Predicting postoperative delirium (POD) in patients who have hip fractures is challenging due to its complex mechanism. Therefore, there is a critical need to explore and evaluate a novel predictive indicator.

There were four hematological markers independently associated with POD that were utilized to construct and evaluate a more reliable predictive indicator for POD. The study employed random sampling, dividing the data into training and validation cohorts in a 7:3 ratio. The strength of association between each predictive indicator and POD was assessed using multivariable logistic analysis and propensity score matching analysis. Predictive indicators with significant correlations underwent receiver operating characteristic curve and characteristic parameter comparisons to identify the optimal predictive indicator. Subsequent validation included the assessment of discriminative ability, correlation, and predictive performance. Furthermore, subgroup analysis was conducted to explore potential interactions. A total of 1,807 patients were included in this study, with a POD incidence rate of 16.5%.

Multivariable logistic analysis and propensity score matching analysis demonstrated that the glucose-to-albumin ratio (GAR) was independently positively associated with POD. Specifically, for every 0.1 unit increase in preoperative GAR levels in hip fracture patients, the risk of POD increased by 1.6 times. The receiver operating characteristic curve curve indicated that the optimal cutoff value for the GAR was 0.2, with an area under the curve of 0.8, sensitivity of 81.2%, and specificity of 59.0%.

Preoperative GAR has a certain predictive value for the occurrence of POD and can function as a novel indicator for predicting POD in geriatric hip fracture patients.

Sedation is a crucial issue in critical care, but the impact of early deep sedation on post-hospital mortality in critically ill surgical patients remains unclear.

We linked the 2015-2020 critical care database at Taichung Veterans General Hospital with the nationwide death registration in Taiwan. Log-rank test was used to estimate survival curves between patients with and without deep sedation, defined by the average Richmond Agitation-Sedation Scale (RASS) level within the first 3 days equal to or lower than - 3. A multivariable Cox proportional hazards regression model was used to determine hazard ratios (HR) and 95% confidence intervals (CI). Furthermore, we used propensity score-matching (PSM) analysis to validate the association.

A total of 7,135 critically ill surgical patients were enrolled, and 13.7% of them experienced early deep sedation. Independent predictors for post-hospital one-year mortality included old age, male, more comorbidities, high acute physiology and chronic health evaluation (APACHE) II score, and low body mass index. We noted that receiving midazolam (aHR 1.368, 95% CI 1.052-1.780) or propofol (aHR 1.459, 95% CI 1.136-1.874) was associated with increased mortality compared with dexmedetomidine. Early deep sedation was independently associated with post-hospital mortality after adjusting for covariates (aHR 1.216, 95% CI 1.019-1.452), and the association remained robust in the PSM analysis (aHR 1.313, 95% CI 1.054-1.636).

We identified the association between early deep sedation and post-hospital mortality, a modifiable factor, in critically ill surgical patients. Further prospective studies are warranted to confirm our findings.

Postoperative delirium is a common complication after major surgery, particularly in patients undergoing emergency gastrointestinal obstruction or perforation surgery. This study aimed to retrospectively assess postoperative delirium incidence and risk factors in this cohort.

We included 583 patients who were diagnosed with gastrointestinal obstruction or perforation and underwent emergency surgery. Postoperative delirium was diagnosed via the DSM-5 criteria or evaluated via the Confusion Assessment Method for the Intensive Care Unit. Risk factors for delirium were analyzed through univariate and multivariate methods.

One hundred and six patients (18.2%) developed delirium within the first 7 days after surgery. The analysis revealed the following independent risk factors: age (Adjusted odds ratios, aOR 1.097; 95% CI 1.065 - 1.131; P < 0.001), coronary heart disease (aOR 3.125; 95% CI 1.485 - 6.577; P = 0.003), hypoproteinemia (aOR 16.782; 95%CI 5.484 - 51.355; P < 0.001), septic shock (aOR 8.565; 95% CI 4.140 - 17.721; P < 0.001) and intraoperative hypotension (aOR 4.223; 95% CI 1.901 - 9.382; P < 0.001). Low-dose dexamethasone (aOR 0.414; 95% CI 0.217 - 0.787; P = 0.007) was confirmed as an independent protective factor for postoperative delirium. The delirium group experienced a significantly longer hospitalization duration, higher 7-day mortality, and increased in-hospital mortality.

This study identified several high-risk factors for postoperative delirium in patients with acute gastrointestinal obstruction or perforation conditions. Low-dose dexamethasone maybe an independent protective factor.

Due to the sensitive nature of the clinical data collected in this study, the raw data would remain confidential and would not be shared except under specific requests. Please contact the corresponding author: Haiyun Wang, why819@126.com.

Antipsychotic medications continue to be frequently prescribed by clinicians in the intensive care unit (ICU) for delirium, despite inconclusive data.

To determine if using a combination of antipsychotics reduces the time patients spend in delirium compared with monotherapy.

This was a single-center, retrospective, cohort medical record review of patients who scored positive on Confusion Assessment Method for the ICU (CAM-ICU) and received antipsychotic therapy. Patients were excluded if they received any antipsychotics prior to hospital admission or had a Richmond Agitation-Sedation Scale (RASS) scores of -4 or -5 at the time of CAM-ICU assessment. The primary outcome was duration of delirium. The secondary outcomes included ICU length of stay (LOS), hospital LOS, overall mortality, occurrence of adverse events (AEs), and whether antipsychotics were continued at hospital discharge.

A total of 84 patients were included, of these 45 and 39 received monotherapy and combination therapy, respectively. Median Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were significantly higher in the monotherapy group (18 vs 13, P = 0.006). Median duration of delirium was not significantly different between the monotherapy and combination therapy groups (8 vs 8 days, P = 0.932). Median ICU and hospital LOS, and occurrence of AEs were not significantly different. A significant difference in mortality was found between monotherapy and combination therapy (31% vs 10%, P = 0.02). Antipsychotics were continued at hospital discharge in 64% of the monotherapy and in 44% of the combination therapy group.

In patients with ICU delirium, there was no difference in duration of delirium among patients receiving monotherapy compared with combination therapy with antipsychotics, though they may be sicker and have a higher mortality. Patients commonly remain on antipsychotics at hospital discharge, the implications of which warrant further study.

Delirium is a complex medical condition marked by acute episodes of cognitive dysfunction and behavioral disturbances, with a multifaceted etiology and challenging management across various clinical settings. Older adults, particularly in postoperative contexts, are at increased risk of developing delirium. Despite extensive research, a single underlying pathophysiological mechanism for delirium remains elusive. However, emerging evidence suggests a correlation between lipid dysregulation and delirium development in elderly patients, especially in postoperative settings. This connection has led to proposed treatments targeting dyslipidemia and associated neuroinflammatory effects in acute-phase delirium. This review aims to synthesize current literature on the relationship between lipid dysregulation and delirium in older adults, highlighting the need for further research into specific neurolipidome constituents and age-related lipid profile changes, potentially uncovering novel therapeutic strategies for delirium.

Malnutrition is a prevalent phenomenon among patients with ischaemic stroke, and it is associated with a multitude of adverse health outcomes.

To evaluate the Geriatric Nutritional Risk Index (GNRI) as a predictor of both delirium and pressure injuries in critically ill older adults with ischaemic stroke.

An observational cohort study of 969 patients with ischaemic stroke conducted at a tertiary academic medical centre in the United States, divided into two groups based on GNRI scores: at risk of malnutrition (GNRI ≤ 98) and not at risk (GNRI > 98). Delirium was assessed via the Confusion Assessment Method for the Intensive Care Unit and nursing notes; pressure injuries were identified through direct clinical observation using the International Pressure Injury Staging System. Multivariable logistic regression, propensity score matching, and inverse probability of treatment weighting were used for analysis.

