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1.
Aging Clin Exp Res ; 34(3): 633-642, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1729437

ABSTRACT

BACKGROUND: Delirium is associated with a variety of adverse healthcare outcomes but is highly predictable, preventable and treatable. For this reason, numerous guidelines have been developed for delirium recognition, prevention and management across different countries and disciplines. Although research is adduced as evidence for these guidelines, a constant finding is the lack of implementation if they exist at all. Implementation is a human behaviour that can be influenced by various factors including culture at a micro- and macro-level. Hofstede's model proposes that national cultures vary along six consistent dimensions. AIM: Using this model, we examined the nature of delirium guidelines across countries in relation to Hofstede's six cultural dimensions. METHODS: Data collected for each country on: the six dimensions of Hofstede's model, number of delirium guidelines approved by a National professional body of each country (through searching databases), the annual old-age dependency ratio for each country. RESULTS: Sixty-four countries had the completed six dimensions of Hofstede's model. Twenty of them (31%) had one or more delirium guidelines. The total number of different delirium guidelines was 45. Countries with formal delirium guidelines have significantly lower power distance among their members, are more individualistic societies, have lower levels of uncertainty avoidance and higher old-age dependency ratio compared to those without delirium guidelines. DISCUSSION/CONCLUSION: The development and implementation of delirium guidelines vary across countries. Specific combinations of cultural dimensions influence the production of delirium guidelines. Understanding these important cultural differences can facilitate more widespread acceptance and implementation of guidelines.


Subject(s)
Delirium , Practice Guidelines as Topic , Cultural Characteristics , Delirium/diagnosis , Delirium/therapy , Humans , Internationality
2.
BMC Psychiatry ; 22(1): 151, 2022 02 28.
Article in English | MEDLINE | ID: covidwho-1714654

ABSTRACT

BACKGROUND: Despite recognition of the neurologic and psychiatric complications associated with SARS-CoV-2 infection, the relationship between coronavirus disease 19 (COVID-19) severity on hospital admission and delirium in hospitalized patients is poorly understood. This study sought to measure the association between COVID-19 severity and presence of delirium in both intensive care unit (ICU) and acute care patients by leveraging an existing hospital-wide systematic delirium screening protocol. The secondary analyses included measuring the association between age and presence of delirium, as well as the association between delirium and safety attendant use, restraint use, discharge home, and length of stay. METHODS: In this single center retrospective cohort study, we obtained electronic medical record (EMR) data using the institutional Epic Clarity database to identify all adults diagnosed with COVID-19 and hospitalized for at least 48-h from February 1-July 15, 2020. COVID-19 severity was classified into four groups. These EMR data include twice-daily delirium screenings of all patients using the Nursing Delirium Screening Scale (non-ICU) or CAM-ICU (ICU) per existing hospital-wide protocols. RESULTS: A total of 99 patients were diagnosed with COVID-19, of whom 44 patients required ICU care and 17 met criteria for severe disease within 24-h of admission. Forty-three patients (43%) met criteria for delirium at any point in their hospitalization. Of patients with delirium, 24 (56%) were 65 years old or younger. After adjustment, patients meeting criteria for the two highest COVID-19 severity groups within 24-h of admission had 7.2 times the odds of having delirium compared to those in the lowest category [adjusted odds ratio (aOR) 7.2; 95% confidence interval (CI) 1.9, 27.4; P = 0.003]. Patients > 65 years old had increased odds of delirium compared to those < 45 years old (aOR 8.7; 95% CI 2.2, 33.5; P = 0.003). Delirium was associated with increased odds of safety attendant use (aOR 4.5; 95% CI 1.0, 20.7; P = 0.050), decreased odds of discharge home (aOR 0.2; 95% CI 0.06, 0.6; P = 0.005), and increased length of stay (aOR 7.5; 95% CI 2.0, 13; P = 0.008). CONCLUSIONS: While delirium is common in hospitalized patients of all ages with COVID-19, it is especially common in those with severe disease on hospital admission and those who are older. Patients with COVID-19 and delirium, compared to COVID-19 without delirium, are more likely to require safety attendants during hospitalization, less likely to be discharged home, and have a longer length of stay. Individuals with COVID-19, including younger patients, represent an important population to target for delirium screening and management as delirium is associated with important differences in both clinical care and disposition.


