ICU Delirium: Difference between revisions

(Grammar and spelling)
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[[File:Clinicians_in_Intensive_Care_Unit.jpg|thumb|512x512px|Source: [https://commons.wikimedia.org/wiki/File:Clinicians_in_Intensive_Care_Unit.jpg Wikimedia Commons], Author: Calleamanecer, License: Creative Commons [https://creativecommons.org/licenses/by-sa/3.0/deed.en Attribution-Share Alike 3.0 Unported]]]As the survival of critically ill patients improves, ICU delirium has become a growing public health issue. Delirium is defined as a rapid change in consciousness (hours to days) characterized by reduced environmental awareness, decreased attention and altered cognition. These clinical features can manifest themselves as memory deficits, disorientation, hallucinations, fluctuating levels of alertness, and motor abnormalities.<ref>American Psychiatric A. Diagnostic and statistical manual of mental disorders. 5th edition. Washington, DC: American Psychiatric Association; 2013</ref>
[[File:Clinicians_in_Intensive_Care_Unit.jpg|thumb|512x512px|Source: [https://commons.wikimedia.org/wiki/File:Clinicians_in_Intensive_Care_Unit.jpg Wikimedia Commons], Author: Calleamanecer, License: Creative Commons [https://creativecommons.org/licenses/by-sa/3.0/deed.en Attribution-Share Alike 3.0 Unported]]]As the survival of critically ill patients improves, ICU delirium has become a growing public health issue. Delirium is defined as a rapid change in consciousness (hours to days) characterized by reduced environmental awareness, decreased attention and altered cognition. These clinical features can manifest themselves as memory deficits, disorientation, hallucinations, fluctuating levels of alertness, and motor abnormalities.<ref>American Psychiatric A. Diagnostic and statistical manual of mental disorders. 5th edition. Washington, DC: American Psychiatric Association; 2013</ref>


There is a significant burden that is associated with this condition. Compared with people who do not develop delirium, people who develop ICU delirium may:
According to Ely et al<ref>Ely EW1, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001; 286(21): 2703-10</ref> as much as 83% of ICU patients on mechanical ventilation develop delirium. This figure is significant as ICU delirium is associated with negative patient and healthcare outcomes. These outcomes include:
* need to stay longer in hospital or in critical care
* increased time on mechanical ventilation,<ref name=":0">Salluh J, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, Serafim RB, Stevens RD. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015; 350: h2538</ref>  
* have an increased incidence of dementia
* increased likelihood of being discharged to a long-term care facility<ref>Young J, Murthy L, Westby M, Akunne A, O’Mahony R. Diagnosis, prevention, and management of delirium: summary of NICE guidance. Bmj. 2010 Jul 28;341:c3704.</ref>
* have more hospital-acquired complications, such as falls and pressure sores
* longer ICU and hospital length of stay, <ref>Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK. The impact of delirium in the Intensive care unit on hospital length of stay. Intensive Care Med 2001; 27:1892-1900</ref><ref>Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 2005; 9(4): R375–R381</ref>  
* be more likely to need to be admitted to long-term care if they are in hospital
* elevated health care costs,<ref>Milbrandt, E.B., Deppen, S., Harrison, P.L., Shintani, A.K., Speroff, T., Stiles, R.A., Truman, B., Bernard, G.R., Dittus, R.S., Ely, E.W. Costs Associated with Delirium in Mechanically Ventilated Patients. Crit. Care Med. 32 (4):955-962, 2004</ref>  
* be more likely to die<ref>Young J, Murthy L, Westby M, Akunne A, O’Mahony R. Diagnosis, prevention, and management of delirium: summary of NICE guidance. Bmj. 2010 Jul 28;341:c3704.</ref>
* increased cognitive dysfunction,<ref name=":0" />  
According to Ely et al<ref>Ely EW1, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001; 286(21): 2703-10</ref> as much as 83% of ICU patients on mechanical ventilation develop delirium. This figure is significant as ICU delirium is associated with negative patient and healthcare outcomes. These outcomes include increased time on mechanical ventilation,<ref name=":0">Salluh J, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, Serafim RB, Stevens RD. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015; 350: h2538</ref> longer ICU and hospital length of stay, <ref>Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK. The impact of delirium in the Intensive care unit on hospital length of stay. Intensive Care Med 2001; 27:1892-1900</ref><ref>Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 2005; 9(4): R375–R381</ref> elevated health care costs,<ref>Milbrandt, E.B., Deppen, S., Harrison, P.L., Shintani, A.K., Speroff, T., Stiles, R.A., Truman, B., Bernard, G.R., Dittus, R.S., Ely, E.W. Costs Associated with Delirium in Mechanically Ventilated Patients. Crit. Care Med. 32 (4):955-962, 2004</ref> increased cognitive dysfunction<ref name=":0" /> and increased risk of death.<ref>Ely EW, Shintani A., Truman B, Speroff T, Gordon SM, Harrell FE, Inouye SK, Bernard GR, Dittus RS. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291(14): 1753-62</ref>
* and increased risk of death.<ref>Ely EW, Shintani A., Truman B, Speroff T, Gordon SM, Harrell FE, Inouye SK, Bernard GR, Dittus RS. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291(14): 1753-62</ref>
 
