Delirium In Patients Research Articles

Predicting Postoperative Emergence Delirium From the Heart Rate Variability of Patients Undergoing Elective Cardiac Surgery.

Background and objective The complication of postoperative delirium is directly linked to prognosis, leading to prolonged hospital stays and an increase in mortality. Since there is no magic medicine that cures delirium, the prevention of its onset is important, and the development of simple tools that enable the early assessment of the risk is valuable. In the previous study, we hypothesized that postoperative delirium could be predicted from heart rate variability (HRV) measured by using an electrocardiogram (ECG) on the day before elective esophageal cancer surgery. HRV is calculated based on the fluctuation of RR intervals on ECG. The preoperative high-frequency (HF) power in delirium patients was significantly lower than that in non-delirium patients. The HF component is considereda reflection of parasympathetic function. In the current study, we evaluated the hypothesis that parasympathetic nerve activity is low in the resting HRV on the night before surgery in patients who go on to develop postoperative delirium. To that end, we recorded resting HRV in patients scheduled for cardiac surgery on the night before surgery. We then compared the HRV between patients with and without delirium in the postoperative intensive care unit (ICU). The Confusion Assessment Method for the ICU (CAM-ICU) was used to diagnosedelirium. Methods This was a prospective observational study involving patients undergoing elective cardiac surgery. After obtaining approval from the institutional review board, patients aged 65 years and older were enrolled in the study. The day before surgery, a Mini-Mental State Examination (MMSE) was performed. The ECG was used in patients for five minutes. All patients were transferred to the ICU after surgery, and CAM-ICU was measured every eight hours until discharge from the ICU, and positive patients were diagnosed with delirium. Results In this study, 14 patients who developed delirium and 22 patients who did notwere included in the analysis. The average MMSE score was 27.4, with no patients diagnosed with preoperative dementia. In the analysis of HRV, the HF component was significantly lower in the group with delirium compared to the group without delirium (Mann-Whitney U test, p<0.05). Conclusion Based on our findings, in patients with postoperativedelirium, the activity of parasympathetic nerves was lower than before surgery, andwe concluded that it is possible to predict the onset of postoperative delirium based on preoperative ECG measurement.

Delirium After Surgery for Proximal Femoral Fractures in the Frail Elderly Patient: Risk Factors and Clinical Outcomes.

The primary aim of this study was to identify risk factors for delirium after hip fracture surgery. The secondary purpose of this study was to verify peri-operative clinical outcomes, adverse events and mortality rates in delirium patients after hip fracture surgery. A prospective hip fracture database was used to obtain data. In total, 2051 patients older than 70 years undergoing a hip fracture surgery between 01-01-2018 and 01-01-2021 were included. A delirium was diagnosed by a geriatrician based on the DSM-V criteria. The results showed that 16% developed a delirium during hospital admission. Multivariable analysis showed that male gender (OR: 1.99, p<0.001), age (OR: 1.06, p<0.001), dementia (OR: 1.66, p=0.001), Parkinson's disease (OR: 2.32, p=0.001), Δhaemoglobin loss (OR: 1.19, p=0.022), pneumonia (OR: 3.86, p<0.001), urinary tract infection (UTI) (OR: 1.97, p=0.001) and wound infection (OR: 3.02, p=0.007) were significant independent prognostic risk factors for the development of a delirium after hip surgery. The median length in-hospital stay was longer in patients with a delirium (9 days) vs patients without a delirium (6 days) (p<0.001). The 30-day mortality was 7% (with delirium 16% vs with no delirium 6% (p<0.001)). Significant independent prognostic factors associated with delirium after hip surgery were male gender, age, dementia, Parkinson's disease, Δhaemoglobin loss, pneumonia, UTI and wound infection.

