Incidence Of Delirium Research Articles

Association between intraoperative electroencephalogram burst suppression and postoperative delirium: A systematic review and meta-analysis.

Electroencephalogram burst suppression can be associated with postoperative delirium; however, the results of relevant studies are discrepant. This systematic review and meta-analysis aimed to assess the association between intraoperative burst suppression and postoperative delirium in adult surgical patients. PubMed, MEDLINE, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials were systematically searched and updated in May 2023. We included cohort studies, case-control studies, and randomized-controlled studies reporting on postoperative delirium incidence with documented intraoperative burst suppression in adults receiving general anesthesia for any surgery. The primary outcome was the pooled odds ratio (OR) for postoperative delirium in cases with intraoperative burst suppression compared to those without burst suppression, calculated using a random-effects model. Two independent investigators extracted the data. The protocol was prospectively registered in PROSPERO (registration number: CRD42022326479); the results were reported according to PRISMA guidelines. Fourteen studies (6435 patients) were included in the analysis. The overall incidence of postoperative delirium was 21.1% (1358/6435). Patients with intraoperative burst suppression had a higher incidence of postoperative delirium than those without burst suppression (pooled OR, 1.492; 95% confidence interval (CI) [1.022-2.178]; I2 =44%; 95% CI [0%-75%]; τ2 = 0.110). The intraoperative duration of burst suppression was significantly longer in patients who developed postoperative delirium (standardized mean difference [SMD] 0.462 [95% CI, 0.293-0.632]; I2 = 63%; 95% CI [16%-84%]; τ2 = 0.027). The burst suppression ratio was significantly higher in the delirium group (SMD 0.150; 95% CI [0.055-0.245]; I2 = 0%; 95% CI [0%-85%]; τ2 = 0.00). Our meta-analysis suggests an association between intraoperative burst suppression and postoperative delirium; however, the quality of evidence was very low. The limited number of studies and substantial heterogeneity across them emphasize the need for further high-quality studies to establish a more robust conclusion.

Adherence to optimal delirium management practices in intensive care units in Brazil: a nationwide survey.

Effective delirium management is crucial, considering its association with adverse outcomes. Adherence to best practices has the potential to reduce the incidence and prevalence of delirium and improve health outcomes. The objectives of this project were to describe self-assessed adherence to best practices in delirium management by health care professionals in intensive care units (ICUs) in Brazil, assess the health care professionals' perception of the importance of adequate delirium prevention and treatment in ICUs, and compare the compliance rates with best practices between public and private ICUs. A cross-sectional study was conducted in Brazil using an online questionnaire consisting of three parts, namely, data about the health care professionals and the ICU in which they worked; statements about the 17 best practices; and questions related to perceptions of delirium prevention and management by ICU physicians and nurses. The survey was sent to email addresses registered with the Brazilian Association of Intensive Care Medicine. The compliance rate exceeded 50% for only eight best practices. These included the identification and management of pressure sores and falls in delirium patients, with compliance rates of 77.8% and 74.1%, respectively. Among ICU professionals in Brazil, adherence to best practices in delirium management is low, particularly for practices involving patient education and involvement of their relatives in their care. These results emphasize the importance of enhancing delirium management in Brazilian health care institutions, regardless of hospital classification. http://links.lww.com/IJEBH/A274.

Projection of visual material on postoperative delirium in patients undergoing cardiac surgery: A double blind randomized clinical trial.

