High Risk For Delirium Research Articles

Association of Obstructive Sleep Apnea With Postoperative Delirium in Procedures of Moderate-to-High Complexity: A Hospital-Registry Study.

Patients suffering from obstructive sleep apnea (OSA) experience chronic sleep disturbances and desaturation, factors that have been associated with postoperative delirium and that can be aggravated after anesthesia for complex procedures. We investigated whether OSA is associated with delirium after anesthesia, and whether this association is modified by procedural complexity. Hospitalized patients ≥60 years who underwent general anesthesia or procedural sedation for procedures of moderate-to-high complexity between 2009 and 2020 at a tertiary health care network in Massachusetts were included. The primary exposure was OSA, defined based on International Classification of Diseases ( Ninth/Tenth Revision, Clinical Modification ) ( ICD-9 / 10-CM ) diagnostic codes, structured nursing interviews, anesthesia alert notes, and a validated risk score (BOSTN [body mass index, observed apnea, snoring, tiredness, and neck circumference]). The primary end point was delirium within 7 days after the procedure. Multivariable logistic regression and effect modification analyses adjusted for patient demographics, comorbidities, and procedural factors were applied. A total of 46,352 patients were included, of which 1694 patients (3.7%) developed delirium, 537 (3.2%) with OSA, and 1,157 (4.0%) without OSA. In adjusted analyses, OSA was not associated with postprocedural delirium in the overall cohort (adjusted odds ratio [OR adj ], 1.06; 95% confidence interval [CI], 0.94-1.20; P = .35). However, a high procedural complexity modified the primary association ( P value for interaction = .002). OSA patients had a higher risk of delirium after high-complexity procedures (≥40 work relative value units) such as cardiac (OR adj , 1.33; 95% CI, 1.08-1.64; P = .007, P value for interaction = .005) or thoracic surgery (OR adj , 1.89; 95% CI, 1.19-3.00; P = .007, P value for interaction = .009), but no increased risk after moderate complexity procedures, including general surgery (OR adj , 0.86; 95% CI, 0.55-1.35; P = .52). Compared to non-OSA patients, a history of OSA is associated with a higher risk after high-complexity procedures such as cardiac or thoracic surgery but not after procedures of moderate complexity.

Delirium Risk Score in Elderly Patients with Cervical Spinal Cord Injury and/or Cervical Fracture

The number of elderly patients with cervical trauma is increasing. Such patients are considered to be at high risk for delirium, which is an acute neuropsychological disorder that reduces the patient's capacity to interact with their environment due to impairments in cognition. This study aimed to establish a risk score that predicts delirium in elderly patients with cervical SCI and/or cervical fracture regardless of treatment type. This retrospective cohort study included 1512 patients aged ≥65 years with cervical SCI and/or cervical fracture. The risk factors for delirium according to treatment type (surgical or conservative) were calculated using multivariate logistic regression. A delirium risk score was established as the simple arithmetic sum of points assigned to variables that were significant in the multivariate analyses. Based on the statistical results, the delirium risk score was defined using six factors: old age (≥80 years), hypoalbuminemia, cervical fracture, major organ injury, dependence on pre-injury mobility, and comorbid diabetes. The score's area under the curve for the prediction of delirium was 0.66 (p < 0.001). Although the current scoring system must be validated with an independent dataset, the system remains beneficial because it can be used after screening examinations upon hospitalization and before deciding the treatment strategy.

Analysis of delirium prediction in the ICU based on the hybrid SGDCS-ANFIS approach.