== Delirium Subtypes ==
== Delirium Subtypes ==
Delirium can be divided into 3 subtypes: hyperactive, hypoactive, and mixed. The table below matches each subtype with common clinical manifestations.   
Delirium can be divided into 3 subtypes: hyperactive, hypoactive, and mixed. The table below matches each subtype with common clinical manifestations.   
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[Adapted from: Saint Louis University Geriatrics Evaluation Mnemonics Screening Tools (SLU GEMS). Developed or compiled by: Faculty from Saint Louis University Geriatrics Division and St. Louis Veterans Affairs GRECC.]
[Adapted from: Saint Louis University Geriatrics Evaluation Mnemonics Screening Tools (SLU GEMS). Developed or compiled by: Faculty from Saint Louis University Geriatrics Division and St. Louis Veterans Affairs GRECC.]


Other risk factors common to the hospital setting include the absence of daylight, lack of visitors, sleep deprivation, immobility, and hospital lines.<ref name=":2" />
In hospitals, other common risk factors include the absence of daylight, lack of visitors, sleep deprivation, immobility, and hospital lines.<ref name=":2" />


== Pathophysiology ==
== Pathophysiology ==
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== Diagnosis ==
== Diagnosis ==
Given the unknown pathophysiology, there are no imaging or laboratory tests that can diagnose delirium. As a result, delirium is a diagnosis of exclusion that requires careful clinical testing and observation.
There are no imaging or laboratory tests to diagnose delirium. Delirium is a diagnosis of exclusion that requires careful clinical testing and observation.