Relationship between body mass index and risk of delirium in an intensive care unit

ObjectiveDelirium in the intensive care unit (ICU) is a common and critical condition that leads to poor prognosis in older patients, but the association between body mass index (BMI) and the incidence of delirium remains unclear. MethodsWe retrospectively analyzed 5,622 patients admitted to the ICU of a tertiary referral hospital between 2013 and 2022. We collected sociodemographic data, vital signs, laboratory results, and delirium scale scores. We subdivided the patients into four categories: underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), and obese (>25 kg/m2). The primary outcome was the incidence of delirium according to the BMI categories. We performed multivariable logistic regression analysis, adjusted for sex, age, past smoking and alcohol history, benzodiazepine use, and laboratory abnormalities. ResultsAmong the 5,622 patients in the ICU (mean age, 72.9 years; male, 60.1%; mean BMI, 24.2 kg/m2), the incidence of delirium was 19.0% (1,069 patients). The mean modified incidence of delirium was higher among underweight patients (odds ratio [OR]=1.51, confidence interval [CI]=1.07–2.12, p = 0.02) than among normal-weight patients. Overweight and obese status were not independently associated with delirium (OR=0.90, CI=0.70–1.17, p = 0.43; OR= 0.97; CI=0.77–1.21, p = 0.78, respectively). The area under the receiver-operating characteristic curve of the multivariable logistic regression model was 0.71 (95% CI=0.69–0.73). ConclusionsUnderweight status is an independent risk factor for delirium in the ICU. Additional caution is required when evaluating underweight patients for delirium. Obese or overweight status are not associated with delirium, providing evidence for the obesity paradox.

Clinical Presentations and Prognosis of Delirium in Patients with Coronavirus Disease 2019

Background: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has emerged as one of the biggest health threats of our generation. Since its outbreak, COVID-19 has been showing many typical and some atypical manifestations. One of the common complications in COVID-19 is delirium. Delirium should be detected at the earliest to reduce mortality in COVID-19. Methods: We prospectively studied hospitalized adult (age ≥ 18 years) patients with confirmed COVID-19 from May 1 to May 31, 2021, at GMERS Medical College and Civil Hospital, Sola, Ahmedabad, India. We included all patients suffering from COVID-19 and diagnosed with delirium in the study. Delirium was assessed using the Confusion Assessment Method and Richmond Agitation Sedation Scale. Follow-up was done for delirium patients on days 0, 5, 10, and 30. Results: We included 1,233 patients in the analysis. The incidence of delirium was found 2.43% in which 63.3% were hypoactive delirium while 36.7% were hypoactive delirium presentation. The mean age ± standard deviation of delirium patients was 68.33 ± 14.67 years (range = 46-92) years, and 20 (66.7%) were male and 10 (33.3%) were female. The result of the study also showed statistical significance between deaths in patients of confirmed cases of COVID-19 with delirium (93.33%) than patients of confirmed cases of COVID-19 without delirium (12.38%, p &lt; 0.001). Conclusion: The presence of delirium was associated with increased risk of mortality in hospitalized adults with COVID-19.

Characteristics of delirium among COVID-19 patients.

This study estimated delirium incidence in Slovak COVID-19 patients, explored treatment associations and examined the impact on hospitalization and mortality. The COVID-19 pandemic caused by SARS-CoV-2 has significantly affected global health. Delirium, a severe form of acute brain dysfunction, is common in hospitalized patients, including those with COVID-19. A retrospective study analyzed data from 474 hospitalized patients with confirmed SARS-CoV-2 infection in Kosice, Slovakia. Delirium was diagnosed using standardized ICD-10 criteria. Statistical analyses examined associations between delirium, psychiatric symptoms, treatment modalities, hospitalization duration, and mortality. 29.54 % (140 patients) had delirium. Insomnia, anxiety, and delirium were prevalent psychiatric symptoms. Delirium patients had higher insomnia, anxiety, somnolence, agitation, and aggression rates. Treatments like high-flow nasal oxygen, glucocorticoids, antibiotics, and anakinra were associated with higher delirium incidence. Delirium was more common with antipsychotic use (tiapride, quetiapine, haloperidol), while citalopram seemed protective. No significant associations were found with mortality. Patients using benzodiazepines, hypnotics, or tiapride had longer hospital stays. This study provides insights into delirium incidence in Slovak COVID-19 patients, treatment associations, and the importance of managing psychiatric symptoms and treatment choices for optimal outcomes (Tab. 6, Ref. 33).

Scopolamine causes delirium-like brain network dysfunction and reversible cognitive impairment without neuronal loss.