Subject(s)
COVID-19 , Delirium , Adult , Aged , COVID-19/complications , Cohort Studies , Delirium/diagnosis , Delirium/etiology , Hospitalization , Humans , Intensive Care Units , Middle Aged , Retrospective Studies , SARS-CoV-2
4.
Gen Hosp Psychiatry ; 74: 9-17, 2022.
Article in English | MEDLINE | ID: covidwho-1568701

ABSTRACT

OBJECTIVE: To validate a previously published machine learning model of delirium risk in hospitalized patients with coronavirus disease 2019 (COVID-19). METHOD: Using data from six hospitals across two academic medical networks covering care occurring after initial model development, we calculated the predicted risk of delirium using a previously developed risk model applied to diagnostic, medication, laboratory, and other clinical features available in the electronic health record (EHR) at time of hospital admission. We evaluated the accuracy of these predictions against subsequent delirium diagnoses during that admission. RESULTS: Of the 5102 patients in this cohort, 716 (14%) developed delirium. The model's risk predictions produced a c-index of 0.75 (95% CI, 0.73-0.77) with 27.7% of cases occurring in the top decile of predicted risk scores. Model calibration was diminished compared to the initial COVID-19 wave. CONCLUSION: This EHR delirium risk prediction model, developed during the initial surge of COVID-19 patients, produced consistent discrimination over subsequent larger waves; however, with changing cohort composition and delirium occurrence rates, model calibration decreased. These results underscore the importance of calibration, and the challenge of developing risk models for clinical contexts where standard of care and clinical populations may shift.


Subject(s)
COVID-19 , Delirium , Delirium/diagnosis , Delirium/epidemiology , Electronic Health Records , Hospitalization , Humans , Retrospective Studies , SARS-CoV-2
5.
BMJ Case Rep ; 14(11)2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1495124

ABSTRACT

Delirious mania (the coexistence of delirium and mania) is described in the literature but not recognised in standard nosologies. We report a woman in her late 30s, with no psychiatric history, who presented with concurrent symptoms of mania and delirium. She was diagnosed with COVID-19 pneumonia (positive reverse transcription-PCR test). There was no history of substance misuse or concurrent medical illness. CT head scan was normal as were blood investigations, other than elevated inflammatory markers. She received standard treatment for COVID-19 pneumonia and lorazepam and quetiapine to treat her neuropsychiatric symptoms. She made a full recovery after 9 days. She was apyrexial with normal oxygen saturation throughout her illness. The case shows that severe neuropsychiatric symptoms can complicate otherwise mild COVID-19 pneumonia with neuroinflammation being a possible mechanism. A diagnosis of delirious mania appears to better capture the complexity of the presentation than a diagnosis of mania or delirium alone.


Subject(s)
Bipolar Disorder , COVID-19 , Delirium , Bipolar Disorder/complications , Bipolar Disorder/diagnosis , Bipolar Disorder/drug therapy , Delirium/diagnosis , Delirium/etiology , Female , Humans , Mania , SARS-CoV-2
7.
Int J Environ Res Public Health ; 18(19)2021 09 26.
Article in English | MEDLINE | ID: covidwho-1463636