In recent years, intensive care unit (ICU) doctors have paid more attention to delirium. ICU patients have a high risk of delirium. Delirium can lead to serious adverse outcomes, but early diagnosis and prediction of delirium are very difficult and lack effective assessment tools. The causes of delirium are many and complex, and there is no definite prediction model. To solve this problem, this paper proposes a delirium prediction model based on a hybrid cuckoo search algorithm with stochastic gradient descent-the adaptive-network-based fuzzy inference system (SGDCS-ANFIS) approach. Thirty-five relevant indicators of 1072 ICU cases (536 delirium cases and 536 nondelirium cases) were selected to establish a delirium prediction model to judge whether patients tended to experience delirium. The experiments show that the delirium prediction model based on the hybrid SGDCS-ANFIS approach has better performance than traditional classification and prediction machine learning approaches, and the accuracy is improved to 73.02%. It can provide some reference for the prediction of delirium, promote early diagnosis, and provide knowledge for early intervention to improve the prognosis of ICU patients. Adding this delirium prediction model to the ICU protocol will potentially improve the treatment outcome, quality, and cost. Doctors can manage sudden symptoms more calmly, and patients will also benefit. By collecting the real-time data commonly used in electronic medical records of ICUs, the proposed delirium prediction model can be easily applied in hospitals. Delirium can lead to serious adverse outcomes, but early diagnosis and prediction of delirium are very difficult and lack effective assessment tools. We propose a hybrid SGDCS-ANFIS approach to establish delirium prediction model to judge whether ICU patients tend to experience delirium. It can provide some reference for the prediction of delirium, promote early diagnosis, and provide knowledge for early intervention to improve the prognosis of ICU patients. By collecting the real-time data commonly used in electronic medical records of ICUs, the proposed delirium prediction model can be easily applied in hospitals. Fig. Development flow from raw data to the building of the delirium prediction model and model comparison.

Association of C-reactive protein to albumin ratio with postoperative delirium and mortality in elderly patients undergoing hip fracture surgery: A retrospective cohort study in a single large center

BackgroundPostoperative delirium is a common complication in elderly patients who have undergone hip fracture surgery. Since postoperative delirium is associated with poor outcomes and the treatment is very complicated, identifying the patients at high risk for delirium and providing more attentive care to prevent postoperative delirium is essential. In this study, we aimed to assess the association of an elevated C-reactive protein (CRP)/albumin ratio with the increased incidence of postoperative delirium in elderly people who had undergone hip fracture surgery. MethodsA total of 629 patients who underwent hip fracture surgery between January 2014 and December 2018 were retrospectively analyzed. Patients were classified into two groups according to preoperative CRP/albumin cut-off levels (<1.5 and ≥1.5). We performed a propensity score matching analysis to compare the incidence of postoperative delirium and overall mortality between the two groups. Multivariate logistic regression and Cox regression analyses were performed to examine the association of the preoperative CRP/albumin ratio with postoperative delirium and overall mortality. ResultsThere were significant differences in the incidence of postoperative delirium (18.0 % vs. 35.8 %, P < 0.001) and overall mortality (26.7 % vs. 46.9 %, P < 0.001) between the groups before matching. We also observed significant differences in the incidence of postoperative delirium (20.7 % vs. 32.7 %, P = 0.019) and overall mortality (34.7 % vs. 46.0 %, P = 0.046) between the groups after matching. A high CRP/albumin ratio (≥1.5) was significantly associated with a higher incidence of postoperative delirium (adjusted odds ratio [OR]: 2.11, 95 % confidence interval [CI]: 1.40–3.18, P < 0.001) and a higher rate of overall mortality (adjusted hazard ratio [HR]: 1.44, 95 % CI: 1.07–1.93, P = 0.015). ConclusionPreoperative CRP/albumin ratio might be an independent risk factor of postoperative delirium and surgical prognosis in elderly patients undergoing hip fracture surgery.