Patients at risk for malnutrition had a significantly higher prevalence of delirium and pressure injuries compared with those not at risk (66.4% vs. 46.4% for delirium and 30.3% vs. 9.7% for pressure injuries, both p < 0.001). Multivariable analysis showed that lower GNRI scores were significantly associated with increased risks of both delirium (OR: 1.75, 95% CI: 1.28-2.40, p < 0.001) and pressure injuries (OR: 2.70, 95% CI: 1.79-4.09, p < 0.001). The results remained consistent even after propensity score matching and inverse probability of treatment weighting analyses.

The study shows that the GNRI is an effective predictor of the risk of pressure injury and delirium in older adults with ischaemic stroke.

The assessment and management of nutritional status using GNRI in clinical practice has the potential to facilitate the early detection of high-risk patients and the implementation of targeted nutritional interventions.

The purpose of this study is to examine the validity, reliability and methodological quality of delirium scales that have been translated and adapted in China using quality assessment tools.

A comprehensive search was conducted in PubMed, Embase, Web of Science, China Knowledge Network (CNKI), VIP database, Wanfang database, and China Biomedical Literature Database. The search covered the period from the establishment of the database until September 1, 2023. Two researchers independently screened the literature and extracted data. Studies were included if they focused on the translation of a delirium scale from English into simplified or traditional Chinese, with a study population aged ≥ 18 years and full text available. The risk of bias was assessed through the QUADAS-2 instrument. Level of evidence recommendation is completed with the GRADE and performed with GRADE GPT. Due to high heterogeneity across studies, a random-effects model was applied to calculate diagnostic accuracy indicators (sensitivity, specificity, and area under the curve index). This study has registered in the prospero.

Thirteen studies were included, of which 2 were case-control studies and 11 were cross-sectional studies. These studies involved 13 adult delirium assessment tools, and were all translated following the Brislin or ISPOR principle. The results of the methodological quality assessment showed that 3D-CAM, 4AT, CAM-ICU, CAM-ICU-7, and S-PTD had higher quality ratings, with 4AT being the highest quality. 4AT, CAM, 3D-CAM, CAM-CR, CAM-ICU, CAM-ICU-7, and Nu-DESC were recommended at a level B. The Cronbach's coefficient of most studies is over 0.8, and the inter-rater reliability of most studies is near or over 0.9, indicating good internal consistency and stability. Besides, a significant inverse correlation was found between these 13 Chinese-adapted delirium scales and their reference tests, with most studies were over 0.7, and especially 3 studies offered S-CVI and I-CVI value that were all larger than 0.9, indicating a good discriminate validity and content validity, though different cut-off points were recommended by different scales. Moreover, the sensitivity and specificity of these studies were mainly larger than 0.9, which proved the good diagnostic accuracy of these included scales. The pooled sensitivity of 7 Chinese delirium adaption scales that provided statistical data is 0.93 (95% CI: 0.89-0.96), and the pooled specificity is 0.94 (95% CI: 0.94-0.96), and the AUC is 0.98 (95% CI: 0.96-0.99).

The research on the Chinese adaptation of the delirium scale in China is relatively abundant and of acceptable quality. Taking into account factors of methodological quality and diagnostic accuracy, Chinese-adapted delirium assessment scales such as 3D-CAM, 4AT, CAM, CAM-ICU, CAM-ICU-7, and NuDESC appear to be suitable alternatives to the original English delirium scales and are recommended for use in primary care settings in China. Future research and continuous optimization are needed to improve the scientific rigor and accuracy of these tools, which will help advance the field. No Patient or Public Contribution is considered.

Delirium can affect over 50% of patients following cardiac surgery in intensive care units (ICU), leading to an increased risk of long-term cognitive impairment, prolonged hospital stays and increased costs. Nurse-led auditory-visual stimulation to help prevent and manage ICU delirium is a novel, unexplored strategy in postoperative cardiac surgical patients but proven to be effective in other long-term conditions. The Delirium after Cardiac Surgery in the Intensive Care Unit (DaCSi-ICU) study aims to assess the feasibility and acceptability of implementing an innovative, family-focused auditory-visual intervention to reduce delirium in ICU patients following major cardiac surgery.

This is a pilot, mixed-methods, non-randomised feasibility study to be delivered in a university hospital cardiac ICU. The primary outcome is to explore the feasibility and acceptability of an innovative family-focused intervention to reduce ICU delirium rates in patients following cardiac surgery. Secondary outcomes are to: explore short-term post-surgical outcomes up to three months of hospital discharge; and investigate participants' perspectives of taking part in the study. A total of 12 patients, alongside 12 family members or significant others and 6 ICU nurses will be recruited. Demographic data will be reported descriptively, and clinical data will be managed statistically through SPSS. Data collected from interviews will be transcribed full verbatim and analysed on NVIVO using framework analysis. This study has received Health Research Authority (HRA) approval (24/YH/0011). Imperial College Healthcare NHS Trust is the sponsor for research governance purposes. This trial is registered at ClinicalTrials.gov (NCT06355570). Findings will be disseminated through peer-reviewed open-access journals and presented in national and international scientific meetings. Findings will also be shared with patients and the clinical team. Study results will determine the feasibility and acceptability of the intervention, facilitating the progression to a future controlled effectiveness trial.

The sound environment, or soundscape, of intensive care units (ICUs) can be stressful for patients. Soundscapes are defined as acoustic environments as perceived by people. Single-patient rooms mitigate noise, but may deprive patients of essential auditory cues. This might harm basic psychological needs, such as safety. Experiences, needs and emotions regarding soundscapes of single-patient ICU rooms remain unexplored. We aimed to understand how patients experienced these soundscapes.

This mixed-methods, single-center study involved semi-structured interviews and questionnaires five days after ICU discharge. Patients experienced the soundscapes during their ICU stay, shared experiences in interviews, and selected one to rate on need fulfilment (with a researcher-developed questionnaire), and emotions (with a validated questionnaire). Using thematic analysis, we analyzed interview transcripts by labelling sound-related experiences, sounds, and emotions.

We interviewed 26 patients. We labelled 259 sound-related experiences, 264 sounds, and 281 emotions, from which six themes emerged: Orientation through sound; Coping with disruptions; Human auditory presence; Monotony and variation; Associations and hallucinations; Communication behind closed doors. Eight patient-selected experiences involved positive emotions. Need fulfilment scores varied: scores were low for communication-related experiences, but relatively high for those involving human presence.

Our findings demonstrated that experiences with single-patient ICU room soundscapes can be positive or negative. For future implementation of such rooms, three insights merit consideration: positive sounds originating from corridors may be unnecessarily removed; alarms in single-patient rooms serve key supportive functions for patients; there is a lack of accessible and appropriate auditory stimulation. We recommend that these insights are taken into consideration to ensure more positive and restorative ICU stays.

In ICUs, balanced approaches that consider both positive and negative aspects of soundscapes may benefit patients in future interventions for noise mitigation. Diversifying the variety of sounds inside patient rooms could further support well-being.

Delirium among hospitalized patients often goes undetected and is associated with increased length of stay and mortality. Cerebral state monitors (CSMs) collect limited lead electroencephalography (EEG) data and have shown promise in delirium detection.

This study compares three methods of detecting delirium: EEG using an Food and Drug Administration-approved CSM, a 3-minute diagnostic interview for the Confusion Assessment Method (3D-CAM), and the traditional reference standard clinical evaluation by a psychiatric consultation-liaison service.