Delirium is a severe acute neuropsychiatric syndrome that commonly occurs in the elderly and is considered an independent risk factor for later dementia. However, given its inherent complexity, few animal models of delirium have been established and the mechanism underlying the onset of delirium remains elusive. Here, we conducted a comparison of three mouse models of delirium induced by clinically relevant risk factors, including anesthesia with surgery (AS), systemic inflammation, and neurotransmission modulation. We found that both bacterial lipopolysaccharide (LPS) and cholinergic receptor antagonist scopolamine (Scop) induction reduced neuronal activities in the delirium-related brain network, with the latter presenting a similar pattern of reduction as found in delirium patients. Consistently, Scop injection resulted in reversible cognitive impairment with hyperactive behavior. No loss of cholinergic neurons was found with treatment, but hippocampal synaptic functions were affected. These findings provide further clues regarding the mechanism underlying delirium onset and demonstrate the successful application of the Scop injection model in mimicking delirium-like phenotypes in mice.

Improving the Prevention, Detection, and Management of Delirium in Adult Inpatients; an Interprofessional Consultative Team Pilot Project.

Delirium is a common, often preventable fluctuating state of cognition associated with increased morbidity and mortality. This report describes the implementation of an interprofessional consultative Delirium Team formed to improve the prevention, detection, and management of delirium in a community hospital. Team members consulted refered inpatients with delirium to establish a care plan and provide recommendations for pharmacological and non-pharmacological management. The team also offered delirium-related education to unit staff, patients, and caregivers. Consultations were initially completed by the team Nurse Practitioner or Occupational Therapist, and complex patients were discussed with the team Geriatrician and Psychiatrist at rounds to optimize specialist input. Of the 160 patients managed by the team over the 8-month study period, two-thirds of referred patients did not require specialist consultation for their delirium management. Strategies most often recommended by experts for managing delirium were related to medical management, social/cognitive engagement, and functional mobility. Two-thirds of all recommendations made by the team were implemented. Barriers and facilitators to implementation and improving unit staff adherence are further described. The consultative Delirium Team is a promising model that should be further explored for managing an aging population in a capacity-limited medical system.

Making Pre-screening for Alzheimer's Disease (AD) and Postoperative Delirium Among Post-Acute COVID-19 Syndrome (PACS) a National Priority: The Deep Neuro Study.

SARS-CoV-2 effects on cognition are a vibrant area of active research. Many researchers suggest that COVID-19 patients with severe symptoms leading to hospitalization sustain significant neurodegenerative injury, such as encephalopathy and poor discharge disposition. However, despite some post-acute COVID-19 syndrome (PACS) case series that have described elevated neurodegenerative biomarkers, no studies have been identified that directly compared levels to those in mild cognitive impairment, non-PACS postoperative delirium patients after major non-emergent surgery, or preclinical Alzheimer's disease (AD) patients that have clinical evidence of Alzheimer's without symptoms. According to recent estimates, there may be 416million people globally on the AD continuum, which include approximately 315million people with preclinical AD. In light of all the above, a more effective application of digital biomarker and explainable artificial intelligence methodologies that explored amyloid beta, neuronal, axonal, and glial markers in relation to neurological complications in-hospital or later outcomes could significantly assist progress in the field. Easy and scalable subjects' risk stratification is of utmost importance, yet current international collaboration initiatives are still challenging due to the limited explainability and accuracy to identify individuals at risk or in the earliest stages that might be candidates for future clinical trials. In this open letter, we propose the administration of selected digital biomarkers previously discovered and validated in other EU-funded studies to become a routine assessment for non-PACS preoperative cognitive impairment, PACS neurological complications in-hospital, or later PACS and non-PACS improvement in cognition after surgery. The open letter also includes an economic analysis of the implications for such national-level initiatives. Similar collaboration initiatives could have existing pre-diagnostic detection and progression prediction solutions pre-screen the stage before and around diagnosis, enabling new disease manifestation mapping and pushing the field into unchartered territory.

Delirium in a surgical context from a nursing perspective: A hybrid concept analysis.