The Interface Of Delirium And Dementia

AbstractBackgroundWhile delirium and dementia are the most common causes of cognitive impairment in older populations, their interrelationship is complex and poorly understood. Dementia is the leading risk factor for delirium, and delirium is an independent risk factor for subsequent dementia. The current evidence for the inter‐relationship of delirium with Alzheimer’s disease and related dementias (AD/ADRD) will be reviewed in detail.MethodsDr. Inouye will present an overview of the evidence of the inter‐relationship between delirium and AD/ADRD, including epidemiologic, clinicopathologic, biomarker and mechanistic evidence. Previous studies have shown that 2/3 of persons with ADRD will have at least one hospitalization each year, and 50% will have 2 or more; these hospitalizations are associated with a high risk of delirium. Emerging evidence provides strong support for shared and potentially synergistic pathophysiologic linkages between delirium and ADRD. Key questions to be addressed include: Does pre‐existing AD pathology increase vulnerability to delirium? Does delirium accelerate the pace of cognitive decline in those with AD and ADRD?Results and ConclusionsAt the conclusion of this presentation, participants should be able to:–Identify the key features of delirium and effective prevention strategies–Understand the contribution of delirium to worsened cognitive trajectories and outcomes in persons with and without dementia–Recognize potential shared pathophysiologic pathways between delirium and dementia–Appreciate that delirium represents an important preventable contributor to dementia

Implementing a Delirium Risk Stratification Tool and Rounds to Identify and Prevent Delirium in Hospitalized Older Adults.

Up to 40% of delirium cases are preventable, and early identification is key to improve patient outcomes. To implement and evaluate a multidisciplinary delirium intervention program. The delirium intervention program targeted patients at high risk for delirium and included patient and nurse education, risk stratification, multidisciplinary rounds, a nonpharmacological intervention bundle, and a treatment order set. After implementation, there was a reduction in length of stay of 6.3 days ( P = .01), a 24% decrease in disposition to a skilled nursing facility ( P = .05), and increased detection of delirium by nurses. Positive patient outcomes were achieved by employing a multifactorial approach for delirium identification, prevention, and management. The components of this quality improvement project provide guidance to hospitals seeking to develop a delirium intervention program.

Dose-dependent relationship between intra-procedural hypoxaemia or hypocapnia and postoperative delirium in older patients

BackgroundPrevious studies indicated an association between impaired cerebral perfusion and post-procedural neurological disorders. We investigated whether intra-procedural hypoxaemia or hypocapnia are associated with delirium after surgery. MethodsInpatients ≥60 yr of age undergoing anaesthesia for surgical or interventional procedures between 2009 and 2020 at an academic healthcare network in the USA (Massachusetts) were included in this hospital registry study. The primary exposure was intra-procedural hypoxaemia, defined as peripheral oxygen saturation <90% for >2 cohering min. The co-primary exposure was hypocapnia during general anaesthesia, defined as end-tidal carbon dioxide pressure ≤25 mm Hg for >5 cohering min. The primary outcome was delirium within 7 days after surgery. ResultsOf 71 717 included patients, 1702 (2.4%) developed postoperative delirium, and hypoxaemia was detected in 2532 (3.5%). Of 42 894 patients undergoing general anaesthesia, 532 (1.2%) experienced hypocapnia. The occurrence of either hypoxaemia (adjusted odds ratio [ORadj]=1.71; 95% confidence interval [CI], 1.40–2.07; P<0.001) or hypocapnia (ORadj=1.77; 95% CI, 1.30–2.41; P<0.001) was associated with a higher risk of delirium within 7 days. Both associations were dependent on the magnitude, and increased with event duration (ORadj=1.03; 95% CI, 1.02–1.04; P<0.001 and ORadj=1.01; 95% CI, 1.00–1.01; P=0.005, for each minute increase in the longest continuous episode, respectively). There was no association between occurrence of hypercapnia and postoperative delirium (ORadj=1.24; 95% CI, 0.90–1.71; P=0.181). ConclusionsIntra-procedural hypoxaemia and hypocapnia were dose-dependently associated with a higher risk of postoperative delirium. These findings support maintaining normal gas exchange to avoid postoperative neurological disorders.