Hospitalized patients >18 years of age evaluated by the consultation-liaison service were screened for inclusion. Consent was obtained from either the patient or authorized surrogate when appropriate. Participants were screened with 3D-CAM, followed by placement of 4 frontotemporal CSM leads and collection of 5 minutes of EEG data with eyes closed. The presence or absence of a delirium diagnosis on psychiatric evaluation using Diagnostic and Statistical Manual-5 criteria the day of data collection was recorded. A MATLAB-based program (Brainstorm) was used to calculate power in each EEG frequency band.

There were 75 participants, 58 with complete 3D-CAM and EEG data. Twenty-three participants were found to be delirious by clinical diagnosis. The 3D-CAM differentiated between delirious and nondelirious participants with a sensitivity of 65%, specificity of 79%, and area under the curve of 0.720. EEG power differed between delirious and nondelirious participants in the HighDelta frequency band in the left temporal (L2) lead (false discovery rate-adjusted P = 0.020) and the LowAlphaHighDelta frequency band ratio in L2 (false discovery rate-adjusted P = 0.039). On receiver operator curve analysis, LowAlphaHighDelta and HighDelta outperformed 3D CAM, although not significant (all P > 0.18).

CSM frequency band power differed significantly between delirious and nondelirious patients but did not outperform 3D-CAM as a predictive test of delirium. Strengths of this study include the use of an Food and Drug Administration-approved CSM and freely available computational software and methods. Limitations include a small sample size, making the results vulnerable to skewing by outliers. Future studies should recruit larger sample sizes and explore the diagnostic utility of combined EEG variables obtained with CSMs at the bedside.

The objective of this study was to examine the impact of diaphragm thickness (DT) on the prognosis of elderly patients infected with COVID-19, particularly with regard to the necessity of intensive care unit (ICU) admission.

Between August 2020 and January 2021, 188 patients aged ≥ 65 years who were admitted to the internal medicine department of our hospital with a diagnosis of COVID-19 infection, were included in this study. The patients' DTs of the patients were measured by a radiologist using computed tomography (CT) scans from the right and left diaphragm dome level. DT was compared with the progression of respiratory distress and the necessity of intensive care. In statistical analysis, p < 0.05 was considered significant.

Right DT was higher in the group of patients with admission to the ICU (p = 0.11). According to multivariate logistic regression analysis, ferritin level (OR = 1; 95% CI = 1-1; p = 0.014), IL-6 level (OR = 1.004; 95% CI = 1-1.007; p = 0.045) and higher right DT (OR = 11.015; 95% CI = 3.739-32.447; p = 0.035) were found to be independent risk factors predicting the ICU admission in COVID-19 patients. There was no significant association with left DT. The predictive value of right DT for ICU requirement in COVID-19 patients was evaluated by ROC analysis. The ROC analysis showed a cut-off value > 1.8, AUC = 0.632, p = 0.009, 95% Cl (0.558-0.701). In correlation analysis, a positive correlation was found between right DT and ICU admission (r = 0.331, p < 0.001).

Our study is the first to evaluate dome-level DT with CT in elderly patients with COVID-19. In the elderly population, higher right DT levels have been observed to enhance the probability of ICU admission. This may be due to the fact that our sample group consists only of elderly people and the effects of COVID-19. We believe that further validation with more comprehensive studies is needed for DT assessment for clinical treatment decisions, particularly in COVID-19 patients. In addition, we think that the proposal for a standardized measurement site and method for DT measurement will be a guide for future studies.

Not applicable.

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.

Nil by mouth (NBM) is a frequent imposition for patients recovering from critical illness. Its impact on patients' wellbeing and rehabilitation is under researched. We sought ICU multidisciplinary opinion to primarily assess the relevance of taste deprivation on patient care and recovery, and to identify future opportunities for innovation and research.

A descriptive, multiformat, observational, online survey investigated the experiences of specialist multidisciplinary healthcare professionals (HCP) from two academic hospitals regarding working with NBM patients. An e-survey containing 16 multiformat questions was developed by an experienced multidisciplinary HCP team and distributed over a 3-month period in 2023. The CHERRIES guidelines were followed for reporting of results.

58 HCPs completed the study. 97% of HCPs reported witnessing patient discomfort or distress when NBM. 91% believed felt that it impacted negatively on patients' engagement in their own recovery. 59% did not discuss food and taste with patients when prolonged NBM was anticipated because there was no solution on offer. 41% of HCPs did discuss flavour and food, to build rapport and help motivate recovery. 57% of HCPs often felt pressure to give oral food/liquid to a NBM patient. 90% of participants reported that a safe taste product could enhance a patient's ICU experience. Concerns regarding safety and a need for guidelines to enable implementation were common.

HCPs recognise the psychological sequalae on the patient and the impact on their relationship with the patient, that taste deprivation creates in recovering critically ill patients. Safe alternatives to oral intake that can enhance the ICU experience are considered desirable; this needs further research and innovation. Furthermore, with training and support HCPs should feel empowered to discuss NBM associated distress and challenge NBM recommendations.

There is demand for safe alternatives to oral flavour intake and belief this could enhance the ICU experience with downstream positive impact on ICU morbidity.

Elderly patients with Chronic obstructive pulmonary disease (COPD) and respiratory failure admitted to the intensive care unit (ICU) have a poor prognosis, and the occurrence of delirium further worsens outcomes and increases hospitalization costs. This study aimed to develop a predictive model for delirium in this patient population and identify associated risk factors.

Data for the machine learning model were obtained from the MIMIC-IV database. Feature variable screening was conducted using Lasso regression and the best subset method. Four models-K-nearest neighbor, random forest, logistic regression, and extreme gradient boosting (XGBoost)-were trained and optimized to predict delirium risk. The stability of the model is evaluated using ten-fold cross validation and the effectiveness of the model on the validation set is evaluated using accuracy, F1 score, precision and recall. The SHapley Additive exPlanations (SHAP) method was used to explain the importance of each variable in the model.

A total of 1,155 patients admitted to the intensive care unit between 2008 and 2019 were included in the study, with a delirium incidence of 12.9% (149/1,155). Among the four ML models evaluated, the XGBoost model demonstrated the best discriminative ability. In the validation set, it achieved an AUC of 0.932, indicating superior performance with high accuracy, precision, recall, and F1 scores of 0.891, 0.839, 0.795, and 0.810, respectively. Key features identified through SHAP analysis included the Glasgow Coma Scale (GCS) verbal score, length of hospital stay, mean SpO₂ on the first day of ICU admission, Modification of Diet in Renal Disease (MDRD) equation score, mean diastolic blood pressure, GCS motor score, gender, and duration of noninvasive ventilation. These findings provide valuable insights for individualized risk management.

The developed prediction model effectively predicts the occurrence of delirium in elderly COPD patients with respiratory failure in the ICU. This model can assist clinical decision-making, potentially improving patient outcomes and reducing healthcare costs.

Intensive Care Unit-Acquired Weakness (ICUAW) is a very common condition in patients admitted to intensive care units (ICUs), even after relatively short stays. This weakness can develop with a pre-existing background of sarcopenia or cachexia, although these conditions are not always the direct cause. Over the years, much of the literature has focused on the nutritional aspect of the issue, leading to the development of widely accepted guidelines recommending the initiation of early nutrition, with the goal of achieving caloric and protein targets within the first five days of ICU admission. Despite adherence to these guidelines, several studies have shown a significant loss of muscle mass in critically ill patients, which directly impacts their ability to generate strength. However, it has become increasingly evident that nutrition alone is not sufficient to counteract this muscle loss, which is often closely linked to the prolonged immobility experienced by ICU patients due to a variety of clinical and logistical factors. In particular, there is growing evidence suggesting that even the introduction of early and minimal rehabilitation-including passive mobilization-when combined with appropriate nutritional support, can be a valuable strategy to help reduce the incidence of ICUAW. In this narrative review, we aim to summarize the current scientific knowledge on this topic, emphasizing the importance of an integrated approach that combines nutrition and early mobilization. Such a combined strategy not only holds the potential to reduce the acute incidence of ICUAW but also contributes to better recovery outcomes and, eventually, improved quality of life for these patients.