The term delirium has been defined in medical diagnosis criteria as a multidimensional disorder, and the term acute confusion is included in nursing classifications. Delirium can be a serious complication assessed in a patient after a surgical procedure. Still, the patient's delirium frequently remains unrecognised. Care of patients with delirium after surgical procedure is complex, and it challenges nursing expertise. From the nurses' viewpoint, delirium is associated with ambiguity of concepts and lack of knowledge. Therefore, reseach on how nurses perceive patients with delirium in a surgical context is needed. The aim of this study was to describe the concepts of delirium and acute confusion, as well as the associated dimensions, in adult patients in a surgical context from the nursing perspective. The study used Schwartz and Barcott's hybrid concept analysis with theoretical, fieldwork, and final analytical phases. Surgical wards, surgical intensive care units, and post-anaesthesia care units. A systematic literature search was performed through Pubmed (Medline), Cinahl, PsycInfo, and Embase. Registered nurses and licensed practical nurses (n=105) participated in the fieldwork phase. In the theoretical phase, the concepts' working definitions were formulated based on a systematic literature search with the year limitations from 2000 until February 2021. At the fieldwork phase, the nurses' descriptions of patients with delirium were analysed using the deductive content analysis method. At the final analytical phase, findings were combined and reported. The concepts of delirium, subsyndromal delirium, and acute confusion are well defined in the literature. From the perspective of the nurses in the study, concepts were seen as a continuum not as individual diagnoses. Nurses described the continuum of delirium as a process with acute onset, duration, and recovery with the associated dimensions of symptoms, symptom severity, risk factors, and early signs. The acute phase of delirium was emphasised, and preoperative or prolonged disturbance did not seem to be relevant in the surgical care context. Patients' compliance with care may be decreased with the continuum of delirium, which might challenge both patients' recovery from surgery and the quality of nursing care. In clinical practice the nurses used term confusion inaccurately. The term acute confusion might be used when illustrating an early stage of delirium. Nurses could benefit from further education where the theoretical knowledge is combined with the clinical practice. The discussion about the delirium, which covers the time both before surgery and after the acute phase should be increased.

Family experiences and attitudes toward care of ICU patients with delirium: A scoping review.

The family has an important role in the care of the ICU patient. Research shows that the implementation of non-pharmacological interventions to prevent delirium, including interventions with the family, can reduce the incidence of delirium. The aim of this review was to search the available literature about the experiences and attitudes of family/carers of ICU patients diagnosed with delirium during hospitalization. A scoping review method was used to map terms relevant to the involvement of relatives in the care of critically ill patients with delirium. To identify studies, the following databases were searched: PubMed, Scopus, EBSCO, Web of Science, and Cochrane Library. The database search was ongoing from 15 July 2022, with a final search on 4 August 2022. Thirteen articles reporting on the experiences and attitudes of family/carers of ICU patients who developed delirium during hospitalization were included in the scoping review. Of the included studies, eight were qualitative studies, three were quantitative studies and two were reviews (systematic review and integrative review). The studies were conducted in North America, Europe, South Africa, and Asia. Our findings show that carers experienced adverse effects associated with delirium in ICU patients such as stress, anxiety, embarrassment, uncertainty, anger, shock. Families/relatives need both emotional and informational support from medical staff. Relatives want to be involved in the care of the delirium patient, although this needs improvement in some aspects of care such as: lack of awareness, family/relatives knowledge of delirium, improved education, and communication with medical staff. Recognition of delirium by families is acceptable and feasible. Family involvement may induce an increased anxiety, but this aspect needs further research.

Impact of early mobilization on the duration of delirium in elderly hospitalized patients: A retrospective cohort pilot study.

Development of delirium during hospitalization impairs the activities of daily living in elderly hospitalized patients. In clinical practice, early mobilization from bed is recommended to reduce delirium incidence and hospitalization stay. However, the effects of early mobilization on elderly inpatients with delirium have not been established yet. The aim of this study was to investigate the association between early mobilization and the duration of delirium in elderly inpatients with delirium. This retrospective cohort pilot study examined 45 participants (23 males, 22 females; mean age: 84.5 ± 6.6 years), who developed delirium during hospitalization. Of the participants, 28 were surgically treated and 17 were non-surgically treated. We classified early or delayed mobilization based on the median number of days until the start of mobilization and compared after propensity score matching to adjust for baseline characteristics. Additionally, we examined the correlation between the number of days until the start of mobilization and the duration of delirium. The duration of delirium was significantly shorter in the early mobilization group, particularly in terms of sitting on the bed and wheelchair use than that in the delayed mobilization group {median: 4.0 [interquartile range (IQR): 2.0-6.0] vs 8.0 [IQR: 7.0-14.5] days, P = .013; median: 3.0 [IQR: 2.0-5.5] vs 11.0 [IQR: 7.5-14.5] days, P = .004, respectively}. Moreover, the duration of delirium significantly positively moderate correlated with the time until the start of sitting on the bed and wheelchair use (Spearman r = 0.527; P = .012, Spearman r = 0.630; P = .002, respectively). The results of this study suggest that early mobilization from sitting on the bed or wheelchair use after hospitalization or surgery may shorten the duration of delirium. Because the sample size of this pilot study is small, careful interpretation is needed, and further research is warranted.

