Are patients in the medical-surgical intensive care unit delirious? A point prevalence study

2.50
Hdl Handle:
http://hdl.handle.net/10755/157180
Category:
Abstract
Type:
Presentation
Title:
Are patients in the medical-surgical intensive care unit delirious? A point prevalence study
Author(s):
Smith, Orla; Kaye, Callum
Author Details:
Orla Smith, St. Michael's Hospital, Toronto, Ontario, Canada, email: smitho@smh.toronto.on.ca; Callum Kaye
Abstract:
PURPOSE: This study was designed to measure the prevalence of delirium in the intensive care unit and to compare delirium prevalence amongst pre-defined subgroups. Clinician documentation of delirium assessment was also evaluated. ) BACKGROUND: Delirium is an acute state of disturbed consciousness and fluctuating cognition. ICU patients are at increased risk for delirium due to older age, acute systemic illness, organ dysfunction, electrolyte abnormalities, psychoactive medications, sleep deprivation, and pre-existing illnesses. Incidence of delirium is estimated at upwards of 80% in ventilated patients yet it is often not identified by ICU clinicians. Unrecognized and untreated delirium may result in increased morbidity and mortality. METHODS: This prospective, observational study recruited 25 subjects from a 24-bed Medical-Surgical Intensive Care Unit (MSICU) in a 550-bed inner-city teaching hospital. All patients in the ICU during the study period without documented dementia or primary neurologic dysfunction were enrolled unless they were deaf or unable to speak English. Enrolled patients were assessed at three time points (morning, afternoon, evening) on three different days to reflect the fluctuating nature of the condition of interest. Delirium screening was conducted using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The study was reviewed and approved by the institutional research ethics board. and APACHE II score of 16 (7.7). 56% were admitted to the ICU post-operatively and median (IQR) ICU length of stay was 17(202.5). Delirium was present in 23% of subjects (n=9), absent in 46% (n=18)of subjects, and not assessable in 31% (n=12)of subjects. There were no significant differences between delirious and non-delirious patients related to: age; length of stay; APACHE II score; or duration of mechanical ventilation. Delirium was identified by the clinical team in only 1/9 patients with a positive CAM-ICU result. RESULTS: 39 observations were recorded in 25 participants. Participants were 88% male with a mean (SD) age of 65 (13.2 CONCLUSIONS: Prevalence of delirium in the study sample is similar to the published literature despite a higher number of males and longer stay patients in our study cohort. Delirium screening could not be conducted in a significant proportion of patients due to high levels of sedation. Delirium was not routinely identified by physicians and nurses. Delirium education should be provided in tandem with education on sedation and analgesia assessment and management.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleAre patients in the medical-surgical intensive care unit delirious? A point prevalence studyen_GB
dc.contributor.authorSmith, Orlaen_GB
dc.contributor.authorKaye, Callumen_GB
dc.author.detailsOrla Smith, St. Michael's Hospital, Toronto, Ontario, Canada, email: smitho@smh.toronto.on.ca; Callum Kayeen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157180-
dc.description.abstractPURPOSE: This study was designed to measure the prevalence of delirium in the intensive care unit and to compare delirium prevalence amongst pre-defined subgroups. Clinician documentation of delirium assessment was also evaluated. ) BACKGROUND: Delirium is an acute state of disturbed consciousness and fluctuating cognition. ICU patients are at increased risk for delirium due to older age, acute systemic illness, organ dysfunction, electrolyte abnormalities, psychoactive medications, sleep deprivation, and pre-existing illnesses. Incidence of delirium is estimated at upwards of 80% in ventilated patients yet it is often not identified by ICU clinicians. Unrecognized and untreated delirium may result in increased morbidity and mortality. METHODS: This prospective, observational study recruited 25 subjects from a 24-bed Medical-Surgical Intensive Care Unit (MSICU) in a 550-bed inner-city teaching hospital. All patients in the ICU during the study period without documented dementia or primary neurologic dysfunction were enrolled unless they were deaf or unable to speak English. Enrolled patients were assessed at three time points (morning, afternoon, evening) on three different days to reflect the fluctuating nature of the condition of interest. Delirium screening was conducted using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The study was reviewed and approved by the institutional research ethics board. and APACHE II score of 16 (7.7). 56% were admitted to the ICU post-operatively and median (IQR) ICU length of stay was 17(202.5). Delirium was present in 23% of subjects (n=9), absent in 46% (n=18)of subjects, and not assessable in 31% (n=12)of subjects. There were no significant differences between delirious and non-delirious patients related to: age; length of stay; APACHE II score; or duration of mechanical ventilation. Delirium was identified by the clinical team in only 1/9 patients with a positive CAM-ICU result. RESULTS: 39 observations were recorded in 25 participants. Participants were 88% male with a mean (SD) age of 65 (13.2 CONCLUSIONS: Prevalence of delirium in the study sample is similar to the published literature despite a higher number of males and longer stay patients in our study cohort. Delirium screening could not be conducted in a significant proportion of patients due to high levels of sedation. Delirium was not routinely identified by physicians and nurses. Delirium education should be provided in tandem with education on sedation and analgesia assessment and management.en_GB
dc.date.available2011-10-26T19:29:35Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:29:35Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.