Olanzapine and quetiapine are frequently administered atypical antipsychotic medications and their effects on the corrected QT (QTc) in the critically ill population remain understudied.

The objective of this study was to compare the impact of olanzapine and quetiapine on QTc changes in critically ill patients.

This was a single-center, retrospective analysis. Adult patients admitted to the intensive care unit (ICU) from January 2023 through July 2023 were included if they received ≥2 doses of either olanzapine or quetiapine within a 48-hour period and had one QTc evaluated within 48 hours of antipsychotic initiation. The major endpoint was a composite of the incidence of QTc prolongation (defined as QTc > 500 ms or QTc > 60 ms above baseline) following antipsychotic initiation. Univariable and multivariable analyses were performed to identify risk factors for QTc prolongation.

There was no statistical difference in the major composite endpoint between patients in the olanzapine and quetiapine groups (8/83 [9.6%] vs 19/129 [14.7%]; P = .28). The incidence of QTc > 500 ms (7/244 [2.9%] vs 20/427 [4.7%]; P = .25) and change from baseline >60 ms (5/244 [2.0%] vs 17/427 [4.0%]; P = .26) were not statistically different between the olanzapine and quetiapine groups, respectively. There were no occurrences of Torsades de Pointes or extrapyramidal symptoms in either group.

The results of this study suggest olanzapine and quetiapine may have similar impact on QTc prolongation in critically ill patients. These findings could contribute to safer prescribing practices in the ICU.

Intensive care units (ICUs) manage patients with or likely to have one or more life-threatening acute organ failures that might require the use of invasive supportive therapies. The use of physical restraint is frequent, with rates up to 50%, and usually initiated to maintain patient safety especially if the patient is agitated. Physical restraints have been associated with delirium, post-traumatic stress disorder and physical injuries while restricting patients' individual freedom. Moreover, the incidence of invasive therapeutic devices' self-removal by patients might not be decreased by physical restraint use. No recommendation is available concerning ICU patients and physical restraint management, despite being a daily practice. The main objective is to evaluate whether a strategy aimed at decreasing physical restraint use in ICU patients with that of a strategy based on routine and subjective caregivers' decision is safe and efficient.

ARBORea is a multicentre randomised, stepped-wedge trial testing an innovative, dedicated web-based, multiprofessionally developed, experts validated, nursing management strategy in comparison with standard care. The primary outcome is physical restraint use rate (effectiveness) measured at least every 8 hours and incidents' rate (tolerance) defined as the rate of incidents attributable to non-compliance, corresponding to the deterioration or self-removal of critical devices, a fall or self-aggressive or heteroaggressive behaviours. Planned enrolment is 4000 ICU adult participants at 20 French academic and non-academic centres. Safety and long-term outcomes will be evaluated.

Trial results will be reported according to the Consolidated Standards of Reporting Trials 2010 guidelines. Findings will be published in peer-reviewed journals and presented at local, national and international meetings and conferences to publicise and explain the research to clinicians, commissioners and service users. The trial is funded by the French Ministry of Health and has been approved by the French local ethics committee (Comité de Protection des Personnes Sud-Ouest et Outre-Mer 2, Toulouse, France with registration number: 2020-A02904-35).

(ClinicalTrials.gov) NCT04957238 on 12 July 2021 before first inclusion in study.

Precise forecasting of delirium in intensive care unit (ICU) may propel effective early prevention strategies and stratification of ICU patients through delirium risks, avoiding waste of medical resources. However, there are few optimal models of delirium in critically ill older patients. This study aimed to propose and verify a nomogram for predicting the incidence of delirium in elderly patients admitted to ICU.

We performed a retrospective study using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. It included data on 13,175 older patients in total. The patients were randomly divided into a training group (n = 9,223) and an internal verification group (n = 3,452). Risk factors were screened using the least absolute shrinkage and selection operator regression. We successfully constructed a multivariate logistic regression model along with a nomogram. We conducted internal verification using 1,000 bootstrap specimens. Performance assessment was conducted using a receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC).

The risk factors included in the nomogram were sepsis, Sequential Organ Failure Assessment (SOFA) score, cerebrovascular disease, mechanical ventilation, sedation, severe hypothermia, and serum calcium levels. The area under the ROC curve (AUC) for the nomogram, incorporating the above-mentioned predictors for the training set was 0.762 (95% confidence interval [CI] 0.749-0.776), whereas that for the verification set was 0.756 (95% CI 0.736-0.776). Based on the calibration curve, the model forecast outcomes matched well with the actual results, and the nomogram's Brier score was 0.12 in the training set and 0.128 in the verification set. DCA and CIC showed that our model had a good net clinical benefit.

We developed a forecast nomogram for delirium in the critically ill elderly patients that enhances clinical decision-making. However, further verification is required.

Postoperative delirium (POD) remains a significant complication following cardiopulmonary bypass (CPB) surgery, particularly in middle-aged patients who constitute the majority of this surgical population. While intranasal insulin (INI) has shown neuroprotective potential in aging cohorts, its efficacy in younger surgical patients and its underlying mechanisms remain under explored. This study investigates whether INI mitigates POD through sleep-wake cycle modulation.

It is a single-center prospective randomized, double-blinded controlled trial from March 4, 2024 to October 18, 2024. 76 middle-aged patients (45-65 years) undergoing elective CPB surgery were randomized to receive INI (20 IU) or placebo preoperatively and on postoperative days 1-2. The primary outcome was POD incidence (CAM-ICU criteria). Secondary outcomes included Mini-Mental State Examination (MMSE) scores, actigraphy-derived sleep metrics (sleep efficiency [SE], total sleep time [TST]). Analyses followed intention-to-treat principles.

INI significantly reduced POD incidence (17.1 % vs. 38.9 %, RR = 3.45, p = 0.037) and improved cognitive recovery, as evidenced by higher MMSE scores at postoperative day 5 with a difference of 1.71 (95 % CI, 0.19 to 3.23; p = 0.027). Sleep analysis revealed robust improvements in the INI group: SE increased by 21.3 % (78.2 ± 12.1 % vs. 64.5 ± 15.3 %, p = 0.031), and TST extended by 27.1 % (6.1 ± 1.2h vs. 4.8 ± 1.5h, p = 0.033) on postoperative day 1. No significant differences were observed in hospital length of stay (p = 0.893), highlighting the specificity of INI's sleep-mediated effects.

This trial demonstrates that INI stabilizes postoperative sleep architecture, leading to reduced POD incidence and enhanced cognitive recovery in middle-aged CPB patients. These findings position INI as a targeted intervention for perioperative neurocognitive protection, particularly in populations vulnerable to circadian disruption.

ChiCTR 2400081444. Registered March 1, 2024, http://www.chictr.org.cn.

Background: Delirium in hospitalized patients has been consistently associated with worse clinical outcomes, including increased mortality and prolonged hospital stays. COPD exacerbation is a common reason for hospitalization, and understanding the impact of delirium on this population is crucial for improving patient care and outcomes. Methods: We conducted a retrospective cohort study using the National In-Patient Sample dataset to assess the impact of delirium on patients hospitalized with COPD exacerbation. Subjects were identified using International Classification of Diseases, 10th Revision, codes for COPD exacerbation and delirium. Baseline characteristics and outcomes, including in-patient mortality and the use of invasive mechanical ventilation, were compared between subjects with and without delirium using chi-square analysis. Multivariate regression analysis was used to adjust for potential confounders. Results: A total of 8,062,333 subjects hospitalized with COPD exacerbation were included, of whom 574,005 (7.2%) had a diagnosis of delirium. Most subjects in both groups were white, covered by Medicare, and treated in large urban teaching hospitals. Subjects with delirium had higher rates of dementia, malnutrition, and chronic kidney disease. The rates of in-patient mortality (13.85% vs 4.29%, P < .01) and use of invasive mechanical ventilation (26.7% vs 7.79%, P < .01) were significantly higher in the delirium group. Delirium was associated with higher odds of mortality (adjusted odds ratio [aOR] 2.48, P < .01) and use of mechanical ventilation (aOR 3.92, P < .01). Subjects with delirium had longer and more costly hospital stays. Conclusions: Delirium was associated with worse outcomes in subjects hospitalized with COPD exacerbation.