A Study of Old Age Delirium and Quality of Life of Family Caregivers

Objectives: To study the aetiology of patients of delirium in old age, to study the severity of delirium in old age and to study the quality of life of family caregivers of delirium patients. Design: Prospective, observational, and cross sectional. Setting: Inpatient tertiary care hospital setting. Participants: Subjects with the diagnosis of Delirium qualifying according to ICD-10 (international classification of disease-10) and confirmed with CAM scale aged &gt;60 years and Patient or patient’s family members willing to give consent. Measurements: Socio-demographic questionnaire, Confusion assessment method, Delirium index, Delirium aetiology check list, ICD -10 DCR, WHO QOL BREF and the Barthel index. Results: There is no significant association between delirium severity and WHOQoL. There is no significant association between Barthel index and WHOQoL. There is no significant association between WHOQoL and delirium aetiologies. There is no significant association between gender and WHOQoL. There is no significant association between marital status and WHOQoL. There is no significant association between religion and WHOQoL. There is no significant association between WHOQol and education. There is significant association between WHOQoL and occupation. Emloyed subjects have better quality of life than unemployed. There is no significant association between WHO QoL and residence. There is no significant association between WHOQoL and duration of delirium. There is no significant association between WHOQoL and medical comorbidities. There is no significant association between WHOQoL and substance use. There is no significant association between medical comorbidities and delirium aetiology. There is significant association between delirium severity and duration of delirium. As duration of delirium increases severity of delirium increases. There is no significant association between duration of delirium and delirium aetiology. There is no significant association between delirium severity and medical comorbidities. Conclusions: In this study results showed that there is significant association between delirium is an acute illness with sudden onset with maximum percentage of duration 2-4 weeks, delirium is more in males than females, majority of the care givers are spouses and parents, multiple aetiologies, diminished psychological QoL are associated with increased care giver burden. Family history of delirium is associated with better care giver burden. Employed subjects with delirium have better overall QoL. As duration of delirium increases, delirium severity increases.

A quality improvement project addressing the underreporting of delirium in hip fracture patients

IntroductionAfter discovering a low incidence of delirium for hip fracture patients at our institution, we evaluated if this was due to underreporting and, if so, where process errors occurred. MethodsHip fracture patients aged ≥60 with a diagnosis of delirium were identified. Chart-Based Delirium Identification Instrument (CHART-DEL) identified missed diagnoses of delirium. Process maps were created based off staff interviews and observations. ResultsThe incidence of delirium was 15.3% (N = 176). Within a random sample (n = 98), 15 patients (15.5%) were diagnosed, while 20 (24.7%) went undiagnosed despite evidence of delirium. Including missed diagnoses, delirium prevalence was higher in the sample compared to all patients (35.7% vs 15.3%, p < 0.001). Most missed diagnoses were due to failure in identifying delirium (60%) or failure in documenting/coding diagnosis (20%). The prevalence of baseline cognitive impairment was higher in undiagnosed delirium patients versus correctly diagnosed patients (80% vs 20%, p = 0.001). ConclusionsOur institution significantly underreports delirium among hip fracture patients mainly due to; (1) failure to identify delirium by the clinical staff, and (2) failure to document/code diagnosis despite correct identification. Baseline cognitive impairment can render delirium diagnosis challenging. These serve as targets for quality improvement and hip fracture care enhancement.

