2007, Number 1
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Med Crit 2007; 21 (1)
Delirium
Carrillo ER, Carrillo CJR
Language: Spanish
References: 42
Page: 38-44
PDF size: 69.37 Kb.
ABSTRACT
Delirium is defined as an acute change or fluctuation in mental status plus innatention and either disorganized thinkings or an altered level of consciousness at the time of evaluation. Numerous studies have described the incidence, prevalence and costly impact of delirium with regard to patients in nursing homes and hospital words, but few prospective investigations have focused on cohorts treated specifically within the intensive care unit. Several studies have now confirmed that delirium occurs in 60% to 80% of mechanically ventilated patients, though two investigations found a lower prevalence in an ICU cohort with a lesser severity of illness. Only 5% of 912 critical care professionals surveyed in 2001 and 2002 suported monitoring for ICU delirium, and yet the Society of Critical Care Medicine has recommended routine monitoring for delirium for all ICU patients. Delirium is an independent predictor of longer stay in the ICU. This article reviews the definition and salient features of delirium, its primary risk factors, a newly validated instrument for delirium assessment that is being developed for ICU nurses and physicians, and pharmacological agents associated with the development of delirium and used in its management.
REFERENCES
Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 1994;97:278-288.
Sanders AB. Missed delirium in older emergency department patients: a quality-of-care problem. Ann Emerg Med 2002;39:338-341.
Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994;123-133.
Ely EW, Siegel MD, Inouye S. Delirium in the intensive care unit: an under-recognized syndrome of organ dysfunction. Semin Respir Crit Care Med 2001;22:115-126.
Webb JM, Carlton EF, Beeham DM. Delirium in the intensive care unit: are we helping the intensive care unit-are we helping the patient? Crit Care Nurs Q. 2000;22:47-60.
Ely EW, Inouye SK, Bernard GR et al. Delirium in mechanically ventilated patients: validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA 2001;286:2703-2710.
Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 2001;27:1297-1304.
Rincon HG, Granados M, Unutzer J et al. Prevalence, detection, and treatment of anxiety, depression, and delirium in the adult critical care unit. Psychosomatics 2001;42:391-396.
Ely EW, Gautam S, Margolin R et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001;27:1892-1900.
Jackson JC, Hart RP, Gordon SM et al. Six-month neuropsychological outcome of medical ICU patients. Crit Care Med. In press.
Trzepacz PT, Mulsant BH, Dew MA, Pasternak R, Sweet RA, Zubenko GS. Is delirium different when it occurs in dementia? A study using the Delirium Rating Scale. J Neuropsychiatry Clin Neurosci 1998;10:199-204.
Cole MG, McCusker J, Dendukuri N, Han L. Symptoms of delirium among elderly medical in patients with or without dementia. J Neuropsychiatry Clin Neurosci 2002;14(2)167-75.
O’Keeffe ST, Lavan JN. Clinical significance of delirium subtypes in older people. Age Ageing 1999;28:115-119.
Meagher DJ, Hanlon DO, Mahony EO, Casey PR, Trzepacz PT. Relationship between symptoms and motoric subtype of delirium. J Neuropsychiatry Clin Neurosci 2000;12:51-56.
Meagher DJ, Trzepacz PT. Motoric subtypes of delirium. Semin Clin Neuropsychiatry 2000;5:75-85.
Justic M. Does «ICU psychosis» really exist? Crit Care Nurse 2000;20:28-37.
Crippen D. Treatment of agitation and its comorbidities in the intensive care unit. In: Hill NS, Levy MM, eds. Ventilator Management Strategies for Critical Care. New York, NY: Marcel Dekker Inc; 2001:243-284.
Lipowski ZJ. Delirium in the elderly patient. N Engl J Med 1989;320:578-582.
Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA 1996;275:852-857.
Francis J. Drug-induced delirium. CNS Drugs 1996;5:103-114.
Williams-Russo P, Urquhart BL, Sharrock NE, Charlson ME. Post-operative delirium: predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc 1992;40:759-767.
Marcantonio ER, Juarez G, Goldman L et al. The relationship of postoperative delirium with psychoactive medications. JAMA 1994;272:1518-1522.
Lynch EP, Lazor MA, Gellis JE, Orav J, Goldman L, Marcantonio ER. The impact of postoperative pain on the development of postoperative delirium. Anesth Analg 1998;86:781-785.
Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 1993;119:474-481.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horowitz RI. Clarifying confusion: the Confusion Asessment Method. Ann Intern Med 1990;113:941-948.
Hart RP, Levenson JL, Sessier CN, Best AM, Schwartz SM, Rutherford LE. Validation of a cognitive test for delirium in medical ICU patients. Psychosomatics 1996;37:533-546.
Bergeron N, Skrobik Y, Dubois MJ. Delirium in critically ill patients. Am J Respir Crit Care Med 2002;6:181-182.
Sesler C, Godnell M, Grap MJ et al. The Richmond agitation-sedation scale: validity and reliability in adult intensive care patients. Am J Respir Crit Care Med 2002; 166:1338-1344.
Ely EW, Gautam S, May L et al. A comparison of different sedation scales in the ICU and validation of the Richmond Agitation Sedation Scale (RASS). Am J Respir Crit Care Med 2001;163:A954.
Inouye SK, Bogardus ST, Charpentier PA et al. A Multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999;340:669-676.
Milisen K, Foreman MD, Abraham IL et al. A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. J Am Geriatr Soc 2001; 49:523-532.
Bogardus ST, Desai MM, Williams CS et al. The effect of a targeted multicomponent delirium intervention of postdischarge outcomes for hospitalized older adults. Am J Med 2003;114:383-390.
Maldonado JR, van der Starre PJ, Wysong A. Post operative sedation and the incidence of ICU delirium in cardiac surgery patients. Anesthesiology 2003; ASA meeting abstracts (October 15 2005).
Tesar GE, Murray GB, Casem NH. Use of high-dose intravenous haloperidol in the treatment of agitated cardiac patients. Journal of Clinical Psychopharmacology 1985; 5:344-347.
Hassan E, Fontaine DK, Nearman HS. Therapeutic Considerations in the management of agitated and delirious critically ill patients. Pharmacotherapy 1998;18:113-129.
Seneff MG, Mathews RA. Use of haloperidol infusions to control delirium in critically ill adults. Annals of Pharmacotherapy 1995;29:690-693.
Levenson JL. High-dose intravenous haloperidol for agitated delirium following lung transplantation. Psychosomatics 1995;36:66-68.
Brown RL, Henke A, Greenhalgh DG, Warden GD. The use of haloperidol in the agitated, critically ill pediatric patient with burns. Journal of Burn Care Rehabilitation 1996;17:34-38.
Ely EW, Stephens RK, Jackson JC et al. Current opinions regarding the importance, diagnosis and management of delirium in the intensive care unit. A survey of 912 healthcare professionals. Crit Care Med 2003;31:106-112.
Riker R, Fraser G, Cox P. Continuous infusion of haloperidol controls agitation in critically ill patients. Crit Care Med 1994;22:433-440.
Milbrandt EB, Kersten A, Kong L, Weissfeld LA, Clermont G, Fink MP. Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients. Critical Care Med 2005;33:226-229.
Skrobik YK, Bergeron N, Dumont M, Gottfried SB. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med 2004;30: 444-449.