Sepsis-associated encephalopathy (SAE) is a common complication of sepsis and the systemic inflammatory response syndrome that leads to lasting consequences in survivors. It manifests as early EEG changes that are region-, time- and state-specific, possibly reflecting distinct mechanisms of injury. Here, we investigated the effects of 5 mg/kg lipopolysaccharide (LPS) on hippocampal and cortical sleep-wake states, oscillatory and non-oscillatory neuronal activity, as well as on within- and between-state dynamics using state-space analysis. LPS induced rapid-onset severe temporal and spatial vigilance state fragmentation, which preceded all other spectral changes by ∼90 min. Thereafter, LPS led to specific destabilization and increased delta oscillatory activity in wakefulness, but not NREM sleep, although state transitions remained largely normal. Instead, reduced NREM delta power resulted from aperiodic spectrum changes. LPS specifically reduced higher frequency hippocampal gamma oscillations (60-80 Hz peak) in wakefulness, but not cortical high gamma or lower frequency gamma oscillations. These results suggest that disruption of sleep-wake patterns could serve as an early indicator of sepsis and associated encephalopathy, independent of spectral changes. Moreover, treatment aimed at stabilizing vigilance states in early stages of sepsis might prove to be a novel option preventing the development of further pathological neurophysiology, as well as limiting inflammation-related brain damage.

Traumatic brain injury (TBI) is a known risk factor for delirium, a condition associated with prolonged hospitalization and cognitive deterioration. Although the relationship between TBI and delirium is established, the influence of traumatic lung injuries on delirium development is less understood. Respiratory disorders can significantly influence the central nervous system, with sequelae such as hypoxia and hypercapnia causing neurologic dysfunction. Therefore, we hypothesized that TBI patients suffering lung-associated conditions, stemming either from traumatic lung injury (TLI) or subsequent pulmonary surgery will be associated with an increased risk of developing delirium.

The 2021 Trauma Quality Improvement Program database was queried for patients with TBI, excluding those with pre-existing dementia. TBI patients developing delirium were compared to those without delirium. A multivariable logistic regression analysis was performed to determine pulmonary and neurogenic-associated risk factors for delirium.

Among 155,252 TBI patients, 3244 (2.1%) developed delirium. Delirium-afflicted patients showed elevated rates of TLI (25.0% vs 13.3%, p < .001), severe head trauma (51.4% vs 37.8%, p < .001), sepsis (3.1% vs 0.5%, p < .001) and more commonly underwent pulmonary operations (21.8% vs 6.6%, p < .001). The strongest associated risk factors for delirium included unplanned intubation (OR 2.79, CI 2.47-3.16, p < .001), pulmonary surgery (OR 1.47, CI 1.32-1.63, p < .001), COPD (OR 1.52, CI 1.34-1.72, p < .001), TLI (OR 1.25, CI 1.14-1.38, p < .001), and severe head injury (OR 1.12, CI 1.04-1.22, p = .003).

Delirium affects approximately 2% of the national TBI population. Our study reveals an influence of lung-related conditions for delirium onset. These results emphasize the intimate relationship of the brain and pulmonary system. Future prospective studies are needed to validate these findings as they may impact TBI management and outcomes.

Background: Delirium and agitation are common syndromes in critically ill patients. Valproic acid (VPA) has shown benefit in intensive care unit (ICU)-associated delirium and agitation, but further evaluation is needed. Objective: The purpose of this study was to evaluate the effectiveness and safety of VPA for hyperactive delirium and agitation in critically ill adult patients. Methods: A retrospective cohort study at NYU Langone Health was conducted in critically ill patients treated with VPA for hyperactive delirium or agitation from October 1, 2017 to October 1, 2022. The primary outcome was effectiveness of VPA, defined as a reduction in the total number of any concomitant psychoactive medication by day 3 of VPA treatment. Secondary outcomes included the effect of VPA on the doses of concomitant medications and adverse events. Results: A total of 87 patients were included in the final analysis. By day 3 of VPA treatment, a 33% reduction (P < .001) in the total number of concomitant psychoactive medications was observed. VPA decreased the need for sedatives, as assessed by midazolam equivalents, but no significant changes were seen with dexmedetomidine alone, opioids, or antipsychotics. A 10 mg/kg loading dose was utilized in 36% of the cohort and its use decreased the risk for initiating additional psychoactive medications by day 3 of therapy (OR 2.8, 95% CI 1.0-7.8, P = .047), with benefits noted as early as 48 h after initiation. Adverse events were low in the total cohort (10.3%). Conclusion and Relevance:The addition of VPA to a complex pharmacologic regimen for hyperactive delirium and agitation is safe and can assist in the prevention of polypharmacy and overall workload in critically ill patients admitted primarily for cardiogenic shock and respiratory failure requiring mechanical ventilation.

Delirium is a common issue in critical care, yet its prevention and management strategies are often inconsistent. Understanding the factors that lead to the omission or delay in delirium-related care by critical care nurses is essential for enhancing patient outcomes.

This study aimed to identify the specific delirium-related prevention and management strategies that are frequently missed or delayed by critical care nurses. It also explored factors influencing nurses' prioritisation of care, including delirium-related strategies.

A mixed-method approach was utilised, combining quantitative data from online surveys and qualitative insights from interviews with critical care nurses in a Canadian health authority. The Missed Nursing Care Survey identified instances of missed or delayed care, while interviews provided deeper insights into care prioritisation decisions.

Quantitative findings indicated frequent delays in patient mobilisation and physical care that were attributed to staffing shortages, high patient volume, and increased admissions and discharges. Qualitative findings revealed that factors such as patient acuity, structured routines, knowledge gaps, limited support, unit culture, and resource inadequacies influenced the prioritisation of delirium-related care, often leading to its inadvertent deprioritisation.

This study underscores the need to integrate delirium care into patient acuity assessments and establish sustainable education programs to enhance the recognition and prioritisation of delirium by critical care nurses. Addressing these factors is critical for improving patient outcomes in critical care settings.

Strengthening critical care nurses' capacity to consistently recognise and prioritise delirium-related care through targeted education and system-level support could potentially contribute to better patient outcomes.

To investigate the incidence rate and risk factors for postoperative delirium (POD) following ophthalmic surgery under local anesthesia.

A retrospective study METHODS: We retrospectively investigated the incidence rate of POD in 4658 patients who underwent vitrectomy or glaucoma surgery between January 2009 to March 2023 and analyzed the risk factors with multivariate logistic regression compared to non-delirium patients. Risk indices included age, sex, operation time, preoperative best-corrected visual acuity (pre-BCVA), comorbidity of dementia, and the use of sedative or hypnotic drugs.

POD developed in 19 out of 4658 patients (0.41%). POD was more prevalent in older patients and those with dementia (P < 0.001 and P < 0.001, respectively). However, sex, longer operation time, the use of sedative or hypnotic drugs were not associated with POD. The low pre-BCVA in either operated eye or fellow eye was more likely observed in patients with POD (P = 0.003 and P = 0.001, respectively). The multivariate logistic regression analysis revealed that age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00-1.12; P = 0.04), dementia (OR, 34.95; 95% CI, 12.32-99.15; P < 0.001), pre-BCVA in the operated eye (OR, 2.00; 95% CI, 1.13-3.53; P = 0.02) and pre-BCVA in the fellow eye (OR, 1.83; 95% CI, 1.16-2.89; P = 0.01) were significantly associated with developing POD.

POD developed following ophthalmic surgery under local anesthesia. Identified risk factors included older age, comorbid dementia and low pre-BCVA.

