding of the negative impact of delirium on patient outcomes have prompted trials evaluating multiple pharmacological interventions. However, considerable uncertainty surrounds the relative (...) benefits and safety of available pharmacological interventions for this population.Primary objective1. To assess the effects of pharmacological interventions for treatment of delirium on duration of delirium in critically ill adults with confirmed or documented high risk of deliriumSecondary objectivesTo assess the following:1. effects of pharmacological interventions on delirium-free and coma-free days; days with coma; delirium relapse; duration of mechanical ventilation; intensive care unit (ICU

2019 Cochrane

3. Antipsychotics for Preventing Delirium in Hospitalized Adults: A Systematic Review. (PubMed)

Antipsychotics for Preventing Delirium in Hospitalized Adults: A Systematic Review. Delirium is an acute disorder marked by impairments in attention and cognition, caused by an underlying medical problem. Antipsychotics are used to prevent delirium, but their benefits and harms are unclear.To conduct a systematic review evaluating the benefits and harms of antipsychotics for prevention of delirium in adults.PubMed, Embase, CENTRAL, CINAHL, and PsycINFO from inception through July 2019, without (...) restrictions based on study setting, language of publication, or length of follow-up.Randomized, controlled trials (RCTs) that compared an antipsychotic with placebo or another antipsychotic, and prospective observational studies with a comparison group.One reviewer extracted data and graded the strength of the evidence, and a second reviewer confirmed the data. Two reviewers independently assessed the risk of bias.A total of 14 RCTs were included. There were no differences in delirium incidence

2019 Annals of Internal Medicine

4. Antipsychotics for Treating Delirium in Hospitalized Adults: A Systematic Review. (PubMed)

Antipsychotics for Treating Delirium in Hospitalized Adults: A Systematic Review. Delirium is common in hospitalized patients and is associated with worse outcomes. Antipsychotics are commonly used; however, the associated benefits and harms are unclear.To conduct a systematic review evaluating the benefits and harms of antipsychotics to treat delirium in adults.PubMed, Embase, CENTRAL, CINAHL, and PsycINFO from inception to July 2019 without language restrictions.Randomized controlled trials (...) (RCTs) of antipsychotic versus placebo or another antipsychotic, and prospective observational studies reporting harms.One reviewer extracted data and assessed strength of evidence (SOE) for critical outcomes, with confirmation by another reviewer. Risk of bias was assessed independently by 2 reviewers.Across 16 RCTs and 10 observational studies of hospitalized adults, there was no difference in sedation status (low and moderate SOE), delirium duration, hospital length of stay (moderate SOE

2019 Annals of Internal Medicine

5. Antipsychotics for the Prevention and Treatment of Delirium

Antipsychotics for the Prevention and Treatment of Delirium Antipsychotics for the Prevention and Treatment of Delirium Comparative Effectiveness Review Number 219 RComparative Effectiveness Review Number 219 Antipsychotics for the Prevention and Treatment of Delirium Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-00006-I, 290-32008-T Prepared by: Johns Hopkins (...) of delirium among adult patients. Key Messages • Haloperidol or second-generation antipsychotics used to prevent or treat delirium did not decrease length of stay in hospital. • There was little or no evidence to determine the effect of antipsychotics on cognitive function, delirium severity, or caregiver burden, or for sedation when used for prevention. • Second-generation antipsychotics may lower the occurrence of delirium in postoperative patients. • Haloperidol or second-generation antipsychotics used

2019 Effective Health Care Program (AHRQ)

6. External Validation of Two Models to Predict Delirium in Critically Ill Adults Using Either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for Delirium Assessment

External Validation of Two Models to Predict Delirium in Critically Ill Adults Using Either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for Delirium Assessment To externally validate two delirium prediction models (early prediction model for ICU delirium and recalibrated prediction model for ICU delirium) using either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for delirium assessment.Prospective (...) , multinational cohort study.Eleven ICUs from seven countries in three continents.Consecutive, delirium-free adults admitted to the ICU for greater than or equal to 6 hours in whom delirium could be reliably assessed.None.The predictors included in each model were collected at the time of ICU admission (early prediction model for ICU delirium) or within 24 hours of ICU admission (recalibrated prediction model for ICU delirium). Delirium was assessed using the Confusion Assessment Method-ICU or the Intensive

