Adverse events caused by potential drug-drug interactions in an intensive care unit of a teaching hospital (original) (raw)
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Delirium in the Intensive Care Unit: A Review
Neurologic Clinics, 2011
This article provides an overview of the literature currently available concerning the epidemiology, definition, diagnosis, pathophysiology, and the management of delirium, with a specific focus on delirium in the intensive care unit (ICU), though the literature and principles described herein generally apply to non-ICU settings and will be relevant to clinicians and researchers working in medical settings outside of critical care. Delirium is a complex and multifaceted syndrome, and though it has a long history in the annals of medicine, key questions pertaining to delirium remain unanswered. Answers to these questions, however, are increasingly being pursued, as reflected in a sharp spike in the number of articles published on delirium in the last decade. EPIDEMIOLOGY OF DELIRIUM Delirium is highly prevalent in medical populations, with rates of up to 80% reported in the highest risk groups (eg, medical ICU cohorts). As with most conditions, rates vary depending on illness severity and diagnostic methods including, and notably, the tools that are used. 1-3 Delirium is associated with adverse outcomes generally, but in ICU Drs Morandi and Jackson have no conflicts of interest to report.
Incidence and factors related to delirium in an intensive care unit
Revista da Escola de Enfermagem da U S P
To identify the incidence of delirium, compare the demographic and clinical characteristics of patients with and without delirium, and verify factors related to delirium in critical care patients. Prospective cohort with a sample made up of patients hospitalized in the Intensive Care Unit (ICU) of a university hospital. Demographic, clinical variables and evaluation with the Confusion Assessment Method for Intensive Care Unit to identify delirium were processed to the univariate analysis and logistic regression to identify factors related to the occurrence of delirium. Of the total 149 patients in the sample, 69 (46.3%) presented delirium during ICU stay, whose mean age, severity of illness and length of ICU stay were statistically higher. The factors related to delirium were: age, midazolam, morphine and propofol. Results showed high incidence of ICU delirium associated with older age, use of sedatives and analgesics, emphasizing the need for relevant nursing care to prevent and id...
Current Anesthesiology Reports, 2021
Purpose of Review Delirium in the intensive care unit (ICU) has become increasingly acknowledged as a significant problem for critically ill patients affecting both the actual course of illness as well as outcomes. In this review, we focus on the current evidence and the gaps in knowledge. Recent Findings This review highlights several areas in which the evidence is weak and further research is needed in both pharmacological and non-pharmacological treatment. A better understanding of subtypes and their different response to therapy is needed and further studies in aetiology are warranted. Larger studies are needed to explore risk factors for developing delirium and for examining long-term consequences. Finally, a stronger focus on experienced delirium and considering the perspectives of both patients and their families is encouraged. Summary With the growing number of studies and a better framework for research leading to stronger evidence, the outcomes for patients suffering from delirium will most definitely improve in the years to come. Keywords Delirium • Intensive care • CAM-ICU • Risk factors • Non-pharmacological • Pharmacological • Core outcome This article is part of the Topical Collection on Critical Care Anesthesia
Prevalence, risk factors and outcome of delirium in intensive care unit
Introduction: Delirium causes serious in-hospital morbidity. Aims: Prevalence, risk factors and outcome of delirium were studied in a medical ICU. Materials and Methods: This prospective study in the medical ICU identified delirium by CAM (Confusion Assessment Method). Comorbidities were assessed by Charlson Comorbidity Index. Socio-demographics, clinical parameters and outcome required a structured questionnaire. Data was analyzed using chi-square test, Pearson correlation and independent sample t test. Results: Of 467 patients assessed, 101satisfied CAM diagnosis of delirium (prevalence-21.6%). Females predominated (51.5%); average age was 59.6 years. Acute exacerbation of chronic obstructive pulmonary disease (COPD) was the most common illness, diabetes mellitus (58.4%) followed by hypertension (17.8%) the most common co-morbidities. Leukocytosis, raised serum creatinine and abnormal EEG were observed. 77.2% had nasogastric feeding, 22.8% needed ventilator support.76.2% of patients were on some medication. Delirium was hyperactive in 78.2%, idiopathic in 38.6%. Hypoactive delirium, the least common, was associated with acute pulmonary oedema and sepsis (51.3%). (p=0.009). Delirium resolved completely in 80.2%. Mortality rate was 13.9%. 78.6% patients died within 72 hours (p=0.008); death was increased in those with respiratory findings (p=0.01) and ventilator (p<0.001). Conclusion: A high prevalence of delirium was found in the Medical ICU. This was mostly hyperactive and idiopathic. Hypoactive delirium, the least common, was found associated with acute pulmonary oedema, sepsis. Acute exacerbation of COPD was the most common cause. Those with respiratory findings and on ventilator had higher mortality.