Delirium is a common and serious condition that frequently affects patients in the intensive care unit (ICU). It is characterised by an acute disturbance in cognition, attention and awareness that develops over a short period of time and tends to fluctuate in severity. Patients with ICU delirium (ICUD) may experience confusion, disorientation, difficulty focusing and perceptual disturbances such as hallucinations or delusions. The prevalence of ICUD is high, with estimates suggesting that it can affect up to 70% of ICU patients. The development of ICUD is associated with several adverse outcomes, including prolonged ICU and hospital stays, increased healthcare costs, higher mortality rates and an increased risk of long-term cognitive impairment, including dementia. It is unclear which components should be included in a complex intervention to prevent and manage ICUD. Furthermore, we need to understand how the different components have been implemented and their impact on clinical practice.

The review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis Protocols (PRISMA-P) and the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) reporting recommendations. We will perform systematic searches to identify relevant interventions and implementation strategies for the prevention or management of ICUD. We will assess primary research, service evaluations and audits for the use of the Standards for QUality Improvement Reporting Excellence (SQUIRE) as a checklist for quality improvement in healthcare. We will extract both qualitative and quantitative data and assess study quality using the Critical Appraisal Skills Programme (CASP) tool. Our findings will be synthesised using a best-fit framework synthesis mapped against the Theoretical Domains Framework (TDF). Our Patient and Public Involvement (PPI) group will contribute to the development of review processes such as the research question and methodology and will help to evaluate which outcomes are most important.

No ethical approval is required for this study. The results of this systematic review of implementation strategies will be disseminated through peer-reviewed publications and conferences. They will also form part of an evidence map and logic model for factors that can improve the implementation of strategies for prevention, identification and management of ICUD.

CRD42024537313.

Delirium is a neuropsychiatric disorder that remains under-recognised and poorly understood in the paediatric population, especially among the very young. In premature neonates, delirium is not yet researched, even though prematurity may also be implicated as a risk factor since younger age, developmental delay and a vulnerable brain are risk factors. However, given the developmental stage of these patients, the assessment of two important Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) criteria for diagnosing delirium, disturbance in consciousness/attention and cognition, is complicated and/or even impossible. Therefore, the main aim of the study is to screen for delirium in premature infants at the neonatal intensive care unit.

An exploratory observational prospective cohort study will be conducted at the Maastricht University Medical Centre+ during a period of 12 months to explore the epidemiology (patient/clinical characteristics and prevalence) of delirium. All admitted infants are screened for agitation and apathy as the main delirium markers, using the neonatal pain agitation and sedation scale and the Cornell Assessment of Paediatric Delirium.

The study protocol and informed consent procedure were submitted to the Medical Ethics Committee (METC) (METC 2023-3709). The METC waived the need for approval. However, although the METC waived the need for approval, informed consent will be collected for consent for publication of the collected data.

Intensive Care Unit (ICU) nurses experience many difficulties and challenges in caring for delirium patients. Identifying and measuring these difficulties experienced by nurses is critical for implementing precise interventions. We currently lack a standard tool for assessing the level of difficulty faced by ICU nurses in caring for delirium patients that fits the nursing context in China. This study aimed to translate the Difficulty Scale for Nurses who Care for Patients with Delirium in the Intensive Care Unit (DSNCPD-ICU) into Chinese (C-DSNCPD-ICU) and psychometrically validate the translated scale.

The English version of DSNCPD-ICU consisted of a main scale with eight factors and an additional scale of one factor. It was translated in strict accordance with Brislin's translation model to yield the Chinese versions. Using a convenience sampling method, 477 ICU nurses from ten general hospitals were recruited for online survey, which collected sociodemographic information, scores on C-DSNCPD-ICU and the Strain of Care for Delirium Index. Subsequent psychometric attributes of the C-DSNCPD-ICU were also tested by the validity and reliability.

There were 437 valid responses. The content validity index was calculated as 0.96. Cronbach's alpha for the total scale and each factor were 0.919 and 0.705-0.878, respectively. Exploratory factor analysis verified an eight-factor scale and an additional scale structure with cumulative variance contributions of the factors of 63.78% and 57.62%, respectively. Confirmatory factor analysis showed that all data-model fits were acceptable.

The C-DSNCPD-ICU validated in this study showed satisfactory psychometric properties. This will help Chinese nurse managers to accurately assess the degree of difficulty and identify the causes of precise barriers in caring for patients with delirium. Using the scale, nurse managers can determine what kind of measures should be taken, including formulating effective and tailored educational programs and providing more resources to support nurses.

Delirium in intensive care unit (ICU) patients poses a significant challenge, affecting patient outcomes and health care efficiency. Developing an accurate, real-time prediction model for delirium represents an advancement in critical care, addressing needs for timely intervention and resource optimization in ICUs.

We aimed to create a novel machine learning model for delirium prediction in ICU patients using only continuous physiological data.

We developed models integrating routinely available clinical data, such as age, sex, and patient monitoring device outputs, to ensure practicality and adaptability in diverse clinical settings. To confirm the reliability of delirium determination records, we prospectively collected results of Confusion Assessment Method for the ICU (CAM-ICU) evaluations performed by qualified investigators from May 17, 2021, to December 23, 2022, determining Cohen κ coefficients. Participants were included in the study if they were aged ≥18 years at ICU admission, had delirium evaluations using the CAM-ICU, and had data collected for at least 4 hours before delirium diagnosis or nondiagnosis. The development cohort from Yongin Severance Hospital (March 1, 2020, to January 12, 2022) comprised 5478 records: 5129 (93.62%) records from 651 patients for training and 349 (6.37%) records from 163 patients for internal validation. For temporal validation, we used 4438 records from the same hospital (January 28, 2022, to December 31, 2022) to reflect potential seasonal variations. External validation was performed using data from 670 patients at Ajou University Hospital (March 2022 to September 2022). We evaluated machine learning algorithms (random forest [RF], extra-trees classifier, and light gradient boosting machine) and selected the RF model as the final model based on its performance. To confirm clinical utility, a decision curve analysis and temporal pattern for model prediction during the ICU stay were performed.

The κ coefficient between labels generated by ICU nurses and prospectively verified by qualified researchers was 0.81, indicating reliable CAM-ICU results. Our final model showed robust performance in internal validation (area under the receiver operating characteristic curve [AUROC]: 0.82; area under the precision-recall curve [AUPRC]: 0.62) and maintained its accuracy in temporal validation (AUROC: 0.73; AUPRC: 0.85). External validation supported its effectiveness (AUROC: 0.84; AUPRC: 0.77). Decision curve analysis showed a positive net benefit at all thresholds, and the temporal pattern analysis showed a gradual increase in the model scores as the actual delirium diagnosis time approached.

We developed a machine learning model for delirium prediction in ICU patients using routinely measured variables, including physiological waveforms. Our study demonstrates the potential of the RF model in predicting delirium, with consistent performance across various validation scenarios. The model uses noninvasive variables, making it applicable to a wide range of ICU patients, with minimal additional risk.

The purpose of this study was to evaluate the effectiveness of virtual reality meditation compared with standard care on sleep quality and delirium incidence in patients admitted to the ICU. We conducted a randomized controlled trial with 96 patients in an 11-bed surgical ICU at a South Korean university hospital. The control group received usual sleep care, whereas the intervention group received an additional 20-minute virtual reality-based mindfulness and relaxation meditation before bedtime. Using the Verran and Snyder-Halpern Sleep Scale, we found significantly improved subjective sleep quality in the intervention group compared with controls during both the first (47.82 vs 39.75, P = .015) and second nights (50.26 vs 43.65, P = .025) of ICU admission. However, objective sleep measurements using Fitbit devices showed no significant differences in total sleep time between groups for either the first (384.59 vs 358.19 minutes, P = .450) or second night (319.94 vs 310.77 minutes, P = .807). Delirium incidence was similar between groups (12.2% vs 12.8%, P = .938). These findings suggest the need for larger-scale studies with robust experimental designs to definitively establish the impact of virtual reality meditation on sleep quality and delirium in ICU patients.