Postoperative delirium is a neurobehavioral disorder that can appear after surgery. It is characterized by an altered level of consciousness and impaired cognitive function. The aim of this study was to evaluate the impact of visual projection of images of relatives or loved ones in patients undergoing cardiac surgery in the immediate postoperative period, and its influence on the incidence and development of postoperative delirium. A randomized, double-blind clinical trial was designed in the immediate postoperative period of adult patients undergoing cardiac surgery. Consolidated Statement of Reporting Trials guidelines were followed. A control group (CG) and an intervention group (IG) were established. In the IG, the patients underwent a visual projection, while the usual unit treatment was carried out with the CG. Sociodemographic, anthropometric, anesthetic, and surgical variables were also recorded. The postoperative delirium assessment scale used was the confusion assessment method for diagnosing delirium in intensive care unit patients. Information was collected from 104 patients undergoing cardiac surgery. Most of the patients included in the study were men (66.35%) and the most performed surgical intervention was aortic valve replacement (34.62%). In the CG, positive patients in postoperative delirium increased from 19.23% to 25%, while in the IG they decreased from 5.77% to 1.92%. The logistic regression analysis presents a prediction model where the variables that influence the model are gender and group membership, meaning that being female and belonging to the IG significantly reduce the presence of delirium. The projection of visual material reduced the incidence of postoperative delirium in patients undergoing cardiac surgery, although it cannot be established that it is effective as a treatment once the pathology is already established.

Prehabilitation for delirium prevention in elderly patients with chronic limb threatening ischemia

Elderly patients with Chronic Limb Threatening Ischemia (CLTI) undergoing revascularization are prone to delirium and prolonged hospitalization. Preoperative prehabilitation may prevent delirium and reduce the length of stay. This study investigates the effect of multimodal prehabilitation on delirium incidence in elderly CLTI patients undergoing revascularization. A comparative observational cohort study conducted in a large teaching hospital (intervention cohort n=101, retrospective control cohort n=207) and a university hospital (prospective control cohort n=48) from 2020 to 2023. Patients aged ≥ 65 years undergoing revascularization were included, with acute treatment or severe cognitive impairment as exclusion criteria. The three-week prehabilitation program included screening of general health and presence of delirium risk factors by a vascular nurse practitioner, screening and provision of personalized, home-based exercises by a physiotherapist, provision of nutritional advice by a dietician, and if indicated comprehensive geriatric assessment by a geriatrician, assessment of self-reliance and home situation by a prearranged homecare nurse, guidance and support for smoking cessation by a quit smoking coach, and anaemia treatment. Primary outcome was 30-day delirium incidence, analysed using regression models adjusting for potential confounders (age, physical impairment, history of delirium, preoperative anaemia and revascularization type). Secondary outcomes were length of stay, postoperative complications, 30-day mortality, and patient experiences. Median age (IQR) was 76 years (71-82). Delirium incidence was lower in the prehabilitation cohort (n=2/101, 2%) compared to controls (n=23/255, 9%; OR=0.21, 95%CI 0.05-0.89, p=.04). Adjusted analysis showed a non-significant delirium reduction (OR=0.28, 95%CI 0.06-1.3, p=.097). The prehabilitation cohort had a significantly shorter length of stay (2 [1-5] vs 4 [2-9] days; p=<.001), and fewer minor complications (14% vs 26%, p=.01). No differences were present in major complications and 30-day mortality. Patients reported high compliance and satisfaction (median score 8/10, IQR 7-9). Prehabilitation among elderly CLTI patients is safe and has the potential to yield multiple beneficial effects on general outcomes following revascularization, while also achieving high levels of patient satisfaction. Further validation and considering implementation in surgical settings is recommended.

The effect of two different modes of anaesthesia maintenance on postoperative delirium in elderly patient with low preoperative mini-cog score

BackgroundPostoperative delirium is a common distressing symptom experienced following laparoscopic cholecystectomy. The study aimed to investigate the influence of a low preoperative Mini-Cog testing score and 2 different anesthesia methods: total intravenous anaesthesia (TIVA) versus sevoflurane, on postoperative delirium in elderly patients undergoing laparoscopic cholecystectomy.MethodsA total of 84 patients over 60 years old who underwent laparoscopic cholecystectomy between March 1and – October 1 2023 were included in the study. Patients with a Mini-Cog score of 0–2 were considered to have low and possibly impaired neurocognitive function. We invastigated the effects of preoperative Mini-Cog score and the two anesthesia methods used on the incidence of postoperative delirium.ResultsThe proportion of patients with low Mini-Cog score in the preoperative period was 17.9%. Sevoflurane and TIVA was used in 41 and 43 patients respectively. The incidence of postoperative delirium in patients with low preoperative Mini-Cog scores was 66.7% at postoperative 0 h and 33.3% at the 1st hours. Postoperative delirium was found to be statistically higher in patients with low Mini-cog scores than in those with negatively-screened for Mini-cog scores (p: 0.01–0.035). In patients using sevoflurane, the incidence of postoperative delirium was 26.8% and 24.4% at the 0 and 1st hours, respectively. This was found to be statistically higher than in patients receiving TIVA (p: 0.036 − 0.010).ConclusionLow Mini-Cog score was an indicator of a higher risk of early postoperative delirium. Sevoflurane is more likely to cause postoperative delirium than TIVA.Trial registrationThe study was registered on ClinicalTrials.gov (Identifier: NCT06597812) .