EVALUATION OF DELIRIUM IN ELDERLY HOSPITALISED PATIENTS IN A TERTIARY CARE HOSPITAL

Objective: Delirium is common in older hospitalized patients and may indicate a life- threatening condition, where a prompt and appropriate evaluation is required for assessment and prevention of the disease which should be done at the time of admission and continue throughout the hospital stay. The present study was undertaken to evaluate delirium in elderly (&gt;65 years) hospitalized patients in a tertiary care hospital and to monitor outcome after 1 month. Methods: This prospective observational study was carried out in the Department of General Medicine of M.K.C.G. Medical College and hospital, Berhampur, Odisha, India from August 2019 to September 2021. After clinical evaluation and diagnosis as delirium patients using (confusion assessment method) score, 50 patients (65 years and above) were selected for the study. Patients with dementia, any psychiatric condition, trauma, intoxication, and poisoning were excluded from the study. They were evaluated for etiology and then followed up for 1 month for outcome. Results: In this present study of 50 patients, 33 were male and 17 were female. About 64% belong to age group 65–75 years. Most common type of delirium was hyperactive (40%). The most common etiologies were hyponatremia (38%), infection (22%), and cerebrovascular accident (16%). Majority of population had both type 2DM (diabetes mellitus) and HTN (Hypertension) (38%). Overall recovery rate was better in metabolic causes (89.4%), most fatal was uremia followed by intracranial bleed. Lower (Glasgow coma scale) score at the time of admission indicates poor prognosis. Conclusion: Delirium in elderly patients is a medical emergency which needs prompt diagnosis and evaluation helping the family and physicians for better management with a good prognosis.

Neurogenesis is disrupted in human hippocampal progenitor cells upon exposure to serum samples from hospitalized COVID-19 patients with neurological symptoms

Coronavirus disease 2019 (COVID-19), represents an enormous new threat to our healthcare system and particularly to the health of older adults. Although the respiratory symptoms of COVID-19 are well recognized, the neurological manifestations, and their underlying cellular and molecular mechanisms, have not been extensively studied yet. Our study is the first one to test the direct effect of serum from hospitalised COVID-19 patients on human hippocampal neurogenesis using a unique in vitro experimental assay with human hippocampal progenitor cells (HPC0A07/03 C). We identify the different molecular pathways activated by serum from COVID-19 patients with and without neurological symptoms (i.e., delirium), and their effects on neuronal proliferation, neurogenesis, and apoptosis. We collected serum sample twice, at time of hospital admission and approximately 5 days after hospitalization. We found that treatment with serum samples from COVID-19 patients with delirium (n = 18) decreased cell proliferation and neurogenesis, and increases apoptosis, when compared with serum samples of sex- and age-matched COVID-19 patients without delirium (n = 18). This effect was due to a higher concentration of interleukin 6 (IL6) in serum samples of patients with delirium (mean ± SD: 229.9 ± 79.1 pg/ml, vs. 32.5 ± 9.5 pg/ml in patients without delirium). Indeed, treatment of cells with an antibody against IL6 prevented the decreased cell proliferation and neurogenesis and the increased apoptosis. Moreover, increased concentration of IL6 in serum samples from delirium patients stimulated the hippocampal cells to produce IL12 and IL13, and treatment with an antibody against IL12 or IL13 also prevented the decreased cell proliferation and neurogenesis, and the increased apoptosis. Interestingly, treatment with the compounds commonly administered to acute COVID-19 patients (the Janus kinase inhibitors, baricitinib, ruxolitinib and tofacitinib) were able to restore normal cell viability, proliferation and neurogenesis by targeting the effects of IL12 and IL13. Overall, our results show that serum from COVID-19 patients with delirium can negatively affect hippocampal-dependent neurogenic processes, and that this effect is mediated by IL6-induced production of the downstream inflammatory cytokines IL12 and IL13, which are ultimately responsible for the detrimental cellular outcomes.

Incidence, Associated Factors, and Outcome of Delirium among Patients Admitted to ICUs in Oman.

Background The incidence of delirium is high up to 46.3% among patients admitted to ICU. Delirium is linked to negative patient outcomes like increased duration of mechanical ventilation use, prolonged ICU stay, increased mortality rate, and healthcare costs. Despite the importance of delirium and its consequences that are significant, there is a scarcity of studies which explored delirium in Oman. Objectives This study was conducted to assess the incidence of delirium, the association between the selected predisposing factors and precipitating factors with delirium, determine the predicators of delirium, and evaluate its impacts on ICU mortality and ICU length of stay among ICU patients in Oman. Methods A multicenter prospective observational design was used. A total of 153 patients were assessed two-times a day by bedside ICU nurses through the Intensive Care Delirium Screening Checklist (ICDSC). Results The results revealed that the delirium incidence was 26.1%. Regression analysis showed that sepsis, metabolic acidosis, nasogastric tube use, and APACHE II score were independent predictors for delirium among ICU patients in Oman and delirium had significant impacts on ICU length of stay and mortality rate. Conclusion Delirium is common among ICU patients and it is associated with negative consequences. Multidisciplinary prevention strategies should be implemented to identify and treat the modifiable risk factors.

