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Latest & greatest articles for delirium
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on delirium or other clinical topics then use Trip today.
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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 email@example.com 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
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
Effect of haloperidol on survival among critically ill adults with a high risk of delirium: The REDUCE randomised controlled trial. 30792766 2019 11 20 1751-1437 20 1 2019 Feb Journal of the Intensive Care Society J Intensive Care Soc Effect of haloperidol on survival among critically ill adults with a high risk of delirium: The REDUCE randomised controlled trial. 74-76 10.1177/1751143718799920 eng Journal Article Review 2018 09 10 England J Intensive Care Soc 101538668 1751-1437 2019 2 23 6 0
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
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
Preventing Postoperative Delirium After Major Noncardiac Thoracic Surgery-A Randomized Clinical Trial To assess the efficacy of haloperidol in reducing postoperative delirium in individuals undergoing thoracic surgery.Randomized double-blind placebo-controlled trial.Surgical intensive care unit (ICU) of tertiary care center.Individuals undergoing thoracic surgery (N=135).Low-dose intravenous haloperidol (0.5 mg three times daily for a total of 11 doses) administered postoperatively.The primary (...) outcome was delirium incidence during hospitalization. Secondary outcomes were time to delirium, delirium duration, delirium severity, and ICU and hospital length of stay. Delirium was assessed using the Confusion Assessment Method for the ICU and delirium severity using the Delirium Rating Scale-Revised.Sixty-eight participants were randomized to receive haloperidol and 67 placebo. No significant differences were observed between those receiving haloperidol and those receiving placebo in incident
Delirium in Adult Cancer Patients: ESMO Clinical Practice Guidelines CLINICAL PRACTICE GUIDELINES Delirium in adult cancer patients: ESMO Clinical Practice Guidelines † S. H. Bush 1,2,3,4 , P. G. Lawlor 1,2,3,4 , K. Ryan 5,6,7 , C. Centeno 8,9,10 , M. Lucchesi 11 , S. Kanji 2,12 , N. Siddiqi 13,14 , A. Morandi 15 , D. H. J. Davis 16 , M. Laurent 17,18 , N. Schofield 19 , E. Barallat 20 & C. I. Ripamonti 21 , on behalf of the ESMO Guidelines Committee * 1 Division of Palliative Care, Department (...) , Istituto Nazionale dei Tumori, Milano, Italy *Correspondence to: ESMO Guidelines Committee, ESMO Head Of?ce, Via Ginevra 4, 6900 Lugano, Switzerland. E-mail: firstname.lastname@example.org † Approved by the ESMO Guidelines Committee: April 2018. Delirium is a neurocognitive syndrome that commonly occurs in older populations and people with cancer, particularly in those with advanced disease and in the last hours or days of life. While an underlying malignancy and its complications predispose a person
Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. There are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU).In a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume (...) and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention. The primary end point was the number of days alive without delirium or coma during the 14-day intervention period. Secondary end points included 30-day and 90-day survival, time to freedom from mechanical ventilation, and time to ICU and hospital discharge
Mind the gap on UTI?s and delirium Core IM: Mind the Gap on UTI’s and Delirium – Clinical Correlations Search Core IM: Mind the Gap on UTI’s and Delirium September 12, 2018 4 min read Podcast: | Subscribe: | Join us in this episode as we question everything you ever thought you knew about… urinary tract infections (UTI) and delirium. || By Steven R. Liu MD, Charlie Madeira MD and Dr. Janine Knudsen MD || Graphic Design by Ramon Thompson Time Stamps: The basics – what are the official (IDSA (...) ) definitions for bacteriuria, pyuria, and UTI? (02:07) The lay of the land – how common are bacteriuria and delirium? (07:09) The big money question – do UTIs really cause delirium and what does the evidence tell us? (10:50) Review of teaching points (15:59) Thank you to infectious disease attendings from NYU and Bellevue Hospitals, Dr. Ellie Carmody and Dr. Tania Kupferman, for peer reviewing this podcast! Subscribe to CORE IM on any podcast app! Follow us on Facebook || Twitter || Instagram . Please give
Effect of Depth of Sedation in Older Patients Undergoing Hip Fracture Repair on Postoperative Delirium: The STRIDE Randomized Clinical Trial Postoperative delirium is the most common complication following major surgery in older patients. Intraoperative sedation levels are a possible modifiable risk factor for postoperative delirium.To determine whether limiting sedation levels during spinal anesthesia reduces incident delirium overall.This double-blind randomized clinical trial (A Strategy (...) to Reduce the Incidence of Postoperative Delirum in Elderly Patients [STRIDE]) was conducted from November 18, 2011, to May 19, 2016, at a single academic medical center and included a consecutive sample of older patients (≥65 years) who were undergoing nonelective hip fracture repair with spinal anesthesia and propofol sedation. Patients were excluded for preoperative delirium or severe dementia. Of 538 hip fractures screened, 225 patients (41.8%) were eligible, 10 (1.9%) declined participation, 15
Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Clinical Practice Guidelines for the Prevention and Manageme... : Critical Care Medicine You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Login No user account? Lippincott Journals Subscribers , use your username or email along with your password to log in. Remember me (...) Note Procite Reference Manager Save my selection doi: 10.1097/CCM.0000000000003299 Online Special Article Free Objective: To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain , Agitation, and Delirium in Adult Patients in the ICU. Design: Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual
Ability of suvorexant to prevent delirium in patients in the intensive care unit: a randomized controlled trial There are no effective, tolerable, and established medications for preventing delirium in critically ill patients admitted to the intensive care unit (ICU). We investigated whether suvorexant was effective in preventing ICU delirium.This randomized controlled study evaluated 70 adult patients (age ≥20 years) admitted to the mixed medical ICU of the Tokyo Medical University Hospital (...) (Tokyo, Japan) between May 2015 and February 2017. Patients were randomized using a sealed envelope method to receive either suvorexant (n = 34; 15 mg for elderly patients and 20 mg for younger adults) or conventional treatment (n = 36) for a 7-day period. The primary outcome was delirium incidence based on the definition in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders.No significant between-group differences were observed in the demographic or clinical characteristics