Severe sleep disruption is common among intensive care unit (ICU) patients. However, the applicability of standard sleep scoring guidelines by the American Academy of Sleep Medicine (AASM) has been questioned, with most polysomnography (PSG) studies in critically ill patients reporting difficulties in setting up and processing and scoring the recordings. The present study explores human inter-rater agreement in sleep stage scoring following the AASM guidelines, within a heterogenous ICU patient cohort.

Two human experts independently scored a total of 51,454 epochs in 20 PSG recordings acquired at the ICU. Epoch-per-epoch comparison of scored stages revealed a Cohen's κ coefficient of agreement of 0.36 for standard 5-stage scoring. Highest agreement occurred in Wake (κ = 0.46), while REM showed the lowest (κ = 0.12). Significant correlations were found between inter-rater agreement, and Simplified Acute Physiology Score (SAPS II, r = - 0.506, p = 0.038), and 12-month mortality (r = - 0.524, p = 0.031). Comparison with similar studies underscore challenges in applying AASM criteria to ICU patients. Despite accounting for artifacts, disparities persisted, emphasizing the need for a nuanced exploration of factors influencing scoring inconsistencies in critically ill patients.

Trial was registered as "Sleep and biorhythm in the ICU", in the Centrale Commissie Mensgebonden Onderzoek register, with number NL-OMON43659 ( https://onderzoekmetmensen.nl/nl/trial/43659 ), on registration date august 4th 2015.

Acute encephalopathy in the ICU poses significant diagnostic, therapeutic, and prognostic challenges. Standardized expert guidelines on acute encephalopathy are needed to improve diagnostic methods, therapeutic decisions, and prognostication.

The experts conducted a review of the literature, analysed it according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology and made proposals for guidelines, which were rated by other experts. Only expert opinions with strong agreement were selected.

The synthesis of expert work and the application of the GRADE method resulted in 39 recommendations. Among the 39 formalized recommendations, 1 had a high level of evidence (GRADE 1 +) and 10 had a low level of evidence (GRADE 2 + or 2-). These recommendations describe indication for ICU admission, use of clinical scores and EEG for diagnosis, detection of complications, and prognostication. The remaining 28 recommendations were based on expert consensus. These recomandations describe common indications for blood and CSF studies, neuroimaging, use of neuromonitoring, and provide guidelines for management in the acute phase.

This expert consensus statement aims to provide a structured framework to enhance the consistency and quality of care for ICU patients presenting with acute encephalopathy. By integrating high-quality evidence with expert opinion, it offers a pragmatic approach to addressing the complex nature of acute encephalopathy in the ICU, promoting best practices in patient care and facilitating future research in the field.

Among the deleterious effects caused by hospitalization of elderly patients in intensive care unit (ICU), delirium and impaired performance in occupations are frequent and have long-term negative outcomes. Delirium protocols described in the literature vary in frequency, intensity, and content regarding pertinent interventions. Occupational Therapy (OT) practices are heterogeneous and generally consist of non-personalized interventions. For this reason, the primary outcome of this research is to evaluate the effect of a person-centered OT protocol on the prevention of delirium and the occupational performance of elderly patients admitted to the ICU. This is a randomized clinical trial with blinded assessment of the primary outcome (delirium). A total of 114 patients will be recruited and randomized to the intervention group, where care goals will be defined according to meaningful occupations and personalized cognitive stimulation will be based on patient´s topics of interest, in addition to the institutional standard protocol (ISP); or to the control group, which will receive only the ISP. To our knowledge, this will be the first randomized controlled trial with personalized occupational therapy interventions, as well as care goals, based on patients´ meaningful occupations for the prevention of delirium and improvement of occupational performance in critically ill elderly patients. This clinical trial is duly registered on the ClinicalTrials.gov platform (NCT06479031).

Post-stroke delirium, a frequent and significant complication of stroke, manifests as a sudden onset of confusion, altered consciousness, and cognitive decline. Various factors contribute to its occurrence, including old age, multiple comorbidity, electrolyte abnormalities, and infections. The impact of post-stroke delirium on stroke recovery is substantial. It leads to prolonged hospital stays, heightened risk of institutionalization, increased dependence, and elevated mortality rates. As a result, early identification and prompt treatment of post-stroke delirium are imperative for optimizing outcomes in stroke patients.

The objective of this study is to determine the Prevalence of post-stroke delirium and associated risk factors in hospitalized patients at TASH, Y12HMC, and YSC, Addis Ababa, Ethiopia from August to December 2023.

We performed a prospective observational study, including all the stroke patients admitted to the respective study areas during the study period from August to December 2023. Participants who fulfilled the inclusion criteria were involved in this study. Data was collected using an interviewer-administered Questionnaire with a well-tested and validated tool, Patients were assessed for Delirium within 48 h of admission and subsequently screened every 12 h. Descriptive statistics was used to summarize the data in terms of frequency, proportion, mean, and standard deviation. Bivariate and multivariate logistic regression analyses were carried out to identify associated factors. Statistical significance was considered when the p-value was below 0.05.

Out of 101 patients 26(25.7%) had Post-Stroke Delirium. The majority 56 (55.4%) of the patients were females. The mean (SD) age of the study participants was 56.05 ± 15.38 years, and the mean time in days until the occurrence of delirium was 3 ± 1 days. Multivariable logistic regression analysis showed that, Age Greater than 60(AOR = 19.1, 95% CI (1.7-211) p = 0.016, Presence of Sepsis (AOR = 8.3, 95% CI (1.2-56) P = 0.029, Presence of Polypharmacy (AOR = 157, 95% CI (10.2-244) P = 0.0001, Presence of Electrolyte Derangement (AOR = 65.2, 95% CI (3.4-124.1) P = 0.005 were statistically significant risk factors.

Our Study showed that Post Stroke Delirium occurs in a quarter of patients admitted with a Diagnosis of Acute Stroke, and the Identified risk factors were Age greater than 60, Polypharmacy, Presence of Sepsis and Electrolyte Derangement. Medical professionals responsible for caring for acute stroke patients should be vigilant in identifying those at higher risk of developing post-stroke delirium. Additionally, they should focus on preventing and treating possible precipitating factors such as infections or electrolyte abnormalities. Incorporating delirium screening into routine patient assessments is crucial.

Postoperative hyperactive delirium is a common and serious complication in older patients undergoing surgery, but the association between delirium and mortality remains controversial. Compared to other delirium subtypes, hyperactive delirium is characterized by more overt clinical manifestations, facilitating accurate detection and evaluation. This study aimed to clarify this association by comparing long-term mortality between patients with and without postoperative hyperactive delirium, using propensity score matching for robust analysis.

We conducted a cohort study to evaluate the association between postoperative hyperactive delirium and long-term mortality in older patients undergoing emergency hip fracture surgery. We used the Taiwan National Health Insurance Service database to identify patients aged 65 years or older who underwent emergency hip fracture surgery between 2008 and 2018. The primary outcome was all-cause mortality.

A total of 270,437 patients were included in the analysis, with 6,795 patients in the postoperative hyperactive delirium group and 263,642 patients in the no postoperative hyperactive delirium group. After PSM, both groups contained 6,795 patients, ensuring balanced baseline characteristics for comparison. Postoperative hyperactive delirium was an independent risk factor for all-cause death, with an adjusted hazard ratio of 1.62 (95% confidence interval, 1.51-1.74; P < 0.0001) after PSM. Subgroup analysis revealed that older patients with postoperative hyperactive delirium consistently exhibited significantly higher adjusted hazard ratios of all-cause death compared with those without postoperative hyperactive delirium, regardless of age, sex, income levels, or ASA scores. Although the difference in 5-year overall survival between groups (81.7% vs. 89.8%, P < 0.0001) was statistically significant, the high survival rates in both groups suggest a modest absolute clinical impact.