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.

To establish a nomogram for predicting the occurrence of postoperative delirium (POD) in patients undergoing cardiac surgery.

Data from 5379 patients were retrieved from the Medical Information Mart for Intensive Care (MIMIC-IV) database and divided into a training set and a validation set at a 7:3 ratio. Multivariate logistic regression was conducted to identify independent predictors and establish nomograms to predict the occurrence of POD. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the accuracy and reliability of the model.

A total of 5379 post-cardiac surgery patients were included in the study, with 258 patients in the training set and 113 patients in the validation set developing POD. Multivariate logistic regression analysis identified seven independent predictors: age, partial pressure of carbon dioxide (PCO2), glucose, white blood cell count (Wbc), stroke, anemia and chronic obstructive pulmonary disease (COPD). The prediction model demonstrated good discrimination, with an AUC of 0.702 (95 CI: 0.671-0.734) in the training set and 0.711 (95 CI: 0.7662 - 0.761) in the validation set. The calibration curve of the prediction model closely matched the ideal curve in both the training set and the validation set. In addition, the DCA curve demonstrated that the nomogram has better clinical applicability.

We constructed a nomogram for the personalized prediction of delirium in post-cardiac surgery patients, demonstrating satisfactory performance and clinical utility. This tool may help clinicians initiate preventive interventions for POD.

Introduction Cognitive dysfunction represents a major healthcare concern in the 21st century. Prolonged cognitive dysfunction and concomitant psychological and physical disorders in patients admitted to the intensive care unit (ICU) are components of the post-ICU syndrome (PICS). Notwithstanding the numerous published studies in this area, our work is the first to explore the relationship between PICS and delirium in the ICU in Uruguay. This research underscores the significance and potential of our study, which we believe will make a substantial contribution to this field of research in Latin America. Objectives The incidence rates of the cognitive, psychological, and physical sequelae constituting PICS were evaluated, and the relationships between these disorders and delirium in the ICU were studied. Methods This was a prospective cohort study in which patients were followed up for one year after admission to the ICU of Hospital Pasteur between 03/01/2017 and 05/31/2017. The pre-ICU condition of each patient was considered in the analysis. An initial telephone interview was conducted using the following scales: the Hamilton scale was used to assess anxiety, the Pfeiffer scale was used to assess cognitive impairment, and the Barthel scale was used to assess activities of daily living (ADLs). In a second face-to-face interview, the Mini-Mental State Examination (MMSE) and the Beck Depression Scale II (BDS-II) were used. Results Forty-three patients were divided into two groups: 15 (34%) with delirium in the ICU and 28 (66%) without delirium. The association of delirium with different sequelae was evaluated using the corresponding scales: Pfeiffer scale: Cognitive impairment was observed in 7/13 patients (53%) in the delirium group vs. 0/29 patients (0%) in the non-delirious group (p 0.001); MMSE score: Deterioration was observed in 6/7 patients (86%) in the delirium group vs. 1/7 patients (14%) in the non-delirious group (p 0.007). Cognitive impairment was found in 3/6 patients (50%) who presented with delirium in the ICU, while 1/8 patients (13%) who did not present with delirium experienced cognitive impairment (p = 0.036); Hamilton scale: Anxiety was found in 8/15 patients (57%) in the delirium group and 20/29 patients (68%) in the non-delirious group; BDS-II: Depression was found in 12/12 patients (100%) in the delirium group vs. 27/29 patients (93%) in the non-delirious group (p 0.57). Barthel scale: Dependence on others for ADLs was observed in 3/15 patients (20%) in the delirium group vs. 4/29 patients (14%) in the non-delirious group (p = 0.23). Conclusions Cognitive impairment was observed to be associated with delirium in the ICU, opening new avenues for research and possible treatment options. Although dependence on activities of daily living (ADLs) was more common in the delirium group, the difference between the two groups was not significant, highlighting the need for further research to understand the whole picture. Rates of anxiety and depression after ICU stay were also similar between the two groups, providing a baseline for comparison and informing future studies. The study highlights the urgent need for delirium-specific interventions in the ICU to address cognitive dysfunction and improve long-term outcomes in critically ill patients.

Delirium is a common complication observed in intensive care units (ICUs). Propofol is one of the most widely used sedatives and is believed to be closely connected with the incidence of delirium. The study was carried out to explore the relationship between delirium and the average rate of propofol infusion.

Patients who underwent invasive mechanical ventilation (IMV) while receiving propofol from the Medical Information Mart for Intensive Care IV (MIMIC IV) database were included in the study. The primary outcome was to identify the potential risk factors for the incidence of delirium and investigate the relationship between the average rate of propofol infusion and the incidence of delirium. The secondary outcome was to further analyze the relationship by subgroup analysis. Propensity score matching (PSM) was employed to minimize bias.

A total of 16,956 patients (delirium: 5805; control: 11,151) were ultimately included in the study after PSM. The median diagnostic time of delirium was 18 h. An average propofol infusion rate ≥ 20 μg/(kg*h) during the initial 18 h was found to be independently significant [OR = 1.84, 95% CI = (1.72, 1.98), p < 0.001], while an average propofol infusion rate ≤ 40 μg/(kg*h) in the first hour showed no statistically significant difference in the incidence of delirium [OR = 0.95, 95% CI = (0.88, 1.02), p = 0.163]. Besides, an average propofol infusion rate ≥ 20 μg/(kg*h) was also found to be statistically significant in all the subgroup analyses.

An average propofol infusion rate ≥ 20 μg/(kg*h) during the initial 18 h was identified as an independent risk factor for delirium, suggesting that the accumulation of propofol might be associated with an increased incidence of delirium.

Intensive care unit (ICU) admissions can be traumatic for critically ill, ventilated acute respiratory distress syndrome (ARDS) patients due to fear of death, an inability to verbally communicate, reliance on health care professionals, and invasive medical interventions. Adult ARDS patients hospitalized during the COVID-19 pandemic were strictly isolated and had limited to no visitation from loved ones, impacting their access to support systems.

To explore the memories and sensory triggers for them (if applicable) of adult ARDS survivors hospitalized during the COVID-19 pandemic.

This study used a phenomenological design with an interpretative descriptive approach. Semistructured interviews with open-ended questions were conducted with survivors. Thematic analysis of 16 ARDS survivors' responses to ICU memories and sensory triggers questions was completed to identify the most prevalent themes.

Major themes for vivid memories included (1) altered reality, (2) vivid nonsense dreams, (3) medical treatment/procedures, and (4) feeling lonely/isolated. Themes for triggers included (1) seeing doctors/nurses/hospitals and medical equipment or seeing/hearing media depictions of them, (2) hearing ringtones and beeping/alarms, (3) seeing/hearing helicopters, (4) smelling cleaning products, and (5) seeing/touching scars.

Fifteen of the 16 ARDS survivors reported traumatic vivid memories, often triggered by sensory stimuli they encountered in their everyday lives. It is important for acute care and outpatient nurses to understand the impact of an ICU admission on ARDS survivors' mental health, so they can adopt evidence-based interventions to prevent or limit these effects.

