COVID-19: ICU delirium management during SARS-CoV-2 pandemic

Critical Care, Journal Year: 2020, Volume and Issue: 24(1)

Published: April 28, 2020

Abstract The novel coronavirus, SARS-CoV-2-causing Coronavirus Disease 19 (COVID-19), emerged as a public health threat in December 2019 and was declared pandemic by the World Health Organization March 2020. Delirium, dangerous untoward prognostic development, serves barometer of systemic injury critical illness. early reports 25% encephalopathy from China are likely gross underestimation, which we know occurs whenever delirium is not monitored with valid tool. Indeed, patients COVID-19 at accelerated risk for due to least seven factors including (1) direct central nervous system (CNS) invasion, (2) induction CNS inflammatory mediators, (3) secondary effect other organ failure, (4) sedative strategies, (5) prolonged mechanical ventilation time, (6) immobilization, (7) needed but unfortunate environmental social isolation quarantine without family. Given insights into pathobiology virus, well emerging interventions utilized treat critically ill patients, prevention management will prove exceedingly challenging, especially intensive care unit (ICU). main focus during lies within organizational issues, i.e., lack ventilators, shortage personal protection equipment, resource allocation, prioritization limited options, end-of-life care. However, standard ICU management, must remain highest quality possible an eye towards long-term survival minimization issues related post-intensive syndrome (PICS). This article discusses how professionals (e.g., physicians, nurses, physiotherapists, pharmacologists) can use our knowledge resources limit burden on reducing modifiable despite imposed heavy workload difficult clinical challenges posed pandemic.

Language: Английский

---

The inter-relationship between delirium and dementia: the importance of delirium prevention

Nature Reviews Neurology, Journal Year: 2022, Volume and Issue: 18(10), P. 579 - 596

Published: Aug. 26, 2022

Language: Английский

---

Mental health care for older adults: recent advances and new directions in clinical practice and research

World Psychiatry, Journal Year: 2022, Volume and Issue: 21(3), P. 336 - 363

Published: Sept. 8, 2022

The world's population is aging, bringing about an ever-greater burden of mental disorders in older adults. Given multimorbidities, the health care these people and their family caregivers labor-intensive. At same time, ageism a big problem for people, with without disorders. Positive elements such as resilience, wisdom prosocial behaviors, need to be highlighted promoted, both combat stigma help protect improve positive psychiatry aging not oxymoron, but scientific construct strongly informed by research evidence. We champion broader concept geriatric - one that encompasses well illness. In present paper, we address issues context four are greatest source years lived disability: neurocognitive disorders, major depression, schizophrenia, substance use emphasize implementation multidisciplinary team care, comprehensive assessment, clinical management, intensive outreach, coordination mental, physical social services. also underscore further into moderators mediators treatment response variability. Because optimal adults patient-focused family-centered, call enhancing well-being caregivers. To optimize safety efficacy pharmacotherapy, attention metabolic, cardiovascular neurological tolerability much needed, together development testing medications reduce risk suicide. normal cognitive antidote catalyst change way think per se late-life more specifically. It this provide directions future research.

Language: Английский

---

The critically ill older patient with sepsis: a narrative review

Annals of Intensive Care, Journal Year: 2024, Volume and Issue: 14(1)

Published: Jan. 10, 2024

Abstract Sepsis is a significant public health concern, particularly affecting individuals above 70 years in developed countries. This crucial fact due to the increasing aging population, their heightened vulnerability sepsis, and associated high mortality rates. However, morbidity long-term outcomes are even more notable. While many patients respond well timely appropriate interventions, it imperative enhance efforts identifying, documenting, preventing, treating sepsis. Managing sepsis older poses greater challenges necessitates comprehensive understanding of predisposing factors suspicion for diagnosing infections assessing risk sudden deterioration into Despite age often being considered an independent factor morbidity, recent research emphasizes pivotal roles frailty, disease severity, comorbid conditions influencing outcomes. In addition, important inquire about patient's preferences establish personalized treatment plan that considers potential recovery with quality life functional review provides summary most aspects consider when dealing old critically ill patient

Language: Английский

---

Delirium and Adverse Outcomes in Hospitalized Patients with COVID‐19

Journal of the American Geriatrics Society, Journal Year: 2020, Volume and Issue: 68(11), P. 2440 - 2446

Published: Aug. 25, 2020

Little is known about the association between acute mental changes and adverse outcomes in hospitalized adults with COVID-19.

Language: Английский

---

Biomarkers of Delirium Duration and Delirium Severity in the ICU*

Critical Care Medicine, Journal Year: 2019, Volume and Issue: 48(3), P. 353 - 361

Published: Nov. 26, 2019

Both delirium duration and severity are associated with adverse patient outcomes. Serum biomarkers in ICU patients have not been reliably identified. We conducted our study to identify peripheral representing systemic inflammation, impaired neuroprotection, astrocyte activation duration, severity, in-hospital mortality.Observational study.Three Indianapolis hospitals.Three-hundred twenty-one critically ill delirious patients.None.We analyzed the associations between collected at onset delirium-/coma-free days assessed through Richmond Agitation-Sedation Scale/Confusion Assessment Method for ICU, Confusion ICU-7, mortality. After adjusting age, gender, Acute Physiology Chronic Health Evaluation II score, Charlson comorbidity sepsis diagnosis intervention group, interleukin-6, -8, -10, tumor necrosis factor-α, C-reactive protein, S-100β levels quartile 4 were negatively by 1 week 30 post enrollment. Insulin-like growth factor-1 both time points. Interleukin-6, also week. At hospital discharge, -10 retained association but lost their severity. Interleukin-8 higher Interleukin-6 insulin-like found be mortality.Biomarkers of inflammation those glial longer Utility these early a risk severe prolonged delirium, related complications during hospitalization needs explored future studies.