Delirium Associated with COVID-19 in Critically ill Children: An Observational Cohort Study.

Delirium is an under-recognized problem in critically ill children. Although delirium is common in adults hospitalized with COVID-19, the relationship between pediatric COVID-19 and delirium has not been described. To address this gap, we characterized delirium in critically ill children with different manifestations of COVID-19 and investigated associations among demographic, disease, and treatment factors. We hypothesized that multisystem inflammatory syndrome in children (MIS-C) would be associated with a higher incidence of delirium given its underlying pathophysiology of hyperinflammation. Retrospective, single-center cohort study. Quaternary-care pediatric intensive care unit (PICU). Children less than 18 years of age hospitalized in the PICU between March 2020 and March 2023 with either active SARS-CoV-2 infection or serological evidence of prior infection. The cohort included 149 PICU hospitalizations among children with evidence of COVID-19. Patients were categorized by reason for PICU admission: 75 (50%) for COVID-19 respiratory disease, 36 (24%) MIS-C, and 38 (26%) any other primary reason with positive COVID-19 testing. Delirium was diagnosed in 43 (29%) patients. Delirium incidence was highest in patients requiring invasive mechanical ventilation (IMV) (56% vs 7.5% in patients who did not require IMV, p < .001). Patients who were exposed to opioids, dexmedetomidine, paralytics or benzodiazepines more frequently experienced delirium compared to those unexposed (p < .001, p < .001, p < .001 and p = .001, respectively). After multivariable adjustment, delirium was associated with IMV (HR 3 [95% CI 1.5-5.7]), female sex (HR 2.4 [1.2-4.7]), and developmental disability (HR 3.4 [95% CI 1-11.1]). There was no association between delirium and reason for PICU hospitalization. Delirium was common among children hospitalized with COVID-19. The overall incidence was much less than has been reported in adults with COVID-19. Delirium reduction efforts should focus on children with developmental disability and minimizing ongoing risks during IMV.

Benefits of an automated postoperative delirium risk prediction tool combined with non-pharmacological delirium prevention on delirium incidence and length of stay: a before-after analysis based on a quality improvement project.

Postoperative delirium (POD) significantly impacts older surgical patients, necessitating effective prevention strategies. To assess the effectiveness of the Pre-Interventional Preventive Risk Assessment (PIPRA) automated delirium risk prediction tool alongside non-pharmacological prevention strategies on POD incidence, hospital length of stay (LOS) and nursing time. This quality improvement project, set in a 335-bed Swiss private hospital, employed a before-after design to evaluate the impact of PIPRA and preventive measures on POD, LOS and nursing time in non-cardiac and non-intracranial surgery inpatients aged 60 or older. The control phase focused on enhancing POD screening, whilst the intervention phase incorporated PIPRA for risk assessment and staff training to enable targeted non-pharmacological prevention in patients at risk. A total of 866 patients were included; 299 control and 567 intervention. The odds ratio of POD, comparing the intervention group to the control, was 0.71 [95% confidence interval (CI) 0.44-1.16] when adjusting for baseline patient characteristics. The intervention was associated with an LOS 0.94 (95% CI 0.85-1.05) and nursing time 0.96 (95% CI 0.86-1.07) times that of the control, adjusted for baseline patient characteristics. Medium risk patients (21.6% of patients) had an LOS 0.74 (95% CI 0.59-0.92) and required nursing time 0.79 (95% CI from 0.62-1.00) times the control, adjusted for baseline patient characteristics, equivalent to an LOS reduction of 1.36days and nursing time saving of 19.3hours per patient. Medium risk patients in the intervention group had shorter LOS and nursing time compared to the control group, underscoring the importance of targeted prevention.