Needs assessment survey of healthcare providers' perceptions and practices regarding delirium prevention at a university medical center.

Background: Despite the high prevalence and serious implications of delirium, identification, tracking, and documentation of the condition remain a challenge for the health care team, impeding management of patients. This survey is the first phase of a qualitative study to build a conversational agent-based tool for screening and managing delirium-prone patients. Objectives: To assess healthcare providers’ perceptions of delirium management, focusing on patient assessment, therapeutic interventions, and subsequent communication and documentation. Design: An electronic web-based survey was distributed to healthcare providers identified as caring for inpatient acutely ill older adults admitted for medical and orthopedic surgery needs. Respondent contact information was removed to preserve anonymity. Setting: A 1,000 bed university-affiliated teaching hospital in an urban setting. Participants: 23 residents in family practice, 36 residents in internal medicine, and a total of 492 advanced care nurses, nurses, and clinical staff. Approach: The analysis of survey responses provided insight into providers’ current experiences with delirium assessment tools including computerized documentation, as well as their perceptions and attitudes toward delirium prevention. Key results: Most respondents (89%) thought delirium could be prevented, and 85% thought targeting delirium risk factors was helpful. Fifty one percent reported patients’ loneliness and need for companionship, and 65% believed delirium was linked to higher mortality. Only 14% of respondents thought existing Electronic Health Record (EHR) alerts to identify high-risk delirium patients were useful, and 38% thought current delirium assessment protocols were helpful. In addition, 33% of nurses never received formal delirium prevention training, and 48% indicated that they needed improved systems to assess and manage patients at risk for delirium. Conclusion: A majority of providers affirmed that current delirium protocols are helpful; however, existing screening instruments and methods for documentation are cumbersome, resulting in incomplete or limited documentation of episodes. These barriers lead to an understatement of evidence available for continuous improvement of the patient management process.

Relation between postoperative delirium and preoperative routine serum biomarkers

Background: Delirium is an acute and fluctuating change in the mental state characterised by diminished awareness and attention disturbance. Postoperative delirium (POD) is one of the most prevalent complications after surgery, especially in older indiviuals, and is related to a longer hospital stay and increased mortality.1 Although the cause of POD is less clear, several hypothesised causes include neuroinflammation, neurotransmitter imbalance, and oxidative stress, all of which may contribute to the pathophysiology of POD.2 This study aimed to investigate the relationship between routine preoperative blood inflammatory markers and POD, and the incidence and outcomes of POD. Methods: We included patients from the National Emergency Laparotomy Audit (NELA) database aged ≥65 yr at the time of operation at Queen Elizabeth Hospital, Birmingham, UK. The study was conducted prospectively and retrospectively. In the prospective part, we screened the patients for delirium 5 days postoperatively using the modified Richmond Agitation Sedation Scale (mRASS), Confusion Assessment Method for ICU (CAM-ICU),3 and patient notes. Retrospectively, the clinical notes were scanned for keywords according to a validated chart abstraction method.4 We applied the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) criteria to diagnose POD in those who screened positive. We documented the preoperative blood results, including haemoglobin, white blood cells (WBCs), neutrophils, lymphocytes, platelets, neutrophil/lymphocyte ratio (NLR), urea, creatinine, and lactate. Multivariate logistic regression analyses were performed. Results: POD was diagnosed in 49 of 164 patients (29.9%). Sepsis, renal disease, and higher ASA grade and NELA mortality scores were significantly related to POD incidence. Statistical analysis showed a significant relation between POD and higher levels of preoperative urea, C-reactive protein (CRP), CRP/albumin ratio (CAR), NLR, and platelet/lymphocyte ratio (PLR). Furthermore, low levels of haemoglobin and albumin were significantly associated with POD. POD patients required significantly longer hospital stays with higher mortality. Multivariate logistic regression analysis demonstrated that age >75 yr, sepsis, and high preoperative PLR are independent risk factors for POD. Conclusions: Higher preoperative CAR, PLR, and NLR were associated with a higher incidence of POD in patients aged ≥65 yr undergoing emergency laparotomy. Our study supports that preoperative inflammatory status can be linked to POD. Knowing the mechanisms and risk factors can help clinicians to decrease POD incidence. 1.Aldecoa C, Bettelli G, Bilotta F, et al. Eur J Anaesth 2017; 34: 192–2142.Moppett I, Noah A. Br J Anaesth 2021; 127: 424–343.Oh ES, Fong TG, Hsieh TT, Inouye SK. JAMA 2017; 318: 1161–744.Kuhn E, Lorenz R, Banaschewski T, et al. PloS One 2014; 9: e91506