Postoperative hyperactive delirium is an independent risk factor for long-term mortality in older patients undergoing emergency hip fracture surgery. While the statistical association is evident, it is important to carefully consider the modest absolute difference in survival rates and its implications for clinical application.

Alcohol withdrawal syndrome (AWS) is a complication of alcohol use disorder that manifests as a range of symptoms. Symptom-triggered benzodiazepines (BZDs) are often used as first-line treatment of AWS. However, recent literature suggests phenobarbital (PHB) may be safer and more efficacious, but studies are limited by exclusion of patients with neurological injuries.

We aimed to evaluate the safety of PHB compared to BZDs for the management of AWS among patients with primary neurologic injuries.

Retrospective cohort study of patients with primary neurologic injuries admitted to an ICU who received PHB or symptom-triggered BZD for AWS between December 2013 and February 2020. The primary outcome was incidence of oversedation, defined as Richmond Agitation Sedation Scale (RASS) scores from -5 to -3 within 24 hours of initial PHB or BZD dose. Secondary outcomes included largest decrease in RASS, need for mechanical ventilation, and additional sedative use within 24 hours of initial PHB or BZD dose. A multivariable analysis was performed to evaluate the association of PHB administration with the primary outcome.

Among 600 patients treated for AWS, 84 patients were included in our analysis (PHB, n = 56; BZD, n = 28). In the unadjusted analysis, there were no differences between the PHB and BZD groups for the primary outcome of oversedation (21.4 vs. 7.1%, P = 0.13), or secondary outcomes of decrease in RASS (P = 0.34), or new ventilator requirement (P = 0.55). Patients who received PHB had higher rates of additional sedative use (P < 0.01). Multivariable regression revealed an increase in oversedation among intubated patients (P = 0.014), while PHB administration was not independently associated with oversedation (P = 0.516).

Phenobarbital did not independently increase the risk of oversedation compared to BZD for AWS in patients with primary neurologic injuries. Future studies should determine optimal dosing of PHB in this population.

Perme intensive care unit (ICU) mobility score is a comprehensive mobility assessment tool; however, its usefulness and validity for patients after cardiovascular surgery remain unclear. We investigated the association between the Perme Score and clinical outcomes after cardiovascular surgery. We retrospectively enrolled 249 consecutive patients admitted to the ICU after cardiac and/or major vascular surgery. The Perme Score contains categories on mental status, potential mobility barriers, muscle strength and mobility level and was assessed within 2 days after surgery. The outcomes of physical recovery were the number of days until 100-m ambulation achievement and 6-min walk distance (6MWD) at hospital discharge. The endpoint was a composite outcome of all-cause mortality and/or all-cause unplanned readmission. We analyzed the associations of the Perme Score with physical recovery and the incidence of clinical events. After adjusting for clinical confounding factors, a higher Perme Score was an independent factor of earlier achievement of 100-m ambulation (hazard ratio: 1.039, 95% confidence interval [CI]: 1.012-1.066) and higher 6MWD (β: 0.293, P = .001). During the median follow-up period of 1.1 years, we observed an incidence rate of 19.4/100 person-years. In the multivariate Poisson regression analysis, a higher Perme Score was significantly and independently associated with lower rates of all-cause death/readmission (incident rate ratio: 0.961, 95% CI: 0.930-0.992). The Perme Score within 2 days after cardiovascular surgery was associated with physical recovery during hospitalization and clinical events after discharge. Thus, it may be useful for predicting clinical outcomes.

Postoperative delirium (POD) is a prevalent complication following cardiac surgery, characterized by acute brain dysfunction observed in critically ill patients. Despite the significant impact of POD, there is currently no established treatment. Recent research has suggested that modulation of cholinergic neurotransmission and α2-adrenergic receptors may offer a therapeutic strategy for managing delirium during critical illness. This study employs bibliometric analysis to examine the emerging evidence on the role of dexmedetomidine, an α2-receptor agonist drug, in the prevention and treatment of POD. A systematic bibliometric analysis was conducted to identify and evaluate the literature on the use of dexmedetomidine in relation to POD. The study period spanned from 2006 to 2022, and the search was conducted in the Web of Science (WOS) database, focusing on relevant references. The analysis included the examination of the most frequent keywords, research trends, and frontiers to provide a comprehensive overview of the field. The bibliometric analysis revealed 160 research papers on the topic, indicating a significant increase in research output over the past decades. The field distribution, knowledge structure, and research topic evolution were identified as key areas of exploration. The analysis also highlighted the emergence of new topics and trends in the study of POD and its management. This bibliometric analysis provides a robust framework for understanding the current state of research on dexmedetomidine's efficacy in managing POD. It highlights the need for continued investigation and underscores the potential of this pharmacological approach to improve patient outcomes following cardiac surgery.

Delirium in mechanically ventilated patients has resulted in prolonged intensive care unit (ICU) and ventilator stay and higher mortality. Research has shown that a bundle containing sedation awakening and spontaneous breathing trials, appropriate choice of sedatives, early mobilization, and family engagement was associated with a reduced rate of delirium. Music listening and music therapy have also been studied, showing promising results for anxiety and pain control, but have not been studied in terms of preventing delirium.

As part of a quality improvement project, we implemented a protocol of music listening and music therapy for mechanically ventilated patients. The rate of delirium, ICU and ventilator lengths of stay, and mortality were compared between groups (n = 17 protocol, n = 50 control).

There were no statistically significant differences in demographic characteristics, severity of illness, medical comorbidities, or cumulative doses of sedating medications between the groups. The rate of delirium between groups was not statistically significantly different (11.8% vs 16%, P = 0.70). Severity of illness based on APACHE IV score was statistically associated with mortality (estimate coefficient 0.03, P = 0.015), and use of dexmedetomidine was statistically associated with prolonged ICU and ventilator lengths of stay.

The music therapy and music listening protocol did not show a reduction of the delirium rate for mechanically ventilated patients.

To compare the POD rates in patients undergoing non-cardiac surgery who received remimazolam perioperatively versus placebo or other sedatives.

We systematically searched four major databases (Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PubMed) for relevant randomized controlled trials (RCTs) up to July 11, 2024. Literature quality evaluation was used the bias risk table in Review Manager 5.4. The primary outcome of interest was POD, and secondary outcomes were the hypotension risk, bradycardia and, nausea and vomiting.

Across 11 trials involving 1985 participants, we recorded 309 cases of POD during follow-up. In trials where the control group received saline, remimazolam decrease the risk of POD significantly by 70% (RR 0.30, 95% CI [0.19, 0.46]; p < 0.00001). Statistical analysis did not show significant difference in the risk of POD between the remimazolam group and the groups receiving either dexmedetomidine (RR 1.23 [0.64, 2.37]; p = 0.53) or propofol (RR 0.83 [0.60, 1.16]; p = 0.28). Regarding adverse events, remimazolam significantly reduces the morbidity of hypotension compared to dexmedetomidine (RR 0.25 [0.10, 0.65]; p = 0.004) and propofol (RR 0.45 [0.33, 0.60]; p < 0.00001). In addition, there were no significant differences in the incidence of bradycardia (RR 0.85; 95% CI [0.34-2.12], p = 0.72) and nausea and vomiting (RR 1.06; 95% CI [0.74-1.51], p = 0.77) between remimazolam and the control group.

During the perioperative period, using remimazolam can lower POD risk after surgery for patients who had non-cardiac surgery, but remimazolam does not work better than dexmedetomidine or propofol. Compared with the dexmedetomidine and propofol, remimazolam also has apparent advantages in preventing intraoperative hypotension.

Delirium is a common manifestation of acute brain dysfunction among patients in the Intensive Care Unit (ICU), afflicting an estimated 30-35% of this vulnerable population. The prevalence of delirium in ICU settings has catalyzed a surge in academic interest, as evidenced by a growing body of literature on the subject. This study seeks to synthesize the progress in understanding ICU delirium through a bibliometric analysis.