== Assessment and Monitoring ==
== Assessment and Monitoring ==
Guidelines for treating Pain, Agitation, and Delirium (PAD)<ref>Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41(1):263-306</ref> recommend two tests for the assessment of delirium in adult ICU patients:
ICU Pain, Agitation, and Delirium (PAD)<ref>Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41(1):263-306</ref> guidelines recommend two tests for the assessment of delirium in adult ICU patients:
# [http://www.icudelirium.org/docs/2013-Tufts-ICU-Delirium-Screening-Checklist.pdf The Intensive Care Delirium Screening Checklist] (ICDSC)
# [http://www.icudelirium.org/docs/2013-Tufts-ICU-Delirium-Screening-Checklist.pdf The Intensive Care Delirium Screening Checklist] (ICDSC)
# [http://www.icudelirium.org/docs/CAM_ICU_worksheet.pdf The Confusion Assessment Method for the ICU] (CAM-ICU)
# [http://www.icudelirium.org/docs/CAM_ICU_worksheet.pdf The Confusion Assessment Method for the ICU] (CAM-ICU)
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== Prevention and Treatment ==
== Prevention and Treatment ==
In 2010, Vasilevskis et al.<ref>Vasilevskis EE1, Pandharipande PP, Girard TD, Ely EW. A screening, prevention, and restoration model for saving the injured brain in intensive care unit survivors. Crit Care Med 2010;38(10 Suppl):S683-91.</ref> proposed the ABCDE model to screen and prevent delirium among ICU patients. The updated version is expanded to include family engagement.<ref>ICU liberation. ABCDEF Bundle. http://www.iculiberation.org/Bundles/Pages/default.aspx. Accessed March 11, 2018.</ref> The concepts corresponding to each letter of the mnemonic are as follows:
Delirium prevention should be multicomponent intervention tailored to patient needs.<ref name=":0" /> The ABCDEF bundle provides a framework to screen and prevent delirium in ICU patients.<ref>ICU liberation. ABCDEF Bundle. https://www.sccm.org/ICULiberation/ABCDEF-Bundles. Accessed January 28, 2019.</ref> The concepts corresponding to each letter of the mnemonic are as follows:
{| class="wikitable"
{| class="wikitable"
!
!
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|Family engagement and empowerment
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In addition to the ABCDEF bundle, Brummel et al.<ref name=":2" /> advocate identifying and correcting for individualized causal factors of delirium (ex. minimizing unnecessary noise during rest hours to reduce sleep deprivation).
In addition to the aforementioned strategies, patient management should include measures to prevention infection, dehydration, constipation, and hypoxia.<ref name=":0" /> If possible, movement of patients within and between rooms or wards should be avoided. Other simple, yet vital preventative measures include frequent patient reorientation,<ref name=":0" /><ref name=":3" /> use of patients' customary vision and hearing aids,<ref name=":0" /><ref name=":3" /> and promotion of good sleep hygiene.<ref name=":0" /><ref name=":2" />
 
If prevention is unsuccessful, treatment of delirium should focus on identifying and managing the underlying causes. The care team should also ensure effective communication and reorientation, and provide reassurance for people diagnosed with delirium. <ref name=":5">National Institute for Health and Care Excellence. (2013). Delirium: prevention, diagnosis and management. Retrieved from https://www.nice.org.uk/guidance/cg103</ref> If a person with delirium is distressed or considered a risk to themselves or others, and verbal and non-verbal de-escalation techniques are ineffective or not appropriate, short-term haloperidol, a medication often prescribed for acute psychosis, should be considered, starting at the lowest clinically appropriate dose. <ref name=":5" />
== Implications for Physical Therapy Practice ==
== Implications for Physical Therapy Practice ==
Physical therapists have an important role in preventing and managing ICU delirium. Perhaps the most important measure is engaging patients in early mobilization in conjunction with nurses, occupational therapists, and physicians. Early mobilization in the ICU has been shown to reduce the number of days on mechanical ventilation,<ref>Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373(9678):1874-82</ref><ref name=":4">Needham DM, Chandolu S, Zanni J. Interruption of sedation for early rehabilitation improves outcomes in ventilated, critically ill adults. Aust J Physiother 2009; 55(3):210</ref> decrease ICU and hospital length of stay<ref>Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite RD, Haponik E. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008;36(8):2238-43</ref> and is the only intervention to date proven to decrease the number of days of delirium<ref name=":4" />. Frequent patient orientation, use of a patient's customary vision and hearing aids, and family training and education are additional interventions that can be integrated into therapy sessions.<ref name=":3" /> The CAM-ICU is a quick and easy tool for physical therapists to assess and monitor the course of a patient's delirium over time.
Physical therapists play an important role in preventing and managing ICU delirium. Perhaps the most important measure is engaging patients in early mobilization in conjunction with nurses, occupational therapists, and physicians.  
 
Early mobilization in the ICU has been shown to reduce the number of days on mechanical ventilation,<ref>Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373(9678):1874-82</ref><ref name=":4">Needham DM, Chandolu S, Zanni J. Interruption of sedation for early rehabilitation improves outcomes in ventilated, critically ill adults. Aust J Physiother 2009; 55(3):210</ref> decrease ICU and hospital length of stay<ref>Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite RD, Haponik E. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008;36(8):2238-43</ref> and is the only intervention to date proven to decrease the number of days of delirium<ref name=":4" />. Family training, patient reorientation, delirium assessment, use of appropriate vision and hearing aids, and pain management can readily be integrated into therapy sessions. The CAM-ICU is a quick and easy tool that allows physical therapists to assess and monitor the course of a patient's delirium over time.