The development of a web-based app employing machine learning for delirium prevention in long-term care facilities in South Korea

BackgroundLong-term care facilities (LCFs) in South Korea have limited knowledge of and capability to care for patients with delirium. They also often lack an electronic medical record system. These barriers hinder systematic approaches to delirium monitoring and intervention. Therefore, this study aims to develop a web-based app for delirium prevention in LCFs and analyse its feasibility and usability.MethodsThe app was developed based on the validity of the AI prediction model algorithm. A total of 173 participants were selected from LCFs to participate in a study to determine the predictive risk factors for delerium.The app was developed in five phases: (1) the identification of risk factors and preventive intervention strategies from a review of evidence-based literature, (2) the iterative design of the app and components of delirium prevention, (3) the development of a delirium prediction algorithm and cloud platform, (4) a pilot test and validation conducted with 33 patients living in a LCF, and (5) an evaluation of the usability and feasibility of the app, completed by nurses (Main users).ResultsA web-based app was developed to predict high risk of delirium and apply preventive interventions accordingly. Moreover, its validity, usability, and feasibility were confirmed after app development. By employing machine learning, the app can predict the degree of delirium risk and issue a warning alarm. Therefore, it can be used to support clinical decision-making, help initiate the assessment of delirium, and assist in applying preventive interventions.ConclusionsThis web-based app is evidence-based and can be easily mobilised to support care for patients with delirium in LCFs. This app can improve the recognition of delirium and predict the degree of delirium risk, thereby helping develop initiatives for delirium prevention and providing interventions. Moreover, this app can be extended to predict various risk factors of LCF and apply preventive interventions. Its use can ultimately improve patient safety and quality of care.

Management of older and senile patients with a high risk of delirium when providing inpatient care. Clinical protocol

Delirium is an acute, life-threatening condition manifested by disturbance in consciousness, attention and cognition, which has a multifactorial genesis, severe consequences and commonly seen in older and senile people inpatient. Clinical experience in domestic practice shows that delirium diagnosis in older and senile patients is often missed, and its signs may be considered as manifestations of other diseases, while the state of delirium is often perceived only as an alcohol withdrawal. The article presents a clinical protocol developed and based on the firsthand experience and modern ideas by a multidisciplinary team of the Russian Gerontology Research and Clinical Centre, in which the delirium in older and senile people is considered as a geriatric syndrome. The article shows the latest diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the main diagnostic tools are given — Confusion assessment method (CAM), diagnostic and differential diagnostic algorithms; clinical subtypes, management tactics, non-drug and drug approaches to treatment, as well as principles for the prevention of geriatric delirium are described.

Early Recognition, Prevention, and Management of Delirium in the Acute Care Setting

Purpose/Objectives The purpose of this quality improvement initiative was to implement delirium screening, prevention, and management best practices in the non–critical care environment. Description of the Project/Program An interprofessional team at a 483-bed level 1 trauma center implemented a quality improvement initiative on one 24-bed medical ward and one 24-bed surgical ward. The 4 A's Test (4AT) screening tool was administered to patients with risk factors for delirium on admission, every shift, and as needed by nursing staff. Evidence-based prevention and management order sets were created by an interprofessional team to guide patient care planning processes. Results A total of 285 patients who were at high risk for delirium (100%) were screened using the 4AT tool. Forty-three of the 285 patients (15%) were positive on the 4AT screening or diagnosed with delirium, whereas 242 patients (85%) had a negative score on the 4AT. Delirium detection increased from 2.1% to 15% after implementing the 4AT. Fifty-six (19%) of the 285 high-risk patients had prevention order sets placed. Of the 43 patients who scored positive, 2 charts had management order sets placed. Conclusion A validated delirium screening tool and intervention order sets can increase early detection rates and provide staff with tools to prevent and manage delirium. The impact of this project will likely reduce preventable harm to patients and improve the quality of care that staff are able to provide in the medical-surgical acute care setting.