We conducted a comprehensive search of the Web of Science Core (WOS) Collection database for literature on ICU delirium, focusing on studies published between 2013 and 2023. Our analysis utilized two bibliometric software tools, Citespace and VOSviewer, to scrutinize the data across various dimensions, including country contributions, authorship patterns, publishing journals, key thematic terms, and other pertinent metrics, with the aim of identifying emerging trends in the field.

Our search yielded a total of 1,178 publications on ICU delirium within the WOS database from January 2013 to June 2023. The United States emerged as the leading contributor in terms of published articles, with Ely, E. Wesley being the most prolific author, having published 85 articles, and "Critical Care Medicine" as the journal with the highest number of publications, totaling 105. The application of literature clustering and keyword analysis revealed that future research is poised to delve deeper into areas such as pediatric delirium, risk factors, and the development of preventive and therapeutic strategies.

This study employs bibliometric analysis to provide a multifaceted overview of the ICU delirium research landscape over the past decade. By examining the topic from various perspectives, we have not only mapped the current state of ICU delirium research but also illuminated potential avenues for future inquiry and areas of emphasis.

Intensive care unit (ICU) delirium is an acute brain dysfunction that affects up to 7 out of 10 patients admitted to ICUs. Patients who develop ICU delirium cannot think clearly, have trouble paying attention, do not understand what is happening around them and may see or hear things that are not there. ICU delirium increases the time patients spend in ICUs and hospitals and therefore healthcare costs. ICU delirium is also associated with increased mortality and dementia in the longer term. ICU delirium prevention and management strategies are likely to include both pharmacological and non-pharmacological components as part of a complex intervention, but it is unclear which components should be included. The objective of this meta-review is to systematically map the quantity and certainty of the available evidence from reviews and meta-analyses of randomised controlled trials (RCTs) of pharmacological and non-pharmacological interventions, which will be used to design a multicomponent intervention to prevent and manage ICU delirium.

A systematic search strategy was performed in MEDLINE (Ovid), Embase (Elsevier), Cochrane Database of Systematic Reviews, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and Web of Science (from inception to 26 September 2023), as well as Epistemonikos (from inception to 19 July 2023). We will include all critically ill adults (aged≥18 years) and any ICU delirium prevention or management intervention (pharmacological or non-pharmacological). For pharmacological interventions, we will include reviews of RCTs. For non-pharmacological interventions, we will consider reviews of RCTs, quasi-experimental and cohort studies. We will use the International Consensus Study (Del-COrS) core outcome set for research evaluating interventions to prevent or manage ICU delirium and synthesise our findings using quantitative data description methods. We will involve our Patient and Public Involvement group of people who experienced ICU delirium to develop and comment on such aspects as the research question, methodology and which outcomes are most important.

No ethical approval is required for this study. The results of this meta-review will be disseminated through peer-reviewed publications and conferences. They will also form part of an evidence map and logic model for the prevention and management of ICU delirium.

CRD42023473260.

Delirium is an acute and often fluctuating disturbance in attention and awareness and is one of the organ dysfunctions caused by acute illness. A previous study revealed that 8.3% of older patients in the emergency room (ER) had delirium, and dementia and older age were identified as independent risk factors for delirium in the ER. However, different ER structures (intermediate or acute care units) and disease clusters may have different prevalence rates and risk factors.

This study aimed to identify the prevalence and risk factors for delirium on arrival at the ER.

This was an exploratory clinical trial and retrospective cohort study conducted at a tertiary care emergency center in Japan, including patients aged ≥20 years who were transported to and hospitalized at the ER between April 1, 2023, and March 31, 2024. Delirium was evaluated using the Brief Confusion Assessment Method. Multivariate analysis was performed on the 12 variables that were significantly different in the comparison of patient characteristics upon arrival at the ER.

Of the 20,660 patients who visited the ER, 1,486 patients who were transported by ambulance were included in this study. The prevalence of delirium upon arrival at the ER was 20.3% (301/1486 patients, 95% confidence intervals: 18.2-22.4). Multivariable logistic regression analysis revealed a significant association between delirium on arrival at the ER and older age (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04), past history of dementia (OR 3.94, 95%CI 2.41-6.44) and psychiatric illness (OR 2.76, 95%CI 1.41-5.40), higher Glasgow Coma Scale (GCS) scores (OR 0.34, 95%CI 0.29-0.40), and requiring oxygen therapy on arrival at the ER (OR 2.09, 95%CI 1.45-3.02).

The prevalence of delirium on arrival at the ER was approximately 20%. Our findings suggest that older age, history of dementia and psychiatric illness, low GCS score at presentation, and the need for oxygen therapy may be risk factors for delirium symptoms at presentation.

Delirium is not a harmless transient event during ICU hospitalization; rather, it is a severe complication of critical illness associated with increased mortality, morbidity, and persistent disability. Despite being recognized for decades, it remains underdiagnosed. Employing validated tools for detection helps reduce missed cases. Early detection facilitates prompt management. Sedatives, opioids, and antipsychotics should be avoided whenever possible. Optimizing environmental triggers, minimizing iatrogenicity, and treating underlying critical illness constitute the basis of the currently recommended approach to diminish the burden of delirium in ICU patients.

To investigate the: 1) correlation between the maintenance or cessation of selective serotonin reuptake inhibitors (SSRIs) during hospitalization and the incidence of delirium among critically ill patients; 2) evaluate the effectiveness of utilizing SSRIs as a potential intervention for managing delirium in critically ill adults; and 3) evaluate the effects of continuing SSRIs in patients who were previously prescribed these medications on incidence of delirium or withdrawal symptoms manifesting as delirium.

PubMed, Scopus, Embase, PsycInfo, and ProQuest Central, and additional studies identified from reference lists and relevant systematic reviews.

Studies included adults 18 years old and older with critical illness necessitating ICU care administered SSRIs during their hospital stay, where delirium and/or adverse effects were reported as outcomes.

Two team members extracted data from included studies into evidence tables, which were subsequently discussed to synthesize and align the extracted findings. Extraction criteria included study population and the type of control or comparison group, exposures, primary and secondary outcome measures, results, and implications. We used Study Quality Assessment Tools provided by the National Heart, Lung, and Blood Institute and National Institutes of Health public websites along with the TREND checklist to evaluate the quality of articles and analyze for bias.

Two reviewers analyzed the studies' risk for bias. Analysis followed the Grading of Recommendations Assessment, Development, and Evaluation criteria used in Cochrane systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to design and report the study.

The cessation of SSRIs in patients who were previously prescribed these medications is associated with an increased incidence of delirium or withdrawal symptoms manifesting as delirium. Continuing these medications in the setting of critical illness may mitigate the risk of delirium. Further investigation is warranted into the impact of SSRIs on delirium in patients not taking these medications prior to ICU admission.

Rationale: Propofol is one of the first-line sedative-hypnotic agents for critically ill adults requiring mechanical ventilation. Although propofol can elevate triglyceride levels, and the latter is a risk factor for pancreatitis, the association between propofol and acute pancreatitis is unclear. Objectives: We sought to determine the clinical impact and potential associations between propofol infusion, hypertriglyceridemia, and acute pancreatitis. Methods: This is an observational multicenter study of adults (⩾18 yr old) who were admitted to an intensive care unit, who required mechanical ventilation and received continuous propofol infusion for at least 24 hours. The primary outcomes were the frequency of hypertriglyceridemia (>400 mg/dl) and acute pancreatitis. Further analyses were done to determine the clinical impact of elevated triglyceride levels (i.e., sedation changes) and risk factors for pancreatitis development. Results: Of 11,828 patients included, 33.2% (n = 3,922) had triglyceride levels measured, of whom 21.7% (n = 851) had hypertriglyceridemia at 4.5 days (SD = 6.8) after propofol initiation. Of those still requiring sedation, 70.4% (n = 576/818) received alternative sedatives after developing hypertriglyceridemia. Pancreatitis occurred in 1.2% of patients (n = 47/3,922) and was more frequent in those with hypertriglyceridemia (3.2%, 27/851; vs. 0.7%, 20/3,071; P < 0.001). After adjustment for potential confounding variables, each 100 mg/dl increase in triglyceride levels was associated with an 11% increase in risk of pancreatitis. Propofol dose was not associated with pancreatitis development. Conclusions: Acute pancreatitis is uncommon in patients receiving propofol infusion, and it occurs over a wide range of triglyceride levels, indicating a multifactorial pathophysiology. Hypertriglyceridemia frequently prompts the use of alternative sedatives. Further study is needed to determine how to best monitor and treat hypertriglyceridemia in critically ill patients receiving propofol infusion.