Perioperative interventions to enhance surgical outcomes for older adults with cancer: A systematic review.

219 Background: Older adults with cancer have unique needs, particularly in the perioperative setting, which likely influence surgical outcomes in the geriatric oncology population. Little work has sought to describe available literature investigating perioperative interventions to enhance surgical outcomes for these individuals. Our systematic review sought to describe the literature on perioperative interventions in older adults with cancer undergoing surgery. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases, searching for literature published from 1/2010-10/2023 (search terms used relevant terminology for geriatric oncology in the perioperative setting). We included randomized controlled trials (RCT) focusing on patient-centered interventions that enrolled adults &gt;60 years old with cancer, excluding studies with pharmacologic, procedural, and radiographic interventions. Results: We included 11 RCTs with 2,177 patients. Patients’ age ranged from 60-95, and median number of patients per study was 147 (range: 44-690). Most studies included patients with colorectal cancer (81.8% [9/11]), all involving non-emergent elective surgeries. Half the studies (54.5% [6/11]) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (27.2% [3/11]), nutrition optimization (9.1% [1/11]), and patient empowerment (9.1% [1/11]). Primary outcomes were as follows: postoperative complications, quality of life, feasibility of exercise programs, delirium incidence, inspiratory muscle endurance, hospital length of stay, and consistency of nutritional management. All studies had postoperative complications as a primary or secondary outcome. In studies with exercise-based interventions, all but one (83.3% [5/6]) found reduction in postoperative complications, and one showed improvement in quality of life (16.7% [1/6]). Studies focusing on geriatric assessment did not achieve significant differences in outcomes. We found implementation challenges that influenced several studies, including high drop-out rates and intervention fidelity. Conclusions: In this review, we found 11 studies focused on perioperative interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. RCTs to date seem to primarily focus on exercise interventions and geriatric assessment-guided strategies. Although most studies met their primary endpoint, we found heterogeneity in intervention modality and outcome assessment, thus demonstrating a need for ongoing work to address the unique needs of the geriatric oncology population.

Intranasal Dexmedetomidine-Esketamine Combination Premedication versus Monotherapy for Reducing Emergence Delirium and Postoperative Behavioral Changes in Pediatric Tonsillectomy and/or Adenoidectomy: A Randomized Controlled Trial.

Emergence delirium and postoperative negative behavioral changes (PNBC) are common complications in pediatric anesthesia. This study evaluated whether intranasal premedication combining dexmedetomidine and esketamine more effectively reduces these complications compared to either drug alone in children undergoing tonsillectomy and/or adenoidectomy with sevoflurane anesthesia. This randomized, double-blind trial involved 198 children aged 2-5 years undergoing tonsillectomy and/or adenoidectomy. Participants received intranasal premedication with either dexmedetomidine (2μg/kg), esketamine (1 mg/kg), or their combination (dexmedetomidine 1μg/kg plus esketamine 0.5 mg/kg). The primary outcome was the incidence of emergence delirium, defined as a Pediatric Anesthesia Emergence Delirium (PAED) scale score ≥ 10. Secondary outcomes included the incidence of PNBC, sedation depth, easiness of separation from parents, acceptance of the mask for induction, emergence time, postoperative pain score, parental satisfaction, and adverse events. The combination premedication significantly reduced emergence delirium incidence (9.4%) compared to esketamine alone (38.1%; relative risk [RR] 0.25, 95% confidence interval [CI] 0.11-0.57, p < 0.001), but not compared to dexmedetomidine alone (17.2%; RR 0.55, 95% CI 0.21-1.39, p = 0.193). PNBC incidence at day 7 was lower with the combination (28.1%) versus dexmedetomidine (48.4%; RR 0.58, 95% CI 0.36-0.93, p = 0.018), but not significantly different from esketamine alone (20.6%; RR 1.38, 95% CI 0.74-2.58, p = 0.326). The combination also provided significantly superior sedation, improved ease of separation from parents, better acceptance of the mask for induction, shorter emergence time, and higher parental satisfaction than both monotherapies. In children undergoing tonsillectomy and/or adenoidectomy with sevoflurane anesthesia, intranasal dexmedetomidine-esketamine premedication more effectively reduces emergence delirium compared to esketamine alone and PNBC compared to dexmedetomidine alone. This combination also improves sedation, shortens emergence times, and enhances parental satisfaction compared to monotherapy without significant adverse effects. The Chinese Clinical Trial Registry, ChiCTR2300076709.