The Clinical Significance of Delirium in the Intensive Care Unit
Delirium is prevalent among intensive care unit patients. It prolongs length of stay, increases costs, and is independently associated with higher mortality rates. While its specific biological pathways are largely unknown, environmental and iatrogenic determinants have been repeatedly recognized. Removal of the known triggers and pharmacologic intervention constitute available therapies. This review focuses on the clinical significance of delirium in critically ill patients, from its prevalence to its long-term impact, the ways that we have to diagnose it, and the available therapeutic options.
Delirium in the intensive care unit: a narrative review
Journal of gerontology and geriatrics, 2023
Critically ill patients frequently suffer from various acute organ dysfunctions. The most common clinical manifestation of central nervous system dysfunction defined as acute encephalopathy is delirium. Since delirium in intensive care unit (ICU) patients has been associated with worse outcomes, its early diagnosis, prevention, and appropriate treatments are strongly recommended. The PADIS guidelines recommend routine monitoring of delirium with the CAM-ICU or ICDSC, which should be performed at least once during each nursing shift and whenever patients show a change in the level of consciousness. Neuroimaging is useful for studying the pathophysiology of delirium, and it might be helpful in the differential diagnosis, although various and non-specific patterns can be observed in both MRI and functional MRI. Also, the electroencephalogram (EEG) showed different non-specific patterns associated with delirium and its role in the differential diagnosis of neurological complications of the critical patient is still uncertain. This narrative review presents the epidemiology and risk factors of delirium in ICU patients, the different diagnostic tools and procedures useful for its early detection, and the pharmacological and non-pharmacological treatments required for its management.
Delirium in the ICU: an overview
2012
Delirium is characterized by a disturbance of consciousness with accompanying change in cognition. Delirium typically manifests as a constellation of symptoms with an acute onset and a fluctuating course. Delirium is extremely common in the intensive care unit (ICU) especially amongst mechanically ventilated patients. Three subtypes have been recognized: hyperactive, hypoactive, and mixed. Delirium is frequently undiagnosed unless specific diagnostic instruments are used. The CAM-ICU is the most widely studied and validated diagnostic instrument. However, the accuracy of this tool may be less than ideal without adequate training of the providers applying it. The presence of delirium has important prognostic implications; in mechanically ventilated patients it is associated with a 2.5-fold increase in short-term mortality and a 3.2-fold increase in 6-month mortality. Nonpharmacological approaches, such as physical and occupational therapy, decrease the duration of delirium and should be encouraged. Pharmacological treatment for delirium traditionally includes haloperidol; however, more data for haloperidol are needed given the paucity of placebo-controlled trials testing its efficacy to treat delirium in the ICU. Second-generation antipsychotics have emerged as an alternative for the treatment of delirium, and they may have a better safety profile. Dexmedetomidine may prove to be a valuable adjunctive agent for patients with delirium in the ICU.
Incidence, risk factors and consequences of ICU delirium
Intensive Care Medicine, 2007
Objective Delirium in the critically ill is reported in 11–80% of patients. We estimated the incidence of delirium using a validated scale in a large cohort of ICU patients and determined the associated risk factors and outcomes. Design and setting Prospective study in a 16-bed medical-surgical intensive care unit (ICU). Patients 820 consecutive patients admitted to ICU for more than 24 h. Interventions Tools used were: the Intensive Care Delirium Screening Checklist for delirium, Richmond Agitation and Sedation Scale for sedation, and Numerical Rating Scale for pain. Risk factors were evaluated with univariate and multivariate analysis, and factors influencing mortality were determined using Cox regression. Results Delirium occurred in 31.8% of 764 patients. Risk of delirium was independently associated with a history of hypertension (OR 1.88, 95% CI 1.3–2.6), alcoholism (2.03, 1.2–3.2), and severity of illness (1.25, 1.03–1.07 per 5-point increment in APACHE II score) but not with age or corticosteroid use. Sedatives and analgesics increased the risk of delirium when used to induce coma (OR 3.2, 95% CI 1.5–6.8), and not otherwise. Delirium was linked to longer ICU stay (11.5 ± 11.5 vs. 4.4 ± 3.9 days), longer hospital stay (18.2 ± 15.7 vs. 13.2 ± 19.4 days), higher ICU mortality (19.7% vs. 10.3%), and higher hospital mortality (26.7% vs. 21.4%). Conclusion Delirium is associated with a history of hypertension and alcoholism, higher APACHE II score, and with clinical effects of sedative and analgesic drugs.
Delirium in intensive care: an under-diagnosed reality
Revista Brasileira de Terapia Intensiva, 2013
Delirium occurs in up to 80% of patients admitted to intensive care units. Although under-diagnosed, delirium is associated with a significant increase in morbidity and mortality in critical patients. Here, we review the main