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.

Postoperative delirium is a common and significant consequence in patients with type A aortic dissection following surgery; however, there is currently no effective postoperative care plan.

The purpose of this study is to develop and evaluate the practical implementation of a stratified nursing intervention program for postoperative delirium in patients undergoing surgery for Stanford type A aortic dissection.

A stratified nursing intervention program for postoperative delirium was created using a literature review, group discussions, and the Delphi method via expert mail inquiry. A quasi-experimental design was used, with patients admitted to the general ward of a tertiary hospital in Wenzhou, China, functioning as subjects. From September to December 2022, 43 patients were included in the control group and given standard treatment. From January to June 2023, 37 patients were recruited in the intervention group, receiving both routine care and the intervention plan. The intervention's effects were compared in the two groups.

The intervention group had considerably shorter delirium and hospital stays than the control group (P < 0.05), as well as higher patient satisfaction levels. There were no inadvertent extubations in the intervention group. When the incidence and beginning time of delirium in the general ward were compared, there were no significant differences between the two groups (P > 0.05).

Implementing this nurse intervention in the ward context can shorten postoperative delirium and hospital stays, increase patient satisfaction with care, and improve patient prognosis and quality of life. This intervention will also serve as a great resource for future clinical management of postoperative delirium.

The National Health Security Information Platform's Medical Research Registration Information System has registered this study under the registration number MR-33-22-022978.

Critically ill patients frequently encounter disruptions in their circadian rhythms in the intensive care unit (ICU) environment. New lighting systems have been developed to enhance daytime light levels and to promote circadian alignment.

To investigate the impact of implementing an innovative lighting technology that mimics natural light and reproduce the colour of the sky.

Prospective, observational, non-randomized comparative trial. ICU patients were exposed to either a cutting-edge lighting system based on new technology (intervention group) or a conventional lighting system using fluorescent bulbs (control group).

An Italian intensive care unit with ten beds and five windowless rooms, thereby denying access to natural light. Three rooms had new lighting technology.

The two groups were compared to assess the prevalence or absence of delirium and the need for sedatives during ICU stay. The secondary aim was to assess the presence of anxiety, depression, and post-traumatic stress disorder in patients at 3, 6, and 12 months after ICU discharge.

86 patients were included: 52 (60 %) in the intervention group and 34 (40 %) in the control group. Seventy-nine patients (82 %) were alive at ICU discharge. Fourteen patients (16 %) developed delirium (intervention group: n = 8 [15 %] vs. control group: n = 6 [18 %] in the control group, (P=0.781). The use of sedative drugs and neuromuscular blocking agents was similar in both the groups. No differences in the incidence of anxiety, depression, or post-traumatic stress disorders were observed among patients who underwent follow-up visits.

Compared to traditional fluorescent tube lighting, the innovative lighting system did not provide any significant benefit in reducing the frequency of delirium or the necessity for sedative medications.

A single intervention, the use of lights that mimic sunny light and the sky, did not result in a statistically significant reduction in the incidence of delirium. Delirium has a multifactorial aetiology, necessitating interventions that are multifaceted and address different domains.

Development of effective guideline for delirium management is still seeking nowadays. As nurses are in the first confrontation line for delirium, their prospective in identifying barriers are essential in developing integrated strategies and clinical guidelines.

To explore the barriers focusing on intensive care unit (ICU) nurses' point of views to provide an evidence-based support for effective nurse-led delirium management in ICU settings.

Whittemore and Knafl framework was recruited to build up this integrative review. PRISMA guidelines were followed to search about barriers of nurse-led delirium management. Articles published up to June 2024 in five databases; Web of Science, Scopus, PubMed, CINAHL and EMBASE using related keywords were involved. Mixed Methods Appraisal Tool (MMAT) was used to evaluate the quality of articles included in this review and then reported nurse-led delirium barriers were mapped according to COM-B model.

Twenty-three articles out of 1,020 research articles were included in this review after carefully checked according to the exclusion and inclusion criteria. based on MMAT, 7 articles achieved 100%, 11 articles were achieved 80%, and 5 articles achieved 60%. Nurses' knowledge deficit is the most common psychological capability barriers of nurse-led delirium management, while complexity of delirium screening tools was found to be a physical capability barriers. High workload, lack of staff, lack of time, lack of documentation and lack/ shortage of guidelines were barriers mapped to physical opportunity, while communication barriers in particular patient's intubation and sedation were mapped to social opportunity barriers. Motivation was represented by addressing delirium as a major problem, self-confidence, psychological support and considering nurse's views.

Nurse's knowledge deficit, complexity of delirium screening tools, high workload, lack of time, lack of documentation, lack/ shortage of guideline, and impaired communication were barriers of nurse led delirium management. This study is promising in ease of application in clinical practice since delirium barriers in ICU settings were well-presented in a COM-B framework that may facilitate therapeutic strategies and related decision making.

Malnutrition is reportedly associated with the development of delirium. As dental health is essential for nutritional intake, tooth loss may be a risk factor for the development of delirium. This study aimed to investigate the relationship between postoperative delirium and the number of remaining teeth in patients undergoing gastrointestinal surgery.

This retrospective study included 453 consecutive patients aged ≥65 years who underwent programmed gastrointestinal cancer surgery under general anesthesia at the Department of Surgery, Fujita Health University Hospital, between January 2022 and December 2022. Background factors were prepared between the participants with and without dental intervention. In the dental intervention group, associations between background and surgical factors and the presence of postoperative delirium were explored. Factors with significant associations with postoperative delirium in the univariate analysis were subjected to logistic regression analysis to determine their association with the number of remaining teeth.

Overall, 189 participants underwent postoperative management. They had a significantly lower Prognostic Nutritional Index and higher cognitive decline than the 264 patients who underwent no dental intervention during this period. However, no significant difference was observed in the incidence of postoperative delirium between the two groups. In the dental intervention group, logistic regression analyses revealed that postoperative complications and the number of remaining teeth were significantly associated with postoperative delirium development.

The results revealed that a decrease in the number of remaining teeth is associated with postoperative delirium. The cause of this is not clear, but it is thought to be related to brain fragility. Geriatr Gerontol Int 2025; 25: 90-95.

Pain, delirium, and sedation should be assessed routinely using validated assessment scales. Inappropriately managed pain, delirium, and sedation in critically ill patients can have serious consequences regarding mortality, morbidity, and increased healthcare costs. Despite the benefits of a bundled approach to pain, delirium, and sedation assessments, few studies have explored nurses' perceptions of using validated scales for such assessments. Furthermore, no studies have examined nurses' perceptions of undertaking these assessments as a bundled approach.

The objective of this study was to explore nurses' knowledge, perceptions, attitudes, and experiences regarding the use of validated pain, delirium, and sedation assessment tools as a bundled approach in the intensive care unit (ICU).

A qualitative exploratory descriptive design was adopted. We conducted four focus groups and 10 individual interviews with 23 nurses from a 26-bed adult ICU at an Australian metropolitan tertiary teaching hospital. Data were analysed using thematic analysis techniques.

Four themes were identified: (i) factors impacting nurses' ability to undertake pain, delirium, and sedation assessments in the ICU; (ii) use, misuse, and nonuse of tools and use of alternative strategies to assess pain, delirium, and sedation; (iii) implementing assessment tools; and (iv) consequences of suboptimal pain, delirium, and sedation assessments. A gap was found in nurses' use of validated scales to assess pain, delirium, and sedation as a bundled approach, and they were not familiar with using a bundled approach to assessment.