The treatment and prevention of delirium in the intensive care unit (ICU) have gained significant importance in patient care in recent years. Some studies have linked delirium with increased risks of mortality, prolonged hospital stay, and more days of mechanical ventilation. This study aims to analyse the use of psychotropic drugs initiated in the ICU and their continuation upon hospital discharge, as well as to evaluate their contribution to polypharmacy and associated adverse clinical effects.

A multicentre prospective observational case study was designed, focusing on patients over 18 years old admitted to the ICU and treated with psychotropic drugs. Data on demographics, variables related to admission and psychotropic drug treatment, as well as clinical outcomes and adverse effects, will be collected. Among other variables, the frequency of psychotropic treatments initiated in the ICU and continued upon discharge from the ICU and the hospital will be measured. Data collection will be performed through review of electronic medical records and prescription programmes, and IBM SPSS 20.0 statistical package will be used for analysis.

Delirium is common in ICU patients and is associated with long-term negative consequences. Although antipsychotics are used to treat delirium, their prolonged use can have adverse effects, and their continuation after ICU discharge contributes to polypharmacy. This study aims to provide information on the use of psychotropic drugs initiated in the ICU and their continuation upon discharge, with the goal of identifying opportunities for intervention and reducing unnecessary use of these medications.

Delirium is a common complication in patients at the intensive care unit (ICU) and is associated with prolonged ICU-stay and hospitalization and with increased morbidity. The impact of ICU-delirium on long-term survival is not clearly understood.

This retrospective single center observational study was conducted at the Institute of Intensive Care Medicine at the University Hospital Zurich, Switzerland. All adult ICU-survivors over a four-year period were screened for eligibility. ICU-delirium was defined based on the Intensive Care Delirium Screening Checklist (ICDSC), together with the coded diagnosis F05 in the International Classification of Diseases (ICD-2019). ICU-survivors who developed delirium during their ICU stay (group D) were compared with ICU-survivors who did not (group ND). Survival was evaluated according to data from hospital electronic health records up to four years from ICU-discharge. The survival analysis was reported using Kaplan-Meier curves and absolute risk differences (ARD). A multivariable logistic regression model was fitted with long-term survival at four years after ICU-discharge as outcome of interest, including several clinical conditions and interventions associated with long-term survival for ICU patients. For subgroup analysis, ICU-survivors were grouped based on age at the time of admission (45-54, 55-64, ≥ 65 years), and on relevant clinical conditions.

A total of 9'604 patients fulfilled the inclusion criteria, of them 22.6% (n = 2'171) developed ICU-delirium. Overall, patients in the group D had a significantly lower probability of survival than patients in the group ND (p < 0.0001, ARD = 11.8%). In the multivariable analysis, ICU-delirium was confirmed as independently associated with long-term survival. After grouping for age categories, patients between 55 and 64 years of age in the group D were less likely to survive than patients in the group ND at every time point analyzed, up to four years after ICU discharge (p < 0.001, ARD = 7.3%). This difference was even more significant in the comparison between patients over 65 years (p < 0.0001, ARD 11.1%). No significant difference was observed in the other age groups.

In the study population, ICU-delirium was independently associated with a reduced long-term survival. Patients who developed ICU-delirium had a reduced survival up to four years after ICU discharge and this association was particularly evident in patients above 55 years of age.

Delirium is a common acute cognitive impairment characterised by confusion, disorientation and attention deficits, particularly prevalent in intensive care unit (ICU) settings. Given its significant impact on patients, caregivers and healthcare resources, preventing delirium in patients in the ICU is of paramount importance. This is the first randomised-controlled trial designed to evaluate the effects of a virtual reality-based sensory stimulation intervention on preventing delirium in ICU patients.

We employed a paired randomisation method to match eligible participants based on a validated delirium risk scoring model for patients in the ICU. The study will commence in September 2024 and conclude in June 2026. A consecutive sample of 324 patients in the ICU admitted to the study setting will be recruited. Eligible participants will be randomly allocated to receive either virtual reality-based sensory stimulation in addition to usual care or usual care alone. The virtual reality-based sensory stimulation intervention will last for up to 14 days, with all interventions administered by a research team. We define delirium-free days over a 14-day period as the primary outcome. The secondary outcomes will include delirium incidence, duration and severity; patients' psychological well-being (post-traumatic stress disorder, sleep quality and ICU memory); patients' clinical outcomes and other outcomes (quality of life, independence and cognitive function). Data will be collected at baseline, post-intervention and 6 months post-intervention. Two independent t-tests or Wilcoxon-Mann-Whitney tests will be used for continuous variables, while χ2 or Fisher's exact tests will be employed for categorical variables. The analysis will adhere to both the intention-to-treat and per-protocol principles. Additionally, mixed-effects models and subgroup analysis will be planned.

This protocol was approved by the Research Ethics Committee of Shenzhen Hospital of Southern Medical University (NYSZYYEC20230068). All participants or their family caregivers will provide written informed consent. Results will be disseminated through scientific publications, and presentations at local and international conferences.

ClinicalTrials.gov NCT06153472. Trial registration date: 22 November 2023.

The high incidence and mortality rates of postoperative delirium (POD) among elderly patients highlights the pressing need for tailored prophylactic strategies. Despite various pharmacologic prophylactic strategies have been reported effective, their overall benefit and safety remain unclear in the geriatric population. Our network meta-analysis (NMA) aimed to systematically evaluate and rank the effectiveness of various pharmacological interventions in preventing POD in elderly patients.

We conducted an extensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Google Scholar for randomized controlled trials (RCTs) published up to August 1, 2023. We included RCTs examining pharmacological prophylactic effects of POD in elderly patients. To extract data in alignment with predefined areas of interest, we employed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The primary outcome was the incidence of POD. For secondary outcomes, we evaluated tolerability through all-cause discontinuation or drop-out rates, as well as all-cause mortality.

Our analysis encompassed a total of 44 RCTs involving 11,178 patients. Out of these, 26 RCTs involved comparisons with placebo only. For delirium prevention, the treatment groups receiving atypical antipsychotics (odds ratio (OR) of 0.27 and 95% confidence interval (CI) of 0.12-0.58), haloperidol (OR of 0.42; 95% CI of 0.25-0.71), dexmedetomidine (OR of 0.51 and 95% CI of 0.37-0.71 and melatonergic agents (MMA) (OR of 0.57 and 95% CI of 0.33-0.98) had significantly lower rates of delirium compared to the placebo group. Notably, the atypical antipsychotics ranked as the most effective treatment. For tolerability, no statistically differences in rates of dropout discontinuation and all-cause mortality among groups allocated to the placebo or individual pharmacological treatments.

Based on indirect evidence, our network meta-analysis identified atypical antipsychotics, dexmedetomidine, MMA, and haloperidol as effective in preventing POD in the elderly, with atypical antipsychotics ranking highest. However, it is essential to note that these findings should be confirmed through further RCTs.

The objective of this study was to construct and validate a structural equation model (SEM) to identify factors associated with sleep quality in awake patients in the intensive care unit (ICU) and to assist in the development of clinical intervention strategies.