ABSTRACT

INTRODUCTION: Delirium is a common complication of patients hospitalized in Intensive care units (ICU). The risk of delirium is estimated at approximately 80% in intensive care units. In the case of cardiac surgery ICU, the risk of delirium increases due to the type of procedures performed with the use of extracorporeal circulation. The aim of this study was to provide an official translation and evaluation of Nursing Delirium Screening Scale (NuDESC) into Polish. The NuDESC scale is a scale used by nurses around the world to detect delirium at an early stage in treatment. METHODS: The method used in the study was the NuDESC tool, which was translated into Polish. The study was conducted by Cardiac ICU nurses during day shift (at 8 a.m.), night shift (at 8 p.m.) and in other situations where the patients showed delirium-like symptoms. RESULTS: Statistically significant differences were observed between the first and second day in the studied group of patients in the case of illusions/hallucinations. Delirium occurred more frequently during the night, but statistical significance was demonstrated for both daytime and nighttime shifts. It was not demonstrated in relation to the NuDESC scale in the case of insomnia disorders. The diagnosis of delirium and disorientation was the most common diagnosis observed in patients on the first day of their stay in the ICU, followed by problems with communication. Delirium occurred on the first day, mainly at night. On the second day, delirium was much less frequent during the night; the biggest problem was disorientation and problems with communication. CONCLUSION: This study contributed to the development of the Polish version of the scale (NuDESC PL) which is now used as the Polish screening tool for delirium detection. The availability of an easy-to-use nurse-based delirium instrument is a prerequisite for widespread implementation.


Subject(s)
Cardiac Surgical Procedures , Delirium , Nurses , Cardiac Surgical Procedures/adverse effects , Delirium/diagnosis , Humans , Intensive Care Units , Poland
8.
J Am Geriatr Soc ; 69(2): 293-299, 2021 02.
Article in English | MEDLINE | ID: covidwho-1388322

ABSTRACT

OBJECTIVES: The aims of this study are to report the prevalence of delirium on admission to the unit in patients hospitalized with SARS-CoV-2 infection, to identify the factors associated with delirium, and to evaluate the association between delirium and in-hospital mortality. DESIGN: Multicenter observational cohort study. SETTINGS: Acute medical units in four Italian hospitals. PARTICIPANTS: A total of 516 patients (median age 78 years) admitted to the participating centers with SARS-CoV-2 infection from February 22 to May 17, 2020. MEASUREMENTS: Comprehensive medical assessment with detailed history, physical examinations, functional status, laboratory and imaging procedures. On admission, delirium was determined by the Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria, 4AT, m-Richmond Agitation Sedation Scale, or clinical impression depending on the site. The primary outcomes were delirium rates and in-hospital mortality. RESULTS: Overall, 73 (14.1%, 95% confidence interval (CI) = 11.0-17.3%) patients presented delirium on admission. Factors significantly associated with delirium were dementia (odds ratio, OR = 4.66, 95% CI = 2.03-10.69), the number of chronic diseases (OR = 1.20, 95% CI = 1.03; 1.40), and chest X-ray or CT opacity (OR = 3.29, 95% CI = 1.12-9.64 and 3.35, 95% CI = 1.07-10.47, for multiple or bilateral opacities and single opacity vs no opacity, respectively). There were 148 (33.4%) in-hospital deaths in the no-delirium group and 43 (58.9%) in the delirium group (P-value assessed using the Gray test <.001). As assessed by a multivariable Cox model, patients with delirium on admission showed an almost twofold increased hazard ratio for in-hospital mortality with respect to patients without delirium (hazard ratio = 1.88, 95% CI = 1.25-2.83). CONCLUSION: Delirium is prevalent and associated with in-hospital mortality among older patients hospitalized with SARS-CoV-2 infection.


Subject(s)
COVID-19/mortality , Delirium/diagnosis , Delirium/mortality , Inpatients/statistics & numerical data , Aged , Aged, 80 and over , Cohort Studies , Comorbidity , Female , Geriatric Assessment , Hospital Mortality , Humans , Intensive Care Units , Italy/epidemiology , Male , Prevalence , Risk Factors
9.
J Psychiatr Res ; 142: 361-368, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1364283