Language: Английский

---

A call to action for delirium research: Meta-analysis and regression of delirium associated mortality

BMC Geriatrics, Journal Year: 2020, Volume and Issue: 20(1)

Published: Sept. 7, 2020

Abstract Background Delirium is an extremely common hospital complication. No study to date has assessed whether a priori defined covariates; type of setting and year publication, influence the relationship between delirium mortality. This also first examine longitudinal trend delirium-associated mortality over recent decades, analyse trajectory our efforts in combating this disease. Methods MEDLINE, EMBASE PsycINFO, were searched from January 1981 May 2018 for English-language primary articles. Rigorous title abstract screen full-text conducted independently by two reviewers. paper adhered MOOSE guidelines. Data was extracted one reviewer using standardised data-collection sheets, with separate verifying accuracy. The quality included studies Newcastle-Ottawa Quality Assessment Scale. Unadjusted effect sizes event counts analysed random effects model meta-analysis meta-regression, whereas mixed used secondary sub-group analysis. Mortality data at longest follow-up cumulative (hospital combined follow-up) analysed. Results As part larger project, 446 6790 articles retrieved, including 71 that measured Our results demonstrate elderly inpatients had significantly greater odds (OR 3.18 [95%CI: 2.73, 3.70]) compared non-delirious controls. Patients ICU highest (OR: 7.09 3.60, 14.0]); double risk average. Curiously, despite advancements research, associated in-hospital not changed 30 years. Conclusion largest confirm association mortality, older (age ≥ 65) inpatients. current highlights significant after episode delirium, these are much higher patients. However, contrast other medical conditions have seen decrease past few remains unchanged. These findings underscore urgent need better treatments. PROSPERO Registration Number : CRD42018098627, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=98627

Language: Английский

---

Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes

Neurology, Journal Year: 2019, Volume and Issue: 93(13)

Published: Aug. 30, 2019

To determine which findings on routine clinical EEGs correlate with delirium severity across various presentations and to whether EEG independently predict important outcomes.We prospectively studied a cohort of nonintubated inpatients undergoing for evaluation altered mental status. Patients were assessed within 1 hour the 3-Minute Diagnostic Interview Confusion Assessment Method (3D-CAM) 3D-CAM score. interpreted clinically by neurophysiologists, reports reviewed identify features such as theta or delta slowing triphasic waves. Generalized linear models used quantify associations among findings, delirium, outcomes, including length stay, Glasgow Outcome Scale scores, mortality.We evaluated 200 patients (median age 60 years, IQR 48.5-72 years); 121 (60.5%) met criteria. The finding most strongly associated presence was composite generalized (odds ratio 10.3, 95% confidence interval 5.3-20.1). prevalence correlated not only overall (R2 = 0.907) but also each feature CAM-based algorithms. Slowing common in even normal arousal. longer hospitalizations, worse functional increased mortality, after adjustment severity.Generalized correlates may be valuable biomarker severity. In addition, should trigger elevated concern prognosis

Language: Английский

---

COVID-19: What do we need to know about ICU delirium during the SARS-CoV-2 pandemic?

Anaesthesiology Intensive Therapy, Journal Year: 2020, Volume and Issue: 52(2), P. 132 - 138

Published: Jan. 1, 2020

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kotfis K, Williams Roberson S, Wilson JE, et al. COVID-19: What do we need to know about ICU delirium during the SARS-CoV-2 pandemic?. Anaesthesiology Intensive Therapy. 2020;52(2):132-138. doi:10.5114/ait.2020.95164. APA Kotfis, K., Roberson, S., Wilson, J. E., Pun, B. T., Ely, & Jeżowska, I. (2020). Therapy, 52(2), 132-138. https://doi.org/10.5114/ait.2020.95164 Chicago Katarzyna, Shawniqua Jo E Brenda T E. Wesley Ilona and Maja Jezierska 2020. "COVID-19: pandemic?". Therapy 52 (2): Harvard J., B., I., Jezierska, M., Dabrowski, W. pp.132-138. MLA Katarzyna pandemic?." vol. 52, no. 2, 2020, pp. Vancouver J, Pun B, Ely E, Jeżowska I

Language: Английский

---

Delirium Prevention, Detection, and Treatment in Emergency Medicine Settings: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement

Academic Emergency Medicine, Journal Year: 2020, Volume and Issue: 28(1), P. 19 - 35

Published: Nov. 2, 2020

Abstract Background Older adult delirium is often unrecognized in the emergency department (ED), yet most compelling research questions to overcome knowledge‐to‐practice deficits remain undefined. The Geriatric Emergency care Applied Research (GEAR) Network was organized identify and prioritize clinical questions. Methods GEAR identified engaged 49 transdisciplinary stakeholders including physicians, geriatricians, nurses, social workers, pharmacists, patient advocates. Adhering Preferred Reporting Items for Systematic Reviews Meta‐Analyses Scoping Reviews, were derived, medical librarian electronic searches conducted, applicable evidence synthesized ED detection, prevention, management. scoping review served as foundation a consensus conference highest priority foci. Results In review, 27 detection “instruments” described 48 studies used variable criterion standards with result of prevalence ranging from 6% 38%. Clinician gestalt common “instrument” evaluated sensitivity 0% 81% specificity 65% 100%. For management, 15 relevant identified, one randomized controlled trial. Some intervention targeted clinicians via education others pathways. Three medications reduce or prevent delirium. No consistently prevented treated After reviewing results, prevention interventions not reliant on additional nurse physician effort research. Conclusions Transdisciplinary that are health worker tasks instead alternative directions such defining etiologic phenotypes target strategies.

Language: Английский

---