== Differential Diagnosis ==
== Differential Diagnosis ==
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* [[Myocardial Infarction]]  
* [[Myocardial Infarction]]  
[Sources: American Family Physician- [https://www.aafp.org/afp/2003/0301/p1027.html Delirium], BMJ Best Practice- [http://bestpractice.bmj.com/topics/en-gb/241 Assessment of Delirium]]
[Sources: American Family Physician- [https://www.aafp.org/afp/2003/0301/p1027.html Delirium], BMJ Best Practice- [http://bestpractice.bmj.com/topics/en-gb/241 Assessment of Delirium]]
== Clinical Guidelines ==
NICE Guidelines on Delirium have been updated in March 2019. They recommend an initial risk factor assessment on admission. The interventions recommended to prevent delirium include; ensuring people who are at risk are not moved within and between wards or rooms unless absolutely necessary, provision of a multicomponent intervention tailored to the person's individual needs and care settings. Initial management should include identifying and managing the underlying cause or combination of causes. Ensure effective communication and reorientation and provide reassurance for people diagnosed with delirium. <ref name=":5">National Institute for Health and Care Excellence. (2013). Delirium: prevention, diagnosis and management. Retrieved from https://www.nice.org.uk/guidance/cg103</ref>
If a person with delirium is distressed or considered a risk to themselves or others and verbal and non-verbal de-escalation techniques are ineffective or not appropriate, consider giving short-term haloperidol starting at the lowest clinically appropriate dose. <ref name=":5" />
A systematic review and meta-analysis in 2015 reported that almost a third of patients who are admitted to an intensive care unit develop delirium, and these patients are at increased risk of dying during admission, longer stays in hospital, and cognitive impairment after discharge.<ref>Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, Serafim RB, Stevens RD. Outcome of delirium in critically ill patients: systematic review and meta-analysis. bmj. 2015 Jun 3;350:h2538.</ref>


== Further Reading ==
== Further Reading ==
For further reading, the [http://www.icudelirium.org/index.html ICU Delirium and Cognitive Impairment Study Group] is a great resource for learning and staying up to date on best practices for the prevention and management of ICU delirium.
For up to date research and developments on the assessment, prevention, and management of ICU delirium visit the [http://www.icudelirium.org/index.html ICU Delirium and Cognitive Impairment Study Group].  
 
For up to date research and developments in the assessment. prevention and management of delirium in ICU :https://www.icudelirium.org/
 
==References==
==References==


Revision as of 04:14, 29 January 2020

Original Editor - Karen Wilson Top Contributors - Karen Wilson, Kim Jackson, Adam Vallely Farrell, Uchechukwu Chukwuemeka, Admin and Oyemi Sillo

Introduction[edit | edit source]

Source: Wikimedia Commons, Author: Calleamanecer, License: Creative Commons Attribution-Share Alike 3.0 Unported

As the survival of critically ill patients improves, ICU delirium has become a growing public health issue. Delirium is defined as a rapid change in consciousness (hours to days) characterized by reduced environmental awareness, decreased attention and altered cognition. These clinical features can manifest themselves as memory deficits, disorientation, hallucinations, fluctuating levels of alertness, and motor abnormalities.[1]

According to Ely et al[2] as much as 83% of ICU patients on mechanical ventilation develop delirium. This figure is significant as ICU delirium is associated with negative patient and healthcare outcomes. These outcomes include:

  • increased time on mechanical ventilation,[3]
  • increased likelihood of being discharged to a long-term care facility[4]
  • longer ICU and hospital length of stay, [5][6]
  • elevated health care costs,[7]
  • increased cognitive dysfunction,[3]
  • and increased risk of death.[8]

Delirium Subtypes[edit | edit source]

Delirium can be divided into 3 subtypes: hyperactive, hypoactive, and mixed. The table below matches each subtype with common clinical manifestations.