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

Development and Validation of a Delirium Prediction Model for Elderly Patients (DEEP)

Background: Delirium is common among hospitalized elderly patients. It is associated with complications and mortality. Objective: To develop and validate a predictive model for delirium among hospitalized elderly patients. Materials and Methods: The present study was a single-center, retrospective cohort study performed in 589 patients aged 60 years or older admitted to medical or surgical units at a tertiary hospital in Bangkok, Thailand between 2011 and 2017. Results: A sample was randomly split (70:30) into the derivation set (n=412; 120 with delirium) and validation set (n=177; 56 with delirium). In the derivation set, multiple logistic regression reveled six potential risk factors, which were older than 75 years, dementia, infection, liver cirrhosis, hypokalemia, and hyponatremia. Hosmer-Lemeshow goodness-of-fit test showed that the model had a good calibration (p=0.27). The model also had a good discrimination ability based on high area under receiver operating characteristic (AUROC) curve of 0.821 (95% CI 0.784 to 0.858). Regression coefficients were used to get a risk score which varied from 0 to 15. The optimal cutoff point of 4.5 or with a higher risk of delirium, gave a sensitivity of 65.8% (95% CI 56.6 to 74.2), a specificity of 82.2% (95% CI 77.3 to 86.4), a positive predictive value of 60.3% (95% CI 53.5 to 66.7), a negative predictive value of 85.4% (95% CI 82.0 to 88.3), and an accuracy of 77.4% (95% CI 73.1 to 81.4). The risk score was then applied to the derivation set resulting in a higher AUROC of 0.855 (95% CI 0.797 to 0.914). Conclusion: The present study was a simple predictive model that demonstrated good discrimination ability, high specificity, and an excellent negative predictive value. It may permit the use of early preventive intervention to reduce the incidence, severity, and complications of delirium. Keywords: Delirium; Elderly; Hypokalemia; Hyponatremia; Predictive model

The effects of ketamine on pain control in stage IV cancer patients receiving palliative care

Background: We evaluated the effects of intravenous ketamine on cancer pain in stage IV cancer patients receiving palliative care.Methods: In total, 253 stage IV cancer patients with cancer pain hospitalized at a single tertiary hospital palliative care unit were included. The ketamine group contained 112 patients receiving ketamine, and the control group comprised 141 non-ketamine users. To evaluate the odds ratios (ORs) for favorable pain control, optimal pain control, and opioid-sparing effect among ketamine users, we used multivariable logistic regression adjusted for age and objective prognosis score. Differences in the visual analog scale (VAS) score, oral morphine equivalents, inter-dose frequency, and inter-dose amount were compared between both groups at the time of ketamine introduction (T0), after 24 hours (T1), and after 48 hours (T2) using repeated-measures analysis of covariance.Results: The ketamine group was more likely to show favorable pain control (OR, 3.84; 95% confidence interval [CI], 1.76–8.37) and an optimal response (OR, 3.99; 95% CI, 1.73–9.22) than the control group. Compared to the control group, the ketamine group showed a higher VAS score at T0, but a more evident VAS score reduction at T1 and T2 (pint&lt;0.001). The ketamine group was less likely than the control group to experience depressive mood (OR, 0.31; 95% CI, 0.10–0.92), but had a higher risk of delirium (OR, 2.06; 95% CI, 1.12–3.91).Conclusion: Our findings suggest that ketamine can effectively reduce refractory cancer pain in stage IV cancer patients.

Oxidative stress and soluble receptor for advanced glycation end-products play a role in the pathophysiology of delirium after cardiac surgery