Delirium Top results for delirium - Trip Database or use your Google+ account Find evidence fast ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search numbers in the top search box and pressing the search button. An example search might look like (#1 or #2) and (#3 or #4 (...) ) Loading history... Population: Intervention: Comparison: Outcome: Population: Intervention: Latest & greatest articles for delirium The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted
Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial Dexmedetomidine is associated with less delirium than benzodiazepines and better sleep architecture than either benzodiazepines or propofol; its effect on delirium and sleep when administered at night to patients requiring sedation remains unclear.To determine if nocturnal dexmedetomidine prevents delirium and improves sleep in critically ill adults.This two-center, double-blind, placebo-controlled (...) trial randomized 100 delirium-free critically ill adults receiving sedatives to receive nocturnal (9:30 p.m. to 6:15 a.m.) intravenous dexmedetomidine (0.2 μg/kg/h, titrated by 0.1 μg /kg/h every 15 min until a goal Richmond Agitation and Sedation Scale score of -1 or maximum rate of 0.7 μg/kg/h was reached) or placebo until ICU discharge. During study infusions, all sedatives were halved; opioids were unchanged. Delirium was assessed using the Intensive Care Delirium Screening Checklist every 12
Melatonin and Sleep in Preventing Hospitalized Delirium: A Randomized Clinical Trial Studies suggest that melatonin may prevent delirium, a condition of acute brain dysfunction occurring in 20%-30% of hospitalized older adults that is associated with increased morbidity and mortality. We examined the effect of melatonin on delirium prevention in hospitalized older adults while measuring sleep parameters as a possible underlying mechanism.This was a randomized clinical trial measuring the impact (...) of 3 mg of melatonin nightly on incident delirium and both objective and subjective sleep in inpatients age ≥65 years, admitted to internal medicine wards (non-intensive care units). Delirium incidence was measured by bedside nurses using the confusion assessment method. Objective sleep measurements (nighttime sleep duration, total sleep time per 24 hours, and sleep fragmentation as determined by average sleep bout length) were obtained via actigraphy. Subjective sleep quality was measured using
Cholinesterase inhibitors for the treatment of delirium in non-ICU settings. Delirium is a common clinical syndrome defined as alterations in attention with an additional disturbance in cognition or perception, which develop over a short period of time and tend to fluctuate during the course of the episode. Delirium is commonly treated in hospitals or community settings and is often associated with multiple adverse outcomes such as increased cost, morbidity, and even mortality. The first-line (...) intervention involves a multicomponent non-pharmacological approach that includes ensuring effective communication and reorientation in addition to providing reassurance or a suitable care environment. There are currently no drugs approved specifically for the treatment of delirium. Clinically, however, various medications are employed to provide symptomatic relief, such as antipsychotic medications and cholinesterase inhibitors, among others.To evaluate the effectiveness and safety of cholinesterase
Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults. Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) may complicate a patient's postoperative recovery in several ways. Monitoring of processed electroencephalogram (EEG) or evoked potential (EP) indices may prevent or minimize POD and POCD, probably through optimization (...) could reduce the risk of postoperative delirium in patients aged 60 years or over undergoing non-cardiac surgical and non-neurosurgical procedures. We found moderate-quality evidence that postoperative cognitive dysfunction at three months could be reduced in these patients. The effect on POCD at one week and over one year after surgery is uncertain. There are no data available for patients under 60 years. Further blinded randomized controlled trials are needed to elucidate strategies
Comparison of clinical practice guidelines for the management of pain, agitation, and delirium in critically ill adult patients Guideline-based management approaches for pain, agitation, and delirium (PAD) in critically ill adult patients are widely believed to result in good outcomes. However, there are some differences in the recommendations and evidence levels among the management guidelines established for PAD. To identify and compare the current management guidelines, we used the PubMed (...) in the intensive care unit. Intravenous opioids were recommended as the first-line drug of choice for treating pain. Sedative titrated to maintain a light, rather than deep, level of sedation can be given unless clinically contraindicated. Although neither the PAD nor J-PAD guidelines recommend use of a pharmacologic delirium prevention protocol or treatment with any pharmacological agent to reduce the duration of delirium, the FEPIMCTI guidelines provide such recommendations. The FEPIMCTI guidelines provide
Should This Patient Receive Prophylactic Medication to Prevent Delirium?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. In 2015, the American Geriatrics Society released recommendations for prevention and management of postoperative delirium, based on a systematic literature review and evaluation of nonpharmacologic and pharmacologic approaches by an expert panel. The guidelines recommend an interdisciplinary focus on nonpharmacologic measures (reorientation, medication (...) management, early mobility, nutrition, and gastointestinal motility) for prevention and consideration of this strategy for acute management. They also recommend optimizing nonopioid medication as a means to manage pain and avoiding benzodiazepines other than to treat substance withdrawal. The authors concluded that evidence to recommend antipsychotics for prevention of delirium is insufficient but that these drugs may be considered for short-term treatment in the setting of imminent harm to the patient