ABSTRACT

AIM: Delirium is a common presenting symptom among older patients. Patients who presented with delirium may have a higher morbidity and mortality rate due to older age, other comorbidities, and atypical COVID-19 presentation. Currently, the evidence supporting delirium as one of the predictors of poor outcome of COVID-19 is still insufficient. This study aims to explore the potential association between delirium and poor outcomes from COVID-19. METHODS: We systematically searched the PubMed and Google Scholar databases using specific keywords related to our aims until January 30th, 2021. All articles published on COVID-19 and delirium were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies and Joanna Briggs Institute (JBI) Critical Appraisal Tools for case-series studies. Statistical analysis was done using Review Manager 5.4 software. RESULTS: Our meta-analysis of 20 studies showed that delirium symptoms on admission was associated with poor outcomes from COVID-19 [OR 2.36 (95% CI 1.80-3.09), p < 0.00001, I2 = 76%, random-effect models] and its subgroup which consist of severe COVID-19 [OR 3.89 (95% CI 1.72-8.75), p = 0.001, I2 = 91%, random-effect models], and mortality from COVID-19 [OR 1.90 (95% CI 1.55-2.33), p < 0.00001, I2 = 36%, random-effect models]. Meta-regression showed that the association was influenced by age (p = 0.005). CONCLUSIONS: Our study suggests delirium as an important marker to identify patients at higher risk for developing poor COVID-19 outcomes. The physicians should add delirium as one of the common presenting symptoms of COVID-19 in older populations.


Subject(s)
COVID-19 , Delirium , Pneumonia , Aged , Comorbidity , Delirium/diagnosis , Delirium/epidemiology , Humans , Pneumonia/complications , Pneumonia/epidemiology , SARS-CoV-2
10.
Intensive Care Med ; 47(10): 1089-1103, 2021 10.
Article in English | MEDLINE | ID: covidwho-1359936

ABSTRACT

Delirium is the most common manifestation of brain dysfunction in critically ill patients. In the intensive care unit (ICU), duration of delirium is independently predictive of excess death, length of stay, cost of care, and acquired dementia. There are numerous neurotransmitter/functional and/or injury-causing hypotheses rather than a unifying mechanism for delirium. Without using a validated delirium instrument, delirium can be misdiagnosed (under, but also overdiagnosed and trivialized), supporting the recommendation to use a monitoring instrument routinely. The best-validated ICU bedside instruments are CAM-ICU and ICDSC, both of which also detect subsyndromal delirium. Both tools have some inherent limitations in the neurologically injured patients, yet still provide valuable information about delirium once the sequelae of the primary injury settle into a new post-injury baseline. Now it is known that antipsychotics and other psychoactive medications do not reliably improve brain function in critically ill delirious patients. ICU teams should systematically screen for predisposing and precipitating factors. These include exacerbations of cardiac/respiratory failure or sepsis, metabolic disturbances (hypoglycemia, dysnatremia, uremia and ammonemia) receipt of psychoactive medications, and sensory deprivation through prolonged immobilization, uncorrected vision and hearing deficits, poor sleep hygiene, and isolation from loved ones so common during COVID-19 pandemic. The ABCDEF (A2F) bundle is a means to facilitate implementation of the 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS) Guidelines. In over 25,000 patients across nearly 100 institutions, the A2F bundle has been shown in a dose-response fashion (i.e., greater bundle compliance) to yield improved survival, length of stay, coma and delirium duration, cost, and less ICU bounce-backs and discharge to nursing homes.


Subject(s)
COVID-19 , Delirium , Adult , Critical Care , Critical Illness , Delirium/diagnosis , Delirium/etiology , Delirium/therapy , Humans , Intensive Care Units , Pandemics , SARS-CoV-2
11.
Neurol Sci ; 42(10): 3981-3988, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1328622

ABSTRACT

INTRODUCTION: Although recent data show that SARS-CoV-2 infection seems to affect the central nervous system (CNS), little is known about the neuropsychiatric effects resulting from this condition. In addition to the well-known neurotrophism of coronaviruses, recent evidence shows also that the "cytokine storm" induced by the infection is at the basis of the neuroinflammation of the CNS. Furthermore, prolonged hospitalization, polypharmacotherapy, and isolation could be at the basis of the onset of delirium in hospitalized COVID patients. This multicentric observational study explores the incidence of the onset of delirium in an Italian cohort of SARS-CoV-2 positive inpatients. METHODS: Data were collected in the COVIDhospitals of Brescia, Bergamo, Chieti, and Genova. Different socio-demographic, medical, neurological, and pharmacological parameters were collected. As a rapid screening for delirium, the 4AT scale was used. Eighty COVID-19 inpatients (mean age 74.7 ± 14.5 years) met the inclusion criteria (confirmed positivity to the SARS-CoV-2 virus; the presence of delirium and/or psychomotor agitation and/or new onset of other neuropsychiatric symptoms during hospitalization). RESULTS: The majority of these patients (68.8%) had "hyperactive delirium" subtype. Polypharmacotherapy, current treatment with corticosteroids, and higher age were associated with delirium severity. CONCLUSION: These data provide an insight into the onset of delirium among COVID-19 patients underlining the need for monitoring, especially in elderly patients, the neuropsychiatric symptoms, and the therapy in order to have shorter hospitalization times and better outcomes.