Coronary-artery bypass graft (CABG) surgery is known to improve cardiac function and decrease mortality, albeit, this method of treatment is also associated with a neuropsychiatric complications including postoperative delirium. The pathophysiology of delirium after cardiac surgery remains poorly understood. Thus, the purpose of this study was to investigate whether oxidative stress reflected by decreased preoperative and postoperative plasma antioxidant activity is independently associated with delirium after cardiac surgery. The second aim was to assess whether decreased antioxidant activity is stress-related or mediated by other pathologies such as major depressive disorder (MDD), anxiety disorders, and cognitive impairment. Furthermore, the putative relationship between pre- and postoperative soluble receptor for advanced glycation end-products (sRAGE) overexpression and plasma antioxidant capacity was evaluated. The patients cognitive status was assessed 1 day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of MDD and anxiety disorders was established on the basis of DSM-5 criteria. Blood samples for antioxidant capacity and sRAGE levels were collected both preoperatively and postoperatively. The Confusion Assessment Method for the Intensive Care Unit was used within the first 5 days postoperatively to screen for a diagnosis of delirium. Postoperative delirium was diagnosed in 34% (61 of 177) of individuals. Multivariate logistic regression analysis revealed that low baseline antioxidant capacity was independently associated with postoperative delirium development. Moreover, increased risk of delirium was observed among patients with a preoperative diagnosis of MDD associated with antioxidant capacity decreased postoperatively. According to receiver operating characteristic analysis, the most optimal cutoff values of the preoperative and postoperative antioxidant capacity that predict the development of delirium were 1.72 mM and 1.89 mM, respectively. Pre- and postoperative antioxidant capacity levels were negatively correlated with postoperative sRAGE concentration (Spearman's Rank Correlation − 0.198 and − 0.158, p < 0.05, respectively). Patients with decreased preoperative antioxidant activity and those with depressive episodes complicated with lower postoperative antioxidant activity are at significantly higher risk of delirium after cardiac surgery development. sRAGE overexpression may be considered as protective mechanism against increased oxidative stress and subsequent cell damage.

Absence of Longer Reorientation Times in Patients Undergoing Electroconvulsive Therapy and Concomitant Treatment with Lithium.

ObjectiveLithium is a drug of choice in the treatment of bipolar disorder and refractory depressive disorders. However, previous research suggests lithium has a negative cognitive impact in recovery from electroconvulsive therapy (ECT) and a higher risk of delirium, so patients are often required to stop taking lithium before ECT, despite risk of relapse. We studied the cognitive impact of serum lithium levels in patients undergoing ECT.MethodsThis was an observational prospective study. Serum lithium levels, thyroid and biochemical parameters were measured prior to each ECT session. Time elapsed from the anesthetic induction to the electrical stimulus and then to the patients’ reorientation was recorded, as well as the motor seizure duration and electroencephalogram (EEG) seizure duration. A statistical analysis using a linear mixed model was run while adjusting for confounding factors.ResultsTen participants underwent a total of 86 ECT sessions (41% right unilateral ultrabrief pulse, and 59% bilateral brief pulse). A negative interaction between lithium levels and reorientation time was found among those doing bilateral brief pulse ECT. No association was observed in patients doing unilateral ultrabrief pulse ECT. No significant relationship was observed between lithium and both motor and EEG-assessed seizure duration.ConclusionThis study suggests that low to moderate serum lithium levels (< 0.7 mmol/L) might have no harmful cognitive effects in patients under right unilateral ultrabrief pulse and bilateral brief pulse ECT.

Preoperative Vitamin D Deficiency is Associated with Postoperative Functional Recovery and Complications after Hip Fracture Surgery.

BackgroundLow concentrations of vitamin D are considered one of the risk factors for hip fracture and are associated with worse outcomes. The purpose of this retrospective study was to compare vitamin D deficient group and vitamin D sufficient group and assess the association preoperative vitamin D deficiency and postoperative walking ability after hip fracture surgery.MethodsBetween January 2014 and January 2020, 1,029 elderly patients with hip fracture (243 in men and 785 in women) were measured preoperative serum 25-hydroxy-vitamin D3 levels. Among 1,029 elderly patients, 702 patients were classified as Vitamin D deficient group (<20 ng/mL). Outcome parameters for functional recovery were the length of the hospital stay and KOVAL score, and those for complications were delirium, pneumonia, and thromboembolism.ResultsThe mean length of the hospital stay in the vitamin D deficient group was significantly longer than in the vitamin D sufficient group (27.7±17.8 vs. 2.9±11.8 days; odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02–1.05; P=0.001). The mean postoperative KOVAL score in the deficient group was significantly higher than in the sufficient group (4.0±2.1 vs. 3.1±1.9 days; OR, 1.21; 95% CI, 1.11–1.32; P=0.001). Vitamin D deficiency was significantly associated with a higher risk of delirium and pneumonia in deficiency group.ConclusionsPreoperative vitamin D deficiency in hip fractures patients was associated with prolonged duration of hospital stay and decrease of postoperative ambulatory status, and may increase the risk of delirium and pneumonia. Therefore, it is necessary to evaluate the preoperative vitamin D level and recommend vitamin D supplementation in elderly patients with a high probability of hip fracture.