Letter to the Editor Regarding “Incidence and Risk Factors of Delirium Following Brain Tumor Resection: A Retrospective National Inpatient Sample Database Study”

Letter to the Editor Regarding “Incidence and Risk Factors of Delirium Following Brain Tumor Resection: A Retrospective National Inpatient Sample Database Study”

The role of dexmedetomidine infusion and KETOFOL infusion on the incidence of emergence delirium in children

The role of dexmedetomidine infusion and KETOFOL infusion on the incidence of emergence delirium in children

Using Machine Learning and Electronic Health Records to Identify Neuropsychiatric Risk Scores for Delirium in ICU and General Hospital Settings.

Delirium is a common and acute neuropsychiatric syndrome that requires timely intervention to prevent its associated morbidity and mortality. Yet, its diagnosis and symptoms are often overlooked due to its variable clinical presentation and fluctuating nature. Thus, in this study, we address the barriers to delirium diagnosis by utilizing a machine learning-based predictive algorithm for incident delirium that relies on archived electronic health records (EHRs) data. We used the Medical Information Mart for Intensive Care (MIMIC) database to create a detailed dataset for identifying delirium in intensive care unit (ICU) patients. Our approach involved training machine learning models on this dataset to pinpoint critical clinical features for delirium detection. These features were then refined and applied to non-ICU patients using EHRs from the American University of Beirut Medical Center (AUBMC). Our study assessed machine learning models like Extreme Gradient Boosting (XGBoost), Categorical Boosting (CatBoost), Classification and Regression Trees (CART), Random Forest (RF), Neural Oblivious Decision Ensembles (NODE), and Logistic Regression (LR), highlighting superior delirium detection in diverse clinical settings. The CatBoost model excelled in ICU environments with an F1 Score of 89.2%, while XGBoost performed best in general hospital settings with a 75.4% F1 Score. Interpretations using Tabular Local Interpretable Model-agnostic Explanations (LIME) revealed critical indicators such as prothrombin time and hematocrit levels, enhancing model transparency and clinical applicability. These clinical insights help differentiate the delirium predictors between ICU patients, who are often sensitive to various factors. The proposed predictive algorithm improves delirium detection rates and streamlines efficiency in hospital electronic systems, thereby enabling prompt interventions to prevent delirium progression and associated complications. The clinical indicators for delirium that we identified in general hospital settings and ICU can greatly help healthcare professionals identify potential causes of delirium and reduce misdiagnosis.

The Establishment of Geriatric Multidisciplinary Service (GEMS) for the Identification and Management of Frailty and Delirium in Emergency Care

Abstract Background In Ireland the number of people aged 75 and over has grown by greater than 20% in recent years, as a consequence increasing numbers of older adults are presenting to emergency departments. Frailty is a multi-factorial syndrome that diminishes body reserves and impacts on the person's ability to respond to stressors, such as illness or trauma. In October 2023, a Consultant Geriatrician lead GEMS was launched to identify, assess and manage frailty and associated syndromes, this study concentrated on delirium. Methods All patients 75 and older are triaged by GEMS using an electronic IPM System against prioritisation inclusion and exclusion criteria, utilising a case management approach and Rockwood Clinical Frailty Scale to screen for frailty. CFS score 1 to 3 is fit and managing well, alternatively a CFS of 4 or greater initiates a Comprehensive Geriatric Assessment. A 4AT assessment identifies patients at risk and screening for delirium. Results The results demonstrate a total of 744 patients were reviewed by GEMS from Jan - April 2024, 67% (n=503) had a CGA completed and 72% (n=537) of the population sample are living with frailty. A CFS7 (n=121), CFS8 (n=15) and CFS9 (n=3) are severely frail 26% and moderate frailty CFS6 (n=149) 28%. The 4AT results identified 10% of patients had a positive delirium score (n=60). In addition, a total of (n=61) patients had a formal diagnosis of dementia of which (n=12) patients had a positive 4AT. Conclusion The data confirms the prevalence of frailty in emergency care is approximately 70% and the incidence of acute delirium is approximately 10%. These indicators significantly impact on outcomes of care and treatment plans. Therefore, substantiates the need for early identification of frailty and delirium and the requirement for a highly specialised Consultant Geriatrician Lead (GEM) Service to ensure patients are on the right journey.