The practice gap could be addressed using a carefully planned implementation strategy. Strategies could include a policy and protocol for assessing pain, delirium, and sedation in the ICU, engagement of change champions to facilitate uptake of the strategy, reminder and feedback systems, further in-service education, and ongoing workplace training for nurses.

The aim of this study was to codesign a Family Members' Voice Reorientation Intervention (FAMVR) for delirium prevention and management in critically ill adult patients through collaborative process with previous patients, families, and clinical staff.

Delirium is a common consequence of intensive care admission, and there is limited evidence to support family-led interventions to prevent or minimise delirium in intensive care. People with lived experience of intensive care are seldom involved in codesigning delirium prevention and management interventions despite the identified benefits of their involvement in delirium care.

Codesign qualitative study.

The process of co-designing was undertaken using the four stages of the Double Diamond model. Participants included people with lived experience of the intensive care unit, family members, and intensive care clinicians. The codesign approach was utilised, and data were gathered from a series of focus groups and individual interviews. Data were digitally recorded, transcribed verbatim, and analysed using thematic analysis.

Of the 26 people who indicated their interest in participating, 12 (46%) completed the first and second stages, and nine (35%) completed the third and fourth stages of the Family Members' Voice Reorientation Intervention development. All participant groups were represented in the fourth stage: patients (n = 4), family members (n = 1), nurses (n = 2), and medical staff (n = 2). Four themes were identified: message content, wording, reactions, and tone, all of which informed the prototype of the intervention and its associated domains.

A codesign approach was important for developing a delirium management intervention. This process enabled participants to provide their feedback in the context of their unique experiences, which in turn enhanced the authenticity and appropriateness of this unique intervention.

To synthesize evidence on the implementation and effectiveness of age-friendly interventions in intensive care units (ICUs) to optimize care for older adults.

Systematic review of studies published up to February 2024, focusing on interventions tailored to meet the needs of older adults in ICU settings.

Comparative studies conducted in ICUs worldwide, involving older adults receiving critical care, were reviewed.

A systematic search of databases including Embase, MEDLINE, and Cochrane was performed. The quality of studies was assessed using the ROSVIS-II tool, and findings were synthesized narratively and thematically.

Out of 1200 articles initially identified, 45 studies met inclusion criteria. Age-friendly interventions (eg, geriatric assessment teams, multimodal care bundles) demonstrated significant benefits, including a 19% reduction in major in-hospital complications and shorter hospital stays by an average of 3 days.

The review supports the effectiveness of age-friendly interventions in improving clinical outcomes for older ICU patients. However, consistent reporting of effect sizes was lacking, and more high-quality comparative effectiveness research is needed. Implications for practice include integrating these interventions into standard ICU protocols to enhance older adult care. Policy implications involve advocating for health care policies that support the dissemination and implementation of effective age-friendly practices. Further research should focus on establishing a robust evidence base to guide implementation and policy decisions.

Background/Objectives: Although delirium is common during critical illness, standard-of-care detection and prevention practices in real-world intensive care unit (ICU) settings remain inconsistent, often due to a lack of provider education. Despite availability for over 20 years of validated delirium screening tools such as the Confusion Assessment Method in the ICU (CAM-ICU), feasible and rigorous educational efforts continue to be needed to address persistent delirium standard-of-care practice gaps. Methods: Spanning an 8-month quality improvement project period, our single-ICU interdisciplinary effort involved delivery of CAM-ICU pocket cards to bedside nurses, and lectures by experienced champions that included a live delirium detection demonstration using the CAM-ICU, and a comprehensive discussion of evidence-based delirium prevention strategies (e.g., benzodiazepine avoidance). Subsequent engagement by health system leadership motivated the development of an electronic health record dataset to evaluate unit-level outcomes, including CAM-ICU documentation and benzodiazepine administration. Results: Using a dataset that spanned 9 pre- and 37 post-project months and included 3612 patients, 4470 admissions, and 33,913 patient days, we observed that delirium education was followed by a dramatic rise in CAM-ICU documentation, from <1% for daytime and nighttime shifts to peaks of 73% and 71%, respectively (p < 0.0001 for trend), and a fall in the proportion of mechanically ventilated patients ever receiving benzodiazepine infusions (69% to 41%; p < 0.0001). Conclusions: An interdisciplinary delirium project comprising rigorous lectures on standard-of-care practices can yield significant improvements in documentation and sedative administration. This approach can help ICUs jumpstart efforts to build awareness and address longstanding gaps in standard-of-care delirium practices.

Mobilization in the Neurological Intensive Care Unit (NICU) significantly improves outcomes and functional recovery while preventing immobility-related complications. The heterogeneity of neurologic conditions necessitates tailored, interdisciplinary mobilization strategies. This article reviews recent research on enhancing the feasibility and effectiveness of mobilization interventions in NICU settings.

Early mobilization improves functional outcomes, reduces complications like muscle atrophy and pressure ulcers, and can shorten ICU stays. Safe implementation involves individualized protocols and a multidisciplinary team, emphasizing that early mobilization benefits critically ill neurological patients. Development of evidenced-based protocols for interdisciplinary NICU patient mobilization enhances patient outcomes and quality of life. Use of outcome measures can facilitate mobility while preventing complications from immobility. Future research in embracing emerging technologies such as mobilization equipment and virtual/augmented reality will help determine optimal timing as well as dosage of mobility to improve long-term functional outcomes in the unique NICU population.

The negative effects of delirium in intensive care unit (ICU) patients necessitate the identification and management of risk factors. This study aimed to determine the incidence of delirium and its associated modifiable and non-modifiable factors in the ICU setting to provide valuable insights for better patient care and outcomes.

Patients admitted to the ICU underwent delirium screening twice daily. Comprehensive records of modifiable and non-modifiable risk factors were maintained throughout the ICU stay.

The incidence of delirium was 32.5%. Age [odds ratio (OR) 1.04, confidence interval (CI) 1.02-1.06, P < 0.001)]. Illiteracy (OR 4, CI 1.19-13.35, P=0.02), hearing impairment (OR 3.37, CI 1.71-7.01, P=0.001), visual impairment (OR 3.90, CI 2.13-7.15, P < 0.001), hypertension (OR 2.56, CI 1.42-4.62, P=0.002), Sequential Organ Failure Assessment score (OR 1.21, CI 1.08-1.36, P=0.001), Acute Physiology and Chronic Health Evaluation II score (OR 1.20, CI 1.12-1.28, P < 0.001), presence of a nasogastric catheter/drain (OR 2.15, CI 1.18-3. 90, P=0.01), tracheal aspiration (OR 3.63, CI 1.91-6.90, P < 0.001), enteral nutrition (OR 2.54, CI 1.12-5.76, P=0.02), constipation (OR 1.65, Cl 1.11-2.45, P=0.02), oliguria (OR 1.56, Cl 1.06-2.28, P=0.02), midazolam infusion (OR 3. 4, Cl 1.16-10.05, P=0.02), propofol infusion (OR 2.91 Cl 1.03-8.19, P=0.04), albumin use (OR 2.39, Cl 1.11-5.14 P=0.02) and steroid use (OR 2.17, Cl 1.06-4.40, P=0.03) were found to be independent risk factors for delirium.

This study highlights several risk factors contributing to delirium, such as age, sensory impairment, educational level, procedural interventions, and medications. Oral nutrition and mobilization are effective strategies for reducing delirium incidence in the ICU.

Evidence regarding the effect of systemic immune-inflammation index on delirium occurrence is limited. This study aimed to investigate the association between SII and delirium in intensive care unit (ICU) patients.