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).

Delirium occurrence and association with outcomes in hospitalized COVID-19 patients.

Delirium is reported to be one of the manifestations of coronavirus infectious disease 2019 (COVID-19) infection. COVID-19 hospitalized patients are at a higher risk of delirium. Pathophysiology behind the association of delirium and COVID-19 is uncertain. We analyzed the association of delirium occurrence with outcomes in hospitalized COVID-19 patients, across all age groups, at Mayo Clinic hospitals.A retrospective study of all hospitalized COVID-19 patients at Mayo Clinic between March 1, 2020 and December 31, 2020 was performed. Occurrence of delirium and outcomes of mortality, length of stay, readmission, and 30-day mortality after hospital discharge were measured. Chi-square test, student t-test, survival analysis, and logistic regression analysis were performed to measure and compare outcomes of delirium group adjusted for age, sex, Charlson comorbidity score, and COVID-19 severity with no-delirium group.A total of 4351 COVID-19 patients were included in the study. Delirium occurrence in the overall study population was noted to be 22.4%. The highest occurrence of delirium was also noted in patients with critical COVID-19 illness severity. A statistically significant OR 4.35 (3.27-5.83) for in-hospital mortality and an OR 4.54 (3.25-6.38) for 30-day mortality after discharge in the delirium group were noted. Increased hospital length of stay, 30-day readmission, and need for skilled nursing facility on discharge were noted in the delirium group. Delirium in hospitalized COVID-19 patients is a marker for increased mortality and morbidity. In this group, outcomes appear to be much worse when patients are older and have a critical severity of COVID-19 illness.

In-Hospital Delirium as a Prognostic Factor for New Cognitive Disorder in a 1-Year Post-Hip Fracture Follow-Up

Background: Older hip fracture patients are at high risk of delirium during acute hospital care. Pre-fracture dementia is known to increase the risk of in-hospital delirium. Data on the development of new cognitive disorders in patients with delirium are scarce. Objective: The objective of this study is to evaluate the prognostic significance of in-hospital delirium on the development of new cognitive disorders in a 1-year follow-up in older hip fracture patients. Material and Methods: Data consisted of 476 hip fracture patients aged 65 years or more with no known cognitive disorder on admission. Delirium was assessed using the Confusion Assessment Method (CAM). Cognitive disorders were diagnosed following the national guidelines. Information on the new diagnoses of cognitive disorders (NDCD) at 1-year follow-up was elicited in a telephone interview and confirmed from the electronic patient files. Logistic regression analyses were conducted to examine the association of delirium with NDCDs. Results: Of the 476 patients, 87 (18%) had delirium during hospital stay. Patients with delirium were older, they had poorer nutritional status, lower mobility level, and more supported living arrangements than did patients without delirium. At the 1-year time point, 205 (43%) had NDCDs or were strongly suspected of this. CAM result was statistically significantly associated with development of NDCD in multivariable-adjusted analysis (odds ratio [OR] 2.29; 95% confidence interval [CI]: 1.39–3.79). Also, poor nutritional status continued to be associated with NDCDs (multivariable-adjusted OR 1.58; 95% CI: 1.03–2.43). Conclusion: Delirium during hospitalization and poor nutritional status on admission are independent prognostic factors for development of subsequent cognitive disorders in older hip fracture patients.

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).