Subtype Clinical Manifestations
Hyperactive Agitation, restlessness, emotional lability, hallucinations
Hypoactive Lethargy, decreased responsiveness, slowed motor skills
Mixed Fluctuation between hyper- and hypoactive symptoms

[Source: Meagher D. Motor subtypes of delirium: past, present, and future. Int Rev Psychiatry. 2009 Feb;21(1):59-73]

In critically ill patients, mixed delirium is the most common subtype (54.9%). Hypoactive delirium is second (43.5%), followed by a small percentage of patients who display purely hyperactive symptoms (1.6%).[9] ICU patients aged 65 and older are particularly susceptible to hypoactive delirium.[9]

Causes and Risk Factors[edit | edit source]

Delirium develops as a result of multiple causes and risk factors. Old age, dementia, depression, smoking, and alcohol use are among the personal factors that increase patient susceptibility.[10][11] In addition, another 20+ risk factors related to medical status have been identified by the literature.[12] Below is a common mnemonic used to help clinicians identify causes related to illness and treatment:

Illness and Treatment-Related Causes of Delirium
D Drugs
E Eyes, ears, and other sensory deficits
L Low O2 states (e.g. heart attack, stroke, and pulmonary embolism)
I Infection
R Retention (of urine or stool)
I Ictal state
U Underhydraton/undernutrition
M Metabolic causes (DM, Post-operative state, sodium abnormalities)

[Adapted from: Saint Louis University Geriatrics Evaluation Mnemonics Screening Tools (SLU GEMS). Developed or compiled by: Faculty from Saint Louis University Geriatrics Division and St. Louis Veterans Affairs GRECC.]

In hospitals, other common risk factors include the absence of daylight, lack of visitors, sleep deprivation, immobility, and hospital lines.[10]

Pathophysiology[edit | edit source]

The pathophysiology of delirium is not well understood. Theories related to its development and progression cite anatomical changes in the brain and neurotransmitter imbalances (ex. abnormal levels of serotonin, decreased acetylcholine, excess dopamine) as possible physiologic mechanisms.[13]

Diagnosis[edit | edit source]

There are no imaging or laboratory tests to diagnose delirium. Delirium is a diagnosis of exclusion that requires careful clinical testing and observation.

Assessment and Monitoring[edit | edit source]

ICU Pain, Agitation, and Delirium (PAD)[14] guidelines recommend two tests for the assessment of delirium in adult ICU patients:

  1. The Intensive Care Delirium Screening Checklist (ICDSC)
  2. The Confusion Assessment Method for the ICU (CAM-ICU)

The following video demonstrates how to perform the CAM-ICU.

Prevention and Treatment[edit | edit source]

Delirium prevention should be multicomponent intervention tailored to patient needs.[3] The ABCDEF bundle provides a framework to screen and prevent delirium in ICU patients.[15] The concepts corresponding to each letter of the mnemonic are as follows:

Evidenced-Based Prevention and Treatment Strategies for ICU Delirium
A Assess, prevent and manage pain
B Both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT)
C Choice of analgesia and sedation
D Delirium: assess, prevent and manage
E Early mobility and exercise
F Family engagement and empowerment

In addition to the aforementioned strategies, patient management should include measures to prevention infection, dehydration, constipation, and hypoxia.[3] If possible, movement of patients within and between rooms or wards should be avoided. Other simple, yet vital preventative measures include frequent patient reorientation,[3][13] use of patients' customary vision and hearing aids,[3][13] and promotion of good sleep hygiene.[3][10]

If prevention is unsuccessful, treatment of delirium should focus on identifying and managing the underlying causes. The care team should also ensure effective communication and reorientation, and provide reassurance for people diagnosed with delirium. [16] If a person with delirium is distressed or considered a risk to themselves or others, and verbal and non-verbal de-escalation techniques are ineffective or not appropriate, short-term haloperidol, a medication often prescribed for acute psychosis, should be considered, starting at the lowest clinically appropriate dose. [16]

Implications for Physical Therapy Practice[edit | edit source]

Physical therapists play an important role in preventing and managing ICU delirium. Perhaps the most important measure is engaging patients in early mobilization in conjunction with nurses, occupational therapists, and physicians.