In this cross-sectional study, 200 awake patients who were cared for in the ICU of a tertiary hospital in China were surveyed via several self-report questionnaires and wearable actigraphy sleep monitoring devices. Based on the collected data, structural equation modelling analysis was performed using SPSS and AMOS statistical analysis software. The study is reported using the STROBE checklist.

The fit indices of the SEM were acceptable: χ2/df = 1.676 (p < .001) and RMSEA = .058 (p < 0.080). Anxiety/depression had a direct negative effect on the sleep quality of awake patients cared for in the ICU (β = -.440, p < .001). In addition, disease-freeness progress had an indirect negative effect on the sleep quality of awake patients cared for in the ICU (β = -.142, p < .001). Analgesics had an indirect negative effect on the sleep quality of awake patients cared for in the ICU through pain and sedatives (β = -.082, p < .001). Sedation had a direct positive effect on the sleep quality of conscious patients cared for in the ICU (β = .493; p < .001).

The results of the SEM showed that the sleep quality of awake patients cared for in the ICU is mainly affected by psychological and disease-related factors, especially anxiety, depression and pain, so we can improve the sleep quality of patients through psychological intervention and drug intervention.

Implementation of the "B" element-both spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs)-of the ABCDEF bundle improves the outcomes for mechanically ventilated patients. In 2021, the Pragmatic Investigation of optimal Oxygen Targets (PILOT) trial investigating optimal oxygenation targets in patients on mechanical ventilation was completed.

To compare SAT and SBT conduct between a randomized controlled trial and current clinical care.

The 2008 Awakening and Breathing Controlled (ABC) Trial (2003-2006) randomized mechanically ventilated patients to paired SATs and SBTs versus sedation per usual care plus SBTs. The PILOT trial (2018-2021) enrolled patients years later where SAT + SBT conduct was observed. We compared SAT and SBT conduct in ABC's interventional group (SAT + SBT; n = 167, 1140 patient days) to that in PILOT (n = 2083, 8355 patient days).

Spontaneous awakening trial safety screens were done in all 1140 ABC patient-days on sedation and/or analgesia and in 3889 of 4228 (92%) in PILOT. Spontaneous awakening trial safety screens were passed in 939 of 1140 (82%) instances in ABC versus only 1897 of 3889 (49%) in PILOT. Interestingly, SAT was performed in ≥95% of passed SAT safety screens in both trials and was passed in 837 of 895 (94%) in ABC versus 1145 of 1867 (61%) in PILOT. SBT safety screens were performed in all 983 ABC instances and 8031 of 8370 (96%) in PILOT. SBT safety screens were passed in 647 of 983 (66%) in ABC versus 4475 of 8031 (56%) in PILOT. Spontaneous breathing trial was performed in ≥93% of passed SBT safety screens in both trials and was passed in 319 of 603 (53%) in ABC versus 3337 of 4454 (75%) in PILOT.

This study compared SAT/SBT conduction in an ideal setting to real-world practice, 13 years later. Performance of SAT/SBT safety screens, SATs, and SBTs between a definitive clinical trial (ABC) as compared to current clinical care (PILOT) remained high.

The population of very elderly patients (aged 80 years and older) in intensive care units (ICUs) is steadily growing. These patients have unique physiological, cognitive, functional, and social characteristics that affect their entire ICU course. Immobility, delirium, dysphagia, malnutrition, and polypharmacy are among the most common geriatric syndromes in these patients, and they contribute to a higher risk of acute and long-term functional decline and mortality. Risk assessment in very elderly patients is complex, as traditional ICU scoring systems do not account for frailty and baseline disability, making difficult the determination of likely benefits, futility, or harm with ICU interventions. The importance of shared decision-making for treatment plans is critical, as very elderly patients and their families may have uncertain or unrealistic prognostic awareness and expectations of ICU care. Considering the gap between the rapid aging of the population and the socio-health development in Latin America, this population is an important determinant of stress on healthcare systems, however, data on these population is scarce. This review, based on a comprehensive literature search, summarizes recent evidence on triage for ICU admission, specific clinical characteristics, predictive elements of prognosis, and ICU and post-ICU outcomes for very elderly patients while also analyzing the challenges to improve management in the Latin American region.

The factors influencing nurses' knowledge of delirium in acute care settings have not been fully investigated in Saudi Arabia. Therefore, this study aimed to investigate these factors among nurses in acute care settings in the northern region of Saudi Arabia.

A cross-sectional study was conducted using a convenience sample of 234 acute care nurses at the main public hospitals in the Hail region of Saudi Arabia. Data were collected using a structured, self-administered questionnaire, from November 2023 to February 2024. Multiple linear regression was used to identify factors of knowledge about delirium.

Of the acute care nurses, 7.3% had a good level of overall knowledge about delirium, while 66.1% and 26.6% showed poor and moderate levels, respectively. Most nurses (78.2%) had poor knowledge of delirium assessment. Significantly higher scores on delirium assessment were observed for nurses who reported receiving in-service training on delirium (P = 0.006) and when a clear job description was applied (P = 0.031), whereas significantly higher scores on knowledge about risk factors were observed for those who had previous experience in caring for delirious patients (P <0.001), received educational sessions on delirium (P = 0.001), and participated in training on delirium care (P <0.001). Lack of previous experience in caring for delirious patients and participation in delirium care training were significant factors for lower knowledge about delirium scores (CI=-5.750 --1.200, P <0.001).

In-service training, daily clinical discussion, availability of instructional materials, and specific training on delirium significantly influence nurses' knowledge about delirium, particularly regarding delirium assessment and early recognition. Enhancing these factors could improve nurses' knowledge and the care and management of patients complaining of delirium in acute care settings.

Disorientation is an early indicator of developing postoperative delirium (POD), which is associated with increased mortality and cognitive decline. The well-established "Confusion-Assessment-Method-for-Intensive-Care-Unit" (CAM-ICU) for diagnosing POD in intubated patients cannot make use of the feature 'disorientation', as this requires verbal communication. Other tools such as the 4AT test for disorientation but are not established in ICU settings. We therefore combined test-variables of the CAM-ICU (level of consciousness, fluctuating mental status and inattention) with verbal testing for disorientation to develop and enhance diagnostic accuracy of the "Confusion Assessment Method for Intermediate Care Unit" (CAM-IMC). In the present study we describe the development and the evaluation of the diagnostic accuracy of the CAM-IMC.

We conducted a prospective cohort-study to develop and evaluate the diagnostic accuracy of the CAM-IMC and disorientation for diagnosing POD in non-intubated patients undergoing elective cardiac surgery. All patients were eligible during data collection period. Exclusion criteria were preexisting brain-organic disease, age < 50 years, preoperative intubation, and insufficient language skills. Patients were assessed for POD using the CAM-IMC as the index-test by two independent examiners over three postoperative days. Reference-testing was conducted by experienced reference-raters. The primary outcome was the diagnostic test-performance.

Among 178 eligible patients, 624 paired observations were completed with 155 patients. Of these, 9% experienced POD. Sensitivity and specificity were 0.96 (CI-95%: 0.87-1.00) and 0.94 (CI-95%: 0.92-0.96), respectively. Area-Under-the-Receiver-Operating-Characteristic-Curve (AUROC; equivalent to c-statistic) for CAM-IMC with a cut-off at three points was 0.95 (CI-95%: 0.93-0.98). The interrater reliability was 0.80 (CI-95%: 0.69-0.91).

The CAM-IMC demonstrates excellent test performance for diagnosing POD in non-intubated patients by combining features of the CAM-ICU with 'disorientation'. Given an aging community with an increasing delirium risk, the CAM-IMC provides a highly structured assessment tool for POD. It enables early and accurate detection of delirium, which is critical for timely intervention and improved patient outcomes. The CAM-IMC appears to be a useful tool to be implemented in units for not-intubated patients and seems to be the perfect match where the CAM-ICU is already in use for monitoring POD.

DRKS00026980 (German registry of clinical studies).