2019 EvidenceUpdates

7. The 4 'A's test for detecting delirium in acute medical patients: a diagnostic accuracy study

The 4 'A's test for detecting delirium in acute medical patients: a diagnostic accuracy study The 4 'A's test for detecting delirium in acute medical patients: a diagnostic accuracy study Journals Library An error occurred retrieving content to display, please try again. >> >> >> Page Not Found Page not found (404) Sorry - the page you requested could not be found. Please choose a page from the navigation or try a website search above to find the information you need. >> >> >> >> Issue (...) {{metadata .Issue }} Toolkit 1)"> 0)"> 1)"> {{metadata.Title}} {{metadata.Headline}} The 4 'A's test detects delirium in acutely ill patients with a sensitivity of 76% and a specificity of 95%. {{author}} {{($index , , , , , , , , , , , , , , , , , , , & . Alasdair MJ MacLullich 1, * , Susan D Shenkin 1 , Steve Goodacre 2 , Mary Godfrey 3 , Janet Hanley 4 , Antaine Stíobhairt 1 , Elizabeth Lavender 3 , Julia Boyd 5 , Jacqueline Stephen 5, 6 , Christopher Weir 5, 6 , Allan MacRaild 7 , Jill Steven 7

2019 NIHR HTA programme

8. Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit: The ICU Visits Randomized Clinical Trial. (PubMed)

Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit: The ICU Visits Randomized Clinical Trial. The effects of intensive care unit (ICU) visiting hours remain uncertain.To determine whether a flexible family visitation policy in the ICU reduces the incidence of delirium.Cluster-crossover randomized clinical trial involving patients, family members, and clinicians from 36 adult ICUs with restricted visiting hours (<4.5 hours per day) in Brazil. Participants (...) were recruited from April 2017 to June 2018, with follow-up until July 2018.Flexible visitation (up to 12 hours per day) supported by family education (n = 837 patients, 652 family members, and 435 clinicians) or usual restricted visitation (median, 1.5 hours per day; n = 848 patients, 643 family members, and 391 clinicians). Nineteen ICUs started with flexible visitation, and 17 started with restricted visitation.Primary outcome was incidence of delirium during ICU stay, assessed using the CAM-ICU

2019 JAMA

9. 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

10. 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

11. Association of Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium: A Network Meta-analysis

Association of Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium: A Network Meta-analysis Although several pharmacological interventions for delirium have been investigated, their overall benefit and safety remain unclear.To evaluate evidence regarding pharmacological interventions for delirium treatment and prevention.PubMed, Embase, ProQuest, ScienceDirect, Cochrane Central, Web of Science, ClinicalKey, and ClinicalTrials.gov from (...) inception to May 17, 2018.Randomized clinical trials (RCTs) examining pharmacological interventions for delirium treatment and prevention.To extract data according to a predetermined list of interests, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were applied, and all meta-analytic procedures were conducted using a random-effects model.The primary outcomes were treatment response in patients with delirium and the incidence of delirium in patients at risk

2019 EvidenceUpdates

12. Pharmacological Management of Delirium in the Intensive Care Unit: A Randomized Pragmatic Clinical Trial

Pharmacological Management of Delirium in the Intensive Care Unit: A Randomized Pragmatic Clinical Trial Delirium in the intensive care units (ICUs) is prevalent, with both delirium duration and delirium severity associated with adverse outcomes. We designed a pragmatic trial to test the efficacy of a pharmacological management of delirium (PMD) bundle in improving delirium/coma-free days and reducing delirium severity among ICU patients.A randomized pragmatic clinical trial.Medical, surgical (...) , and progressive ICUs of three tertiary care hospitals.A total of 351 critically ill patients.A multicomponent PMD bundle consisting of reducing the exposure to 20 definite anticholinergic medications and benzodiazepines and prescribing low-dose haloperidol.The primary outcomes were delirium/coma-free days, measured through the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU (CAM-ICU), and delirium severity, measured through Delirium Rating Scale-Revised-98 and the CAM-ICU-7

2019 EvidenceUpdates

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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