Information was extracted from Medical Information Mart for Intensive Care-IV. Four logistic regression model was established and incorporated with subgroup analysis and restricted cubic spline (RCS). The cutoff value of SII was acquired from receiver operator characteristic curve (ROC), and propensity score matching (PSM) was utilized to attenuate the confounding effect. Survival analysis was utilized to evaluate the relationship between SII and 30-day or 90-day all-cause mortality.

Among the 7,518 participants, 1,685 cases of delirium occurred. Individuals in the highest quartile of SII exhibited a heightened delirium risk, with a significant multivariable-adjusted odds ratio (OR) of 3.12(2.24,4.33). Tendency analysis, subgroup analysis and PSM together confirmed the positive relationship. Results of Cox regression displayed the risk of both 30-day and 90-day mortality increased about 50% in the higher-SII group.

Higher levels of SII is positively associated with the occurrence of delirium and increased all-cause mortality risk.

Co-designing healthcare interventions is gaining recognition as a novel and collaborative method. Co-design involves end-users from the start, ensuring that an intervention best meets their needs. Despite its potential benefits, this approach is not yet widely used in developing clinical interventions within intensive care units where the perspectives of patients, family members, and clinicians are crucial.

To describe the application, benefits and challenges of the Double Diamond model to co-design a digital family-led voice reorientation intervention for delirium prevention and management in critically ill adult patients.

The co-design process was guided by the Double Diamond model over a period of 12 months. Development involved patients, family members, and nursing and medical staff as co-designers and decision-makers in the iterative development of the intervention. Data from field notes and group meetings were audio recorded, transcribed verbatim, and content analysed at each phase, which were then presented to the co-designers for verification and refinement.

Co-designers included people with lived experience of the ICU as patients (n = 5) and family members (n = 1) and clinical experts (nursing staff n = 3; medical staff n = 3). Co-designers were highly engaged and reported positive experiences and collaboration in the co-design process. Sharing the diversity of their own personal ICU experiences was found to be beneficial as it not only validated individual feelings but also strengthened intervention development. Differences in interpretations and meanings of the voice messages proposed as part of the intervention were challenging. Maintaining sufficient focus on each phase of the Double Diamond was difficult due to the complexity of the context in which the intervention was being co-designed and the resulting challenges of maintaining the engagement of the co-designers throughout the process.

There were benefits and challenges of engaging people with lived experience in an intensive care unit as co-designers through the Double Diamond design process to develop a digital family-led intervention for delirium prevention and management. Overall, applying the Double Diamond to co-design a clinical intervention is recommended, whereby the collaboration process benefits patients, family members, and clinical staff.

ACTRN12622001568707; ANZCTR - Registration.

Nearly one-quarter of adult critical illness survivors develop posttraumatic stress disorder symptoms triggered by sensory stimuli after intensive care unit discharge. Intensive care unit delirium is a risk factor for posttraumatic stress disorder. Compressed virtual reality exposure therapy (C-VRET) incorporates sensory stimuli to reduce posttraumatic stress disorder symptoms through habituation.

A critical illness survivor developed intensive care unit delirium and enrolled in a C-VRET trial to treat posttraumatic stress disorder. She reported self-isolation because of infection fears and posttraumatic stress disorder symptoms triggered by medical commercials and lawn equipment sounds. She repetitively checked her heart rate at night for fear of missing illness signs and waking up intubated.

The participant completed therapy. Screening tests were administered before, 2 weeks after, and 3 months after therapy to measure posttraumatic stress disorder symptoms (Clinician-Administered PTSD Scale for DSM-5; range, 0-60), depression (Center for Epidemiologic Studies Depression Scale; range, 0-60), physical activity (International Physical Activity Questionnaire), and resiliency (Connor-Davidson Resilience Scale; range, 0-100).

The participant's posttraumatic stress disorder symptom scores declined from 36 to 11 to 5; depression scores declined from 19 to 5 to 1; physical activity scores increased from 499 to 2013 to 4599; and resiliency scores increased from 70 to 76 to 83.

This report highlights the severity of posttraumatic stress disorder symptoms in critical illness survivors and the importance of strategies to limit delirium and posttraumatic stress disorder. Compressed virtual reality exposure therapy may reduce posttraumatic stress disorder symptoms in critical illness survivors.

Introduction: Delirium in postoperative geriatric hip fracture patients is a serious and often preventable condition. If detected in time, it can be treated, but a delay in the diagnosis and initiation of treatment impairs outcomes. A novel approach to detect delirium is to use point-of-care electro-encephalogram (EEG) recording with automated analysis. In this study, the authors investigated whether screening for delirium with EEG recording and automated analysis resulted in reduced length of stay after surgery and superior screening performance in comparison to the Delirium Observation Screening Scale (DOS). Methods: This randomized control trial was conducted at two geriatric trauma centres in the Netherlands. Patients were eligible for inclusion if they were aged 70 years or above, were admitted to the geriatric trauma unit and undergoing surgery for a hip fracture. Patients were randomized to either the intervention (EEG-based brainwave analysis) or control group (DOSS screening tool). Participants were screened for delirium twice a day during three consecutive days starting at day 0 of the surgery, with the first measurement before the surgery. The primary outcome was length of stay. In addition, the screening performance for both automated EEG-based brainwave analysis and DOS was determined. Results: A total of 388 patients were included (189 per arm). There were no differences between groups in terms of median hospital length of stay (DOS 7 days (IQR 5.75-9) vs. EEG-based brainwave analysis 7 days (IQR 5-9); p = 0.867). The performance of EEG-based brainwave analysis was considerably lower than that of the DOSS in terms of discrimination between patients with and without postoperative delirium. Conclusions: Screening for postoperative delirium in geriatric hip fracture patients using automated EEG-based brainwave analysis did not result in a shorter length of stay. Additionally, the results of this study show no clear advantage in terms of the screening performance of EEG-based brainwave analysis over the current standard of care for geriatric patients with a hip fracture.

Delirium can result in undesirable outcomes including increased length of stays and mortality in patients admitted to the intensive care unit (ICU). Dexmedetomidine has emerged for delirium prevention in these patients; however, optimal dosing is challenging. A reinforcement learning-based Artificial Intelligence model for Delirium prevention (AID) is proposed to optimize dexmedetomidine dosing. The model was developed and internally validated using 2416 patients (2531 ICU admissions) and externally validated on 270 patients (274 ICU admissions). The estimated performance return of the AID policy was higher than that of the clinicians' policy in both derivation (0.390 95% confidence interval [CI] 0.361 to 0.420 vs. -0.051 95% CI -0.077 to -0.025) and external validation (0.186 95% CI 0.139 to 0.236 vs. -0.436 95% CI -0.474 to -0.402) cohorts. Our finding indicates that AID might support clinicians' decision-making regarding dexmedetomidine dosing to prevent delirium in ICU patients, but further off-policy evaluation is required.

ICU nurses play a critical role in managing delirium in critically ill patients, yet their competency in this area remains under-explored.

To assess ICU nurses' competency including their knowledge, practice, and attitudes toward delirium among critically ill patients.

A correlational descriptive study was conducted with 67 nurses in the medical intensive care unit at Suez Canal University Hospitals. Data was collected using an online survey and analyzed using descriptive statistics, ANOVA, and Pearson's correlation.

Nurses showed a moderate knowledge level (M = 8.55), a low practice level (M = 6.62), and positive attitudes (M = 21.65) toward ICU delirium. ANOVA results indicated significant differences in practice scores based on educational level, F (2, 64) = 3.361, p = .041, and in knowledge scores based on ICU experience, F(3, 63) = 6.455, p < .001. Nurses with Master of Science in Nursing (MSN) degrees had higher practice scores than those with diplomas or Bachelor of Science in Nursing (BSN) degrees. There were no significant differences in knowledge and attitude scores based on educational level or age. Gender differences were minimal, with male nurses slightly outperforming female nurses. Correlation analysis showed positive relationships between age, education, ICU experience, and ICU nurses' levels of knowledge and practice.