Self-efficacy of caring for patients in the intensive care unit with delirium: Development and validation of a scale for intensive care unit nurses

BackgroundImproving the self-efficacy of intensive care unit nurses for delirium care could help them adapt to the changing situation of delirium patients. Validated measures of nurses' self-efficacy of delirium care are lacking ObjectivesThe objective of this study was to develop a Delirium Care Self-Efficacy Scale for assessing nurses' confidence about caring for patients in the intensive care unit and to examine the scale's psychometric properties. MethodsDraft scale items were generated from a review of relevant literature and face-to-face interviews with intensive care unit nurses; content validity was conducted with a panel of five experts in delirium. A group of nurses were recruited by convenience sampling from intensive care units (N = 299) for item analysis of the questionnaire, assessment of validity, and reliability of the scale. Nurse participants were recruited from nine adult critical care units affiliated with a hospital in Taiwan. Data were collected from August 2020 to July 2021. ResultsContent validity index was 0.98 for the initial 26 items, indicating good validity. The critical ratio for item discrimination was 14.47–19.29, and item-to-total correlations ranged from 0.67 to 0.81. Principal component analysis reduced items to 13 and extracted two factors, confidence in delirium assessment and confidence in delirium management, which explained 66.82% of the total variance. Cronbach's alpha for internal consistency was 0.94 with good test–retest reliability (r = 0.92). High scale scores among participants were significantly associated with age (≥40 years), work experience in an intensive care unit (≥10 years), delirium education, and willingness to use delirium assessment tools. ConclusionsThe newly developed Delirium Care Self-Efficacy Scale demonstrated acceptable reliability and validity as a measure of confidence for intensive care nurses caring for and managing patients with delirium in the intensive care unit.

Making pre-screening for Alzheimer's disease (AD) and Postoperative delirium among post-acute COVID-19 syndrome - (PACS) a national priority: The Deep Neuro Study.

SARS-CoV-2 effects on cognition is a vibrant area of active research. Many researchers suggest that COVID-19 patients with severe symptoms leading to hospitalization, sustain significant neurodegenerative injury, such as encephalopathy and poor discharge disposition. However, despite some post-acute COVID-19 syndrome (PACS) case series that have described elevated neurodegenerative biomarkers, no studies have been identified that directly compared levels to those in mild cognitive impairment, non-PACS postoperative delirium patients after major non-emergent surgery or preclinical Alzheimer's Disease (AD) patients, that have clinical evidence of Alzheimer's without symptoms. According to recent estimates, there may be 416 million people globally on the AD continuum, which include approximately 315 million people with preclinical AD. In light of all the above, a more effective application of digital biomarker and explainable artificial intelligence methodologies that explored amyloid beta, neuronal, axonal, and glial markers in relation to neurological complications in-hospital or later outcomes could significantly assist progress in the field. Easy and scalable subjects' risk stratification is of utmost importance, yet current international collaboration initiatives are still challenging due to the limited explainability and accuracy to identify individuals at risk or in the earliest stages that might be candidates for future clinical trials. In this open letter, we propose the administration of selected digital biomarkers previously discovered and validated in other EU funded studies to become a routine assessment for non-PACS preoperative cognitive impairment, PACS neurological complications in-hospital or later PACS and non-PACS improvement in cognition after surgery. The open letter also includes an economic analysis of the implications for such national level initiatives. Similar collaboration initiatives could have existing prediagnostic detection and progression prediction solutions pre-screen the stage before and around diagnosis, enabling new disease manifestation mapping and pushing the field into unchartered territory.