Consequences of Delayed Access to Community Social Care for Older Hospital Inpatients with Frailty

Abstract Background The social care system is currently under enormous pressure leading to delays in home care provision and often unnecessarily prolonged hospital stays for frail, older people. The risks of prolonged hospital admissions for frail older people are well-recognised. The aim of this study therefore was to examine the rate of hospital-associated complications (HAC) amongst older inpatients who are otherwise medically optimised for discharge but are awaiting home care to facilitate discharge home. Methods Electronic medical records of patients ≥65 years with delayed transfer of care (DTOC) while awaiting provision of home care provision were examined for incidence of delirium, falls and infection. A smaller cohort of current inpatients (n=14) awaiting home care were interviewed with focus on quality-of-life (CASP-19), loneliness (UCLA Scale) and depressive symptoms (CES-D). Results 59% (57/97) of patients (median 82 years, 60% female, median Clinical Frailty Scale 6) developed a HAC (delirium, fall or infection) while considered medically optimised for discharge. Logistic regression models demonstrated that for every additional day spent awaiting home care, the likelihood of a HAC increased by 4% (Adjusted Odds Ratio 1.04 (95% CI 1.00 – 1.08; p=0.027; z=2.21). Almost half of interview respondents reported that quality-of-life had declined while discharge home was delayed, while over 1/3 (5/14) met criteria for clinically significant depressive symptoms (CES-D-10 ≥10). Conclusion Almost 60% of frail, older inpatients who are medically optimised have a HAC while awaiting home care provision, with the likelihood increasing significantly for every additional day in hospital awaiting care. Long delays to home care package provision are having a hugely detrimental impact on the health of frail, older people in hospital. While addressing the crisis in social care is challenging, interventions to tackle this deficit in home care provision are required urgently.

Irish Hip Fracture Database Frailty Index Predicts Delirium Incidence and Length of Stay in Older Adults Admitted with Hip Fractures

Abstract Background The Irish Hip Fracture Database (IHFD) Frailty Index was developed with the National Office for Clinical Audit has been shown to predict adverse outcomes in older adults with fractures in retrospective review of national data. Here we examined the tool prospectively in clinical practice and its ability to predict delirium and length of stay. Methods We prospectively collected data on all hip fracture patients admitted to an acute orthopaedic floor from October 2022 to May 2024. Patients aged &amp;lt; 60 years or those with atypical femoral or peri-prosthetic fractures were excluded. The 21-item frailty index was applied to all eligible patients. Delirium diagnosis was based on a composite of clinical diagnosis and a 4AT score ≥ 4. Regression analysis was used to examine the relationship between delirium and length of stay with Frailty Index, age and sex. Results A total of 260 patients were included in the study, of whom 72% were female. The mean age was 80 ± 10 years, and 7.7% were nursing home residents. Additionally, 24.2% of patients were discharged directly home, while 40.3% were discharged to rehabilitation. Delirium developed in 24.6% of patients, and 24.9% of patients had a LOS exceeding 30 days. Higher frailty index scores were significantly associated with both LOS (p = 0.001) and delirium (p = 0.013) in both unadjusted and adjusted analyses. There was no significant association between age or sex and LOS or delirium in adjusted analysis. Conclusion The IHFD Frailty Index facilitates a pro-active risk stratification that is based on comorbidities and functional status. IHFD Frailty index independently predicted delirium and length of stay while age did not. Further studies integrating this tool into everyday practice in the care of older patients with hip fractures is warranted.