Subject(s)
COVID-19 , Delirium , Aged , Aged, 80 and over , Delirium/diagnosis , Delirium/epidemiology , Hospitalization , Humans , Italy/epidemiology , Middle Aged , SARS-CoV-2
12.
J Coll Physicians Surg Pak ; 31(7): 145, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1317413
13.
Intensive Care Med ; 47(10): 1144-1147, 2021 10.
Article in English | MEDLINE | ID: covidwho-1287425
15.
BMJ ; 373: n1007, 2021 06 08.
Article in English | MEDLINE | ID: covidwho-1263910

ABSTRACT

Delirium, a form of acute brain dysfunction, is very common in the critically ill adult patient population. Although its pathophysiology is poorly understood, multiple factors associated with delirium have been identified, many of which are coincident with critical illness. To date, no drug or non-drug treatments have been shown to improve outcomes in patients with delirium. Clinical trials have provided a limited understanding of the contributions of multiple triggers and processes of intensive care unit (ICU) acquired delirium, making identification of therapies difficult. Delirium is independently associated with poor long term outcomes, including persistent cognitive impairment. A longer duration of delirium is associated with worse long term cognition after adjustment for age, education, pre-existing cognitive function, severity of illness, and exposure to sedatives. Interestingly, differences in prevalence are seen between ICU survivor populations, with survivors of acute respiratory distress syndrome experiencing higher rates of cognitive impairment at early follow-up compared with mixed ICU survivor populations. Although cognitive performance improves over time for some ICU survivors, impairment is persistent in others. Studies have so far been unable to identify patients at higher risk of long term cognitive impairment; this is an active area of scientific investigation.


Subject(s)
Cognitive Dysfunction , Critical Illness/psychology , Delirium , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/etiology , Critical Care/methods , Critical Illness/therapy , Delirium/complications , Delirium/diagnosis , Humans , Long Term Adverse Effects , Prognosis
16.
Age Ageing ; 50(5): 1445-1453, 2021 09 11.
Article in English | MEDLINE | ID: covidwho-1226521

ABSTRACT

BACKGROUND: Attention should be paid to delirium in coronavirus disease 2019 (COVID-19) patients, especially older people, since advanced age poses increased risk of both delirium and COVID-19-related death. OBJECTIVE: This study aims to summarise the evidence on prevalence, incidence and mortality of delirium in COVID-19 patients. METHODS: We conducted a comprehensive literature search on Pubmed and Embase from inception to 1 December 2020. Three independent reviewers evaluated study eligibility and data extraction, and assessed study quality. Outcomes were analysed as proportions with 95% confidence interval (CI). We also compared mortality differences in COVID-19 patients using odds ratio. RESULTS: In total, we identified 48 studies with 11,553 COVID-19 patients from 13 countries. Pooled prevalence, incidence and mortality rates for delirium in COVID-19 patients were 24.3% (95% CI: 19.4-29.6%), 32.4% (95% CI: 20.8-45.2%) and 44.5% (95% CI: 36.1-53.0%), respectively. For patients aged over 65 years, prevalence, incidence and mortality rates for delirium in COVID-19 patients were 28.2% (95% CI: 23.5-33.1%), 25.2% (95% CI: 16.0-35.6%) and 48.4% (95% CI: 40.6-56.1%), respectively. For patients under 65 years, prevalence, incidence and mortality rates for delirium in COVID-19 patients were 15.7% (95% CI: 9.2-23.6%), 71.4% (95% CI: 58.5-82.7%) and 21.2% (95% CI: 15.4-27.6%), respectively. Overall, COVID-19 patients with delirium suffered higher risk of mortality, compared with those without delirium (OR: 3.2, 95% CI: 2.1-4.8). CONCLUSION: Delirium developed in almost 1 out of 3 COVID-19 patients, and was associated with 3-fold overall mortality. Our findings suggest that first-line healthcare providers should systematically assess delirium and monitor related symptoms among COVID-19 patients.