ICU nurses demonstrate a knowledge-practice gap in delirium management. Targeted educational interventions, mentorship programs, and a focus on practical skills are essential to enhance delirium care.

These findings highlight the urgent need for comprehensive delirium education and training programs for ICU nurses. By improving nurses' knowledge and practice, healthcare organizations can significantly enhance the early detection, prevention, and management of delirium, ultimately leading to improved patient outcomes and reduced length of stay in the ICU.

The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a robust and reliable instrument for discerning delirium within the specific context of the intensive care unit (ICU). Nonetheless, the CAM-ICU is burdened by various limitations, including a protracted learning curve and the need for frequent daily administration. The 4 A's Test (4AT) was formulated to assess delirium in hospitalized patients and may have distinct advantages over the CAM-ICU, particularly regarding practical applicability within the ICU bundle. This study was performed to assess the utility of the 4AT in detecting delirium in critically ill patients. This multicenter prospective observational study involved critically ill patients at four academic tertiary care hospitals in South Korea from June 2021 to September 2022. In total, 274 patients (median age, 64 years; 56.9% men) were included, and 75 (27.4%) developed delirium. The 4AT showed good performance in detecting ICU delirium (area under the curve, 0.879; P < 0.001). The 4AT showed a sensitivity of 74.0%, specificity of 95.4%, positive predictive value of 77.5%, negative predictive value of 94.6%, and accuracy of 91.7% for ICU detection of delirium. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the CAM-ICU for detecting ICU delirium were 71.3%, 97.1%, 83.8%, 94.1%, and 92.6%, respectively. The 4AT showed acceptable reliability and validity for detecting ICU delirium in critically ill patients. Because the 4AT is simpler and easier to learn, this scale could be a useful alternative to the CAM-ICU for detecting delirium in critically ill patients.

Intensive care unit delirium (ICUD) is an acute cerebral dysfunction accompanied by a change of level of consciousness, disorientation, and cognitive dysfunction, typically occurring over a short duration ranging from hours to days and resulting from underlying medical causes. Family members may sometimes detect changes in consciousness earlier than medical staff. The Sour Seven Questionnaire is a tool to assist family members in screening for delirium, but there is currently no Chinese version. This study aimed to translate and cross-culturally debug the Sour Seven Questionnaire and test the effectiveness of the Chinese version in screening for ICUD by family members.

To create the Chinese version of the questionnaire, the questionnaire was first translated and then culturally debugged through expert consultation and cognitive interviews. Patients and their family members admitted to three ICUs in a Chinese hospital were selected to test the Chinese version of the Sour Seven Questionnaire and the results were compared with those of the validated and recommended Confusion Assessment Method for the intensive care unit (CAM-ICU) assessment.

A total of 190 ICU patients and their families were included in this study. Results of the CAM-ICU assessment showed that 73 (38.4%) patients developed ICUD compared to the 66 (34.7%) using the Chinese version of the Sour Seven Questionnaire, which had a Cohen's kappa coefficient of 0.853, a sensitivity of 0.863, and a specificity of 0.974. The positive predictive value was 0.954 and the negative predictive value was 0.919.

The Chinese version of the Sour Seven Questionnaire is a valid assessment tool for helping families screen for ICUD, and it is effective in identifying altered consciousness in patients even during online visits.

To identify risk factors for postoperative delirium in adult patients undergoing cardiopulmonary bypass.

The medical records of 214 patients who underwent cardiopulmonary bypass at the First Affiliated Hospital of Hunan Normal University from January 2022 to January 2024 were retrospectively analyzed. Based on the occurrence of postoperative delirium, patients were divided into a delirium group (49 cases) and a non-delirium group (165 cases). Outcome measures, including clinical baseline data, preoperative left ventricular ejection fraction (LVEF), preoperative Acute Physiology and Chronic Health Evaluation II (APACHE II) score, anesthesia duration, surgery duration, aortic cross-clamp duration, intraoperative mean arterial pressure (MAP), intraoperative blood loss, length of intensive care unit (ICU) stay, postoperative mechanical ventilation duration, as well as postoperative MAP, were compared between the two groups. Logistic regression analysis was performed to identify the potential factors associated with post-operative delirium in patients.

Of the included 214 patients, 49 patients experienced delirium, resulting in an incidence of 22.90%. The delirium group had significantly lower LVEF and significantly higher APACHE II scores compared to the non-delirium group (all P<0.001). No significant difference was observed between the two groups in terms of anesthesia duration, surgery duration, aortic cross-clamp duration, intraoperative MAP, and intraoperative blood loss (all P>0.05). The delirium group experienced significantly longer length of ICU stay and postoperative mechanical ventilation duration as compared to the non-delirium group (all P<0.001), but no significant difference was observed in terms of postoperative MAP between the two groups (P>0.05). Logistic regression analysis identified preoperative New York Heart Association classification (NYHA) (OR: 6.755, 95% CI: 2.529-18.039, P<0.001), preoperative LVEF (OR: 6.886, 95% CI: 2.383-19.899, P<0.001), preoperative APACHE II score (OR: 7.788, 95% CI: 2.740-22.135, P<0.001), length of ICU stay (OR: 9.463, 95% CI: 3.563-25.135, P<0.001), and postoperative mechanical ventilation duration (OR: 9.744, 95% CI: 3.419-27.768, P<0.001) as independent factors influencing the occurrence of delirium in adult patients undergoing cardiopulmonary bypass.

Postoperative delirium is a prevalent complication among patients undergoing cardiac surgery. Independent risk factors for postoperative delirium in adult patients undergoing cardiopulmonary bypass during cardiac surgery include preoperative NYHA class III or IV, lower LVEF, higher APACHE II score, an extended length of stay in the ICU, and prolonged postoperative mechanical ventilation duration.

Patients with ischemic stroke have an increased propensity to fall, resulting in significant physical and psychological distress. This study examined the association between falls in the 3 months prior to intensive care unit (ICU) admission and mortality within 28 days among 2950 adult ICU patients diagnosed with ischemic stroke from 2008 to 2019, focusing on the potential mediating role of delirium. The primary outcomes were short-term mortality (28, 60, and 90 days) and the risk of delirium. Each patient was followed for at least 1 year. Delirium was primarily assessed using the Confusion Assessment Method for the ICU and by reviewing nursing notes. Group differences between patients with and without a history of falls were compared using the Wilcoxon rank-sum test or the chi-squared test. Cox proportional risk or logistic regression models were used to explore the association between fall history and outcomes, and causal mediation analysis was performed. Results showed that patients with a recent fall history had a significantly increased risk of 28-day (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.35-1.94), 60-day (HR: 1.67, 95% CI: 1.42-1.98), and 90-day mortality (HR: 1.66, 95% CI: 1.41-1.95), as well as an increased risk of delirium (odds ratio: 2.00, 95% CI: 1.66-2.42). Delirium significantly mediated the association between fall history and 28-day mortality (total effect: HR: 1.77, 95% CI: 1.45-2.16; natural indirect effect: HR: 1.12, 95% CI: 1.05-1.21; proportion mediated: 24.6%). These findings suggest that ischemic stroke patients with a recent fall have an increased risk of short-term mortality, partly mediated by delirium. Strategies aimed at preventing delirium may potentially improve prognosis in this patient population.