Early mobilization in the ICU has been shown to reduce the number of days on mechanical ventilation,[17][18] decrease ICU and hospital length of stay[19] and is the only intervention to date proven to decrease the number of days of delirium[18]. Family training, patient reorientation, delirium assessment, use of appropriate vision and hearing aids, and pain management can readily be integrated into therapy sessions. The CAM-ICU is a quick and easy tool that allows physical therapists to assess and monitor the course of a patient's delirium over time.

Differential Diagnosis[edit | edit source]

The multifactorial nature of delirium can make it easy to mistake for other brain dysfunctions. Below is a non-exhaustive list of conditions that should be considered in the differential diagnosis of ICU delirium:

[Sources: American Family Physician- Delirium, BMJ Best Practice- Assessment of Delirium]

Further Reading[edit | edit source]

For up to date research and developments on the assessment, prevention, and management of ICU delirium visit the ICU Delirium and Cognitive Impairment Study Group.

References[edit | edit source]

  1. ↑ American Psychiatric A. Diagnostic and statistical manual of mental disorders. 5th edition. Washington, DC: American Psychiatric Association; 2013
  2. ↑ Ely EW1, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001; 286(21): 2703-10
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Salluh J, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, Serafim RB, Stevens RD. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015; 350: h2538
  4. ↑ Young J, Murthy L, Westby M, Akunne A, O’Mahony R. Diagnosis, prevention, and management of delirium: summary of NICE guidance. Bmj. 2010 Jul 28;341:c3704.
  5. ↑ Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK. The impact of delirium in the Intensive care unit on hospital length of stay. Intensive Care Med 2001; 27:1892-1900
  6. ↑ Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 2005; 9(4): R375–R381
  7. ↑ Milbrandt, E.B., Deppen, S., Harrison, P.L., Shintani, A.K., Speroff, T., Stiles, R.A., Truman, B., Bernard, G.R., Dittus, R.S., Ely, E.W. Costs Associated with Delirium in Mechanically Ventilated Patients. Crit. Care Med. 32 (4):955-962, 2004
  8. ↑ Ely EW, Shintani A., Truman B, Speroff T, Gordon SM, Harrell FE, Inouye SK, Bernard GR, Dittus RS. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291(14): 1753-62
  9. ↑ 9.0 9.1 Peterson J, Pun BT, Dittus RS, Thomason JW, Jackson JC, Shintani AK, Ely EW. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc. 2006; 54(3):479-84
  10. ↑ 10.0 10.1 10.2 Brummel N, Girard T. Preventing delirium in the intensive care unit. Crit Care Clin 2013; 29(1): 51–65
  11. ↑ McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 2003; 51:591-598
  12. ↑ Cavallazzi R, Saad M, Marik PE. Delirium in the ICU: an overview. Ann Intensive Care 2012; 2: 49
  13. ↑ 13.0 13.1 13.2 ICU Delirium and Cognitive Impairment Study Group. For Medical Professionals-- ABCDEF's of prevention and safety. http://www.icudelirium.org/medicalprofessionals.html. Accessed March 8, 2018.
  14. ↑ Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41(1):263-306
  15. ↑ ICU liberation. ABCDEF Bundle. https://www.sccm.org/ICULiberation/ABCDEF-Bundles. Accessed January 28, 2019.
  16. ↑ 16.0 16.1 National Institute for Health and Care Excellence. (2013). Delirium: prevention, diagnosis and management. Retrieved from https://www.nice.org.uk/guidance/cg103
  17. ↑ Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373(9678):1874-82
  18. ↑ 18.0 18.1 Needham DM, Chandolu S, Zanni J. Interruption of sedation for early rehabilitation improves outcomes in ventilated, critically ill adults. Aust J Physiother 2009; 55(3):210
  19. ↑ Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite RD, Haponik E. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008;36(8):2238-43
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