Subject(s)
COVID-19 , Delirium , Aged , Delirium/diagnosis , Delirium/epidemiology , Humans , Incidence , Middle Aged , Prevalence , SARS-CoV-2
17.
J Alzheimers Dis ; 81(1): 75-81, 2021.
Article in English | MEDLINE | ID: covidwho-1215268

ABSTRACT

Acute delirium and other neuropsychiatric symptoms have frequently been reported in COVID-19 patients and are variably referred to as acute encephalopathy, COVID-19 encephalopathy, SARS-CoV-2 encephalitis, or steroid-responsive encephalitis. COVID-19 specific biomarkers of cognitive impairment are currently lacking, but there is some evidence that SARS-CoV-2 could preferentially and directly target the frontal lobes, as suggested by behavioral and dysexecutive symptoms, fronto-temporal hypoperfusion on MRI, EEG slowing in frontal regions, and frontal hypometabolism on 18F-FDG-PET imaging. We suggest that an inflammatory parainfectious process targeting preferentially the frontal lobes (and/or frontal networks) could be the underlying cause of these shared clinical, neurophysiological, and imaging findings in COVID-19 patients. We explore the biological mechanisms and the clinical biomarkers that might underlie such disruption of frontal circuits and highlight the need of standardized diagnostic procedures to be applied when investigating patients with these clinical findings. We also suggest the use of a unique label, to increase comparability across studies.


Subject(s)
Acute Febrile Encephalopathy/physiopathology , COVID-19/physiopathology , Frontal Lobe/physiopathology , Frontal Lobe/virology , SARS-CoV-2/pathogenicity , Acute Febrile Encephalopathy/diagnosis , Acute Febrile Encephalopathy/virology , Biomarkers/analysis , COVID-19/diagnosis , COVID-19/virology , Delirium/diagnosis , Delirium/physiopathology , Delirium/virology , Electroencephalography , Humans , Magnetic Resonance Imaging , Nerve Net/physiopathology , Virulence
18.
Riv Psichiatr ; 56(2): 85-92, 2021.
Article in Italian | MEDLINE | ID: covidwho-1201375

ABSTRACT

Delirium is a phenomenon classified within neuro-cognitive disorders in the DSM-5. It has several etiologies and it is often lethal. This contribute aims at analyzing clinical characteristics and diagnostic possibilities of delirium in patients affected by covid-19. Furthermore, some preliminary recommendations on the use of psychopharmacological treatment of delirium and their interactions with main drugs used to treat covid-19 are given, with a special attention to comorbidities like in immunocompromised patients, in those affected by diabetes and cancer, in pregnant women or in addicted clients.


Subject(s)
COVID-19/complications , Delirium/etiology , COVID-19/drug therapy , Delirium/diagnosis , Delirium/drug therapy , Drug Interactions , Humans , Middle Aged
19.
Am J Health Syst Pharm ; 78(15): 1385-1394, 2021 07 22.
Article in English | MEDLINE | ID: covidwho-1199469