Impact of dexmedetomidine-assisted anesthesia in elderly patients undergoing radical resection of colon cancer.

Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy. However, due to the physiological characteristics of elderly patients, the safety of perioperative anesthesia needs special attention. As an α2-adrenergic receptor agonist, dexmedetomidine (Dex) has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure, inhibitory effect on inflammation, and sedative and analgesic effects. Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer. To investigate the anesthetic effects of Dex during radical surgery for colon cancer under general anesthesia in elderly patients. A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital, Qingdao, China were recruited and divided into two groups: A and B. In group A, Dex was administered 30 min before surgery, while group B received an equivalent amount of normal saline. The hemodynamic changes, pulmonary compliance, airway pressure, inflammatory factors, confusion assessment method scores, Ramsay Sedation-Agitation Scale scores, and cellular immune function indicators were compared between the two groups. Group A showed less intraoperative hemodynamic fluctuations, better pulmonary compliance, and lower airway resistance compared with group B. Twelve hours after the surgery, the serum levels of TLR-2, TLR-4, IL-6, and TNF-α in group A were significantly lower than those of group B (P < 0.05). After extubation, the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients, indicating a higher level of sedation. The incidence of delirium was significantly lower in group A than in group B (P < 0.05). The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.

Evaluation of drug prescriptions on hospital admission in older trauma patients using the Fit fOR The Aged (FORTA) rules.

Orthogeriatric comanagement of older patients with hip fractures has been proven to provide significant benefits concerning functional status, readmissions, nursing home placement, in-hospital complications and mortality. Medication management in older individuals is acornerstone in orthogeriatric comanagement. The aim of the study was to analyze the extent of overprescription and undertreatment in older trauma patients. Personal and medical data of consecutively admitted older trauma patients were analyzed. Evaluation of medication was conducted according to the Fit fOR The Aged (FORTA) criteria. Data were retrieved from an ongoing observational study on the incidence of delirium in surgical patients. Atotal of 492 patients were enrolled. There were 374 cases of overprescription and 575 cases of undertreatment. Only 78(16%) patients had neither overprescription nor undertreatment on admission. Overprescription and undertreatment were most prevalent in cardiovascular disease. Undertreatment was most prevalent concerning osteoporosis. The number of prescribed drugs correlated with the Charlson Comorbidity Index (r = 0.478, p < 0.001), age (r = 0.122; p < 0.01), anticholinergic burden (r = 0.528, p < 0.001), FORTA score (r = 0.352, p < 0.001), and overtreatment (r = 0.492, p < 0.001), but not with undertreatment. Undertreatment also correlated with age (r = 0.172, p < 0.001) and overtreatment (r = 0.364, p < 0.01). The FORTA score correlated significantly with age (r = 0.159, p < 0.001), anticholinergic burden (ACB) score (r = 0.496, p < 0.001), Katz index (r = -0.119, p < 0.01), IADL score (r = -0.243, p < 0.001), and clinical frailty scale (CFS, r = 0.23, p < 0.001). The high numbers of overprescription and undertreatment in older trauma patients underlines the need for orthogeriatric comanagement. Besides the evaluation of multimorbidity and geriatric problems, drug management is acore topic. Future studies should investigate the impact of medication management on outcome parameters such as quality of life, functional status, and mortality. Abenefit can be expected.

Preventing delirium in post-acute care.

Older adults admitted to post-acute care often are frail with multiple comorbidities, making them particularly vulnerable to developing delirium. The purpose of this quality improvement project was to create, implement, and evaluate an NP-led, evidence-based delirium prevention protocol in a skilled nursing facility (SNF). The incidence of new-onset delirium was assessed pre- and postimplementation; following implementation, no patients were diagnosed with new-onset delirium, and nurses and certified nursing assistants reported changes to their practice. Based on project design, the approximately 42,000 NPs in the US with nursing home or long-term-care facility privileges are optimally positioned to lead SNFs in the prevention of new-onset delirium.

