• Humans
• Delirium/diagnosis
• Aged
• Quality of Life/psychology
• Prevalence
• Psychiatric Nursing

• aging
• geriatrics
• pneumology
• ventilation
• weaning failure

• Early complications
• Major surgery
• Medium surgery
• PACU stay
• Post-operative care unit

• Humans
• Retrospective Studies
• Male
• Female
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Middle Aged
• Aged
• Prevalence
• Germany
• Postoperative Care/methods
• Intensive Care Units
• Adult
• Surgical Procedures, Operative/adverse effects
• Length of Stay/statistics & numerical data

• Universitätsklinikum Essen (8912)

• covid-19
• delirium
• intensive care unit
• mechanical ventilation
• sedation

• Delirium
• Hospitalization
• Nursing homes
• Readmission
• Unplanned

• Humans
• Male
• Female
• Aged
• Retrospective Studies
• Patient Readmission/statistics & numerical data
• Delirium/epidemiology
• Longitudinal Studies
• Aged, 80 and over
• Length of Stay/statistics & numerical data
• Logistic Models
• Victoria/epidemiology

• adult
• critical care
• critically ill
• delirium
• intensive care unit
• nursing care

• hepatic encephalopathy
• liver transplantation
• long-term healing

• attitude
• delirium
• intensive care
• knowledge
• professionals

• Humans
• Cross-Sectional Studies
• Ethiopia
• Health Knowledge, Attitudes, Practice
• Health Personnel
• Intensive Care Units
• Hospitals
• Delirium

• Humans
• Pilot Projects
• Critical Illness/therapy
• Prospective Studies
• Retrospective Studies
• Sleep Deprivation/drug therapy
• Pain/diagnosis
• Pain/drug therapy
• Delirium/drug therapy
• Delirium/etiology
• Observational Studies as Topic

• Humans
• Retrospective Studies
• Delirium/epidemiology
• Delirium/etiology
• Delirium/therapy
• COVID-19/complications
• COVID-19/therapy
• Intensive Care Units
• Length of Stay
• Hypertension/complications
• Neuromuscular Blocking Agents
• Risk Factors

• National Cancer Center

• Humans
• Preoperative Exercise
• Databases, Factual
• Morbidity
• Pain, Postoperative
• Postoperative Complications/prevention & control
• Randomized Controlled Trials as Topic

• critical illness
• delirium
• intensive care units
• pakistan
• prevalence

• acute ischemic stroke
• cerebral amyloid angiopathy
• clinical outcome
• data curation
• database
• electronic health record
• intracerebral hemorrhage
• learning health system
• subarachnoid hemorrhage
• transient ischemic attack

• ABCDEF bundle
• Critical illness
• Delirium
• Systematic review
• meta-analysis

• HMG-CoA reductase inhibitor
• delirium
• intensive care unit
• statin

• Critical Care
• ECMO
• ICU outcomes
• intensive care unit
• mortality

As the COVID-19 pandemic is increasingly griping the world, it starts effecting the psychosocial health of the patients, health care workers, frontline workers and their dependents. The entire landscape of existing patient psychological counselling and management needs to be changed to avoid fear and misinformation about COVID-19.

In this article, we have tried to summarize the rules, regulations and protocols in accordance with government guidelines along with practical implementation of counselling in management of psychological health condition of patients and frontline workers.

If used wisely and as per recommendations, psychosocial counselling is a very useful tool in the present COVID-19 pandemic, to avoid spread of misinformation, fear and grief about the disease which creates mental health issue and anxiety among close contacts as well as health care workers.

• COVID-19 pandemic
• Frontline workers
• Mental health
• Psychosocial counselling

• ICU
• critical illness
• delirium
• thiamine

• Critical Illness
• Delirium/