ABSTRACT

PURPOSE: Nearly half of intensive care unit (ICU) patients will develop delirium. Antipsychotics are used routinely for the management of ICU delirium despite limited reliable data supporting this approach. The unwarranted continuation of antipsychotics initiated for ICU delirium is an emerging transitions of care concern, especially considering the adverse event profile of these agents. We sought to evaluate the magnitude of this issue across 6 centers in New Jersey and describe risk factors for continuation. METHODS: This multicenter, retrospective study examined adult ICU patients who developed ICU delirium from June 2016 to June 2018. Patients were included in the study if they received at least 3 doses of antipsychotics while in the ICU with presence of either a clinical diagnosis of delirium or a positive Confusion Assessment Method score. Patients were excluded if they were on an antipsychotic before ICU admission. RESULTS: Of the 300 patients included and initiated on antipsychotics for ICU delirium, 157 (52.3%) were continued on therapy upon transfer from the ICU to another level of inpatient care. The number of patients continued on newly initiated antipsychotics further increased to 183 (61%) upon discharge from the hospital. CONCLUSION: The continuation of antipsychotics for the management of delirium during transitions of care was a common practice across ICUs in New Jersey. Several risk factors for continuation of antipsychotics were identified. Efforts to reduce unnecessary continuation of antipsychotics at transitions of care are warranted.


Subject(s)
Antipsychotic Agents , Delirium , Adult , Antipsychotic Agents/adverse effects , Delirium/chemically induced , Delirium/diagnosis , Delirium/drug therapy , Humans , Intensive Care Units , New Jersey , Retrospective Studies
20.
Rev Bras Ter Intensiva ; 33(1): 48-67, 2021.
Article in Spanish, English | MEDLINE | ID: covidwho-1197640

ABSTRACT

OBJECTIVE: To propose agile strategies for a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for patients with COVID-19-associated acute respiratory distress syndrome, considering the high risk of infection among health workers, the humanitarian treatment that we must provide to patients and the inclusion of patients' families, in a context lacking specific therapeutic strategies against the virus globally available to date and a potential lack of health resources. METHODS: A nonsystematic review of the scientific evidence in the main bibliographic databases was carried out, together with national and international clinical experience and judgment. Finally, a consensus of recommendations was made among the members of the Committee for Analgesia, Sedation and Delirium of the Sociedad Argentina de Terapia Intensiva. RESULTS: Recommendations were agreed upon, and tools were developed to ensure a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for adult patients with acute respiratory distress syndrome due to COVID-19. DISCUSSION: Given the new order generated in intensive therapies due to the advancing COVID-19 pandemic, we propose to not leave aside the usual good practices but to adapt them to the particular context generated. Our consensus is supported by scientific evidence and national and international experience and will be an attractive consultation tool in intensive therapies.


OBJETIVO: Proponer estrategias agile para este abordaje integral de la analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente con síndrome de dificultad respiratoria aguda por COVID-19, considerando el alto riesgo de infección que existe entre los trabajadores de salud, el tratamiento humanitario que debemos brindar al paciente y su familia, en un contexto de falta estrategias terapéuticas específicas contra el virus globalmente disponibles a la fecha y una potencial falta de recursos sanitarios. METODOS: Se llevó a cabo una revision no sistemática de la evidencia científica en las principales bases de datos bibliográficos, sumada a la experiencia y juicio clínico nacional e internacional. Finalmente, se realizó un consenso de recomendaciones entre los integrantes del Comité de Analgesia, Sedación y Delirium de la Sociedad Argentina de Terapia Intensiva. RESULTADOS: Se acordaron recomendaciones y se desarrollaron herramientas para asegurar un abordaje integral de analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente adulto con síndrome de dificultad respiratoria aguda por COVID-19. DISCUSIÓN: Ante el nuevo orden generado en las terapias intensivas por la progresión de la pandemia de COVID-19, proponemos no dejar atrás las buenas prácticas habituales, sino adaptarlas al contexto particular generado. Nuestro consenso está respaldado en la evidencia científica, la experiencia nacional e internacional, y será una herramienta de consulta atractiva en las terapias intensivas.


Subject(s)
Analgesia/standards , COVID-19/complications , Consensus , Delirium/therapy , Pain Management/standards , Respiratory Distress Syndrome/therapy , Analgesia/methods , Analgesics/administration & dosage , COVID-19/drug therapy , Checklist , Delirium/diagnosis , Early Ambulation , Family , Humans , Intensive Care Units , Intubation, Intratracheal/methods , Neuromuscular Blockade/methods , Neuromuscular Blockade/standards , Pain Management/methods , Pain Measurement/methods , Pain Measurement/standards , Psychomotor Agitation/therapy
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