Incidence of Delirium in ICU Patients With and Without COVID-19 in a Costa Rican Hospital.

Delirium is a common and serious neurological complication in intensive care units (ICUs), often leading to poor patient outcomes and increased mortality. This study aimed to compare the incidence of delirium in ICU patients with COVID-19 to those with other respiratory infections in a private hospital in Costa Rica. Additionally, it evaluated the prevalence, severity, duration, and treatment of delirium in these critically ill patients. A retrospective observational study was conducted, analyzing multiple variables obtained from the electronic health records of patients hospitalized in the ICU of Hospital Clinica Biblica. The study included patients admitted between January 2020 and December 2023. It compared the incidence of delirium among patients admitted for COVID-19 and those admitted for other diagnoses. The main outcomes measured were the incidence of delirium and the correlation of its management with international guidelines. The measures included the use of mechanical ventilation, the development of delirium, and the use of sedatives. A total of 137 patients were analyzed, of whom 57.7% were over 70 years old, 67.2% were men, 45.2% were admitted with a diagnosis of COVID-19, 90.5% used mechanical ventilation, and 49.6% of patients developed delirium. Dexmedetomidine was the most used sedative, which was the only one that showed a significant relationship with the development of delirium (p=0.0002). Delirium management was mainly done through the administration of dexmedetomidine (52.9%) and quetiapine (41.2%). There was no correlation between delirium development and mortality (p=0.2670). The study results do not show a significant relationship between COVID-19-positive patients and the development of delirium. Similarly, no higher mortality was observed in those patients who experienced delirium during their ICU stay.

Remimazolam attenuates lipopolysaccharide-induced neuroinflammation and cognitive dysfunction

ObjectiveRemimazolam, a novel benzodiazepine, is widely used as an anesthetic in endoscopic procedures; however, its effects on cognitive function remain unclear, limiting its broader application in general anaesthesia. Neuroinflammation is a well-established key factor in the etiology and progression of cognitive dysfunction, including conditions such as Alzheimer's disease, Parkinson's disease, postoperative delirium, and postoperative cognitive dysfunction. Preclinical studies have demonstrated that remimazolam exerts anti-inflammatory and neuroprotective effects, and clinical reports indicate a reduced incidence of postoperative delirium in patients treated with remimazolam. Nevertheless, whether remimazolam improves cognitive function through its anti-inflammatory properties remains uncertain. This study aimed to investigate the neuroprotective effects of remimazolam and its underlying mechanism in a lipopolysaccharide (LPS)-induced model of neuroinflammation, neuronal injury, and cognitive dysfunction MethodsC57BL/6 J male mice were administered LPS intraperitoneally to establish a model of neuroinflammation-induced cognitive impairment. A subset of mice received remimazolam via intraperitoneal injection 30 minutes prior to LPS administration. Cognitive performance was evaluated using behavioural tests, including the Morris Water Maze (MWM), Novel Object Recognition (NOR) test, and Open Field Test (OFT). Hippocampal tissues were analyzed by haematoxylin-eosin (HE) staining to assess structural changes. Inflammatory markers, including Interleukin (IL)-6, IL-1β, and tumor necrosis factor-α, were quantified using enzyme-linked immunosorbent assay (ELISA) and real-time quantitative PCR. Immunofluorescence was used to detect translocator protein (TSPO) and markers of microglia activation (IBA-1, CD16/32, and CD206). Results(1) Remimazolam reversed LPS-induced cognitive deficits, as evidenced by shorter spatial exploration latency and increased platform crossings in the MWM, and an elevated recognition index in the NOR test. (2) Remimazolam improved hippocampal morphology, reducing LPS-induced neuronal damage. (3) Remimazolam significantly decreased levels of hippocampal inflammatory cytokines, inhibited microglial activation, promoted M2-type microglia polarization, and increased TSPO expression. ConclusionRemimazolam demonstrated neuroprotective and anti-neuroinflammatory effects in a mouse model of LPS-induced cognitive impairment. These effects are likely mediated through the regulation of TSPO, which inhibits microglial activation and promotes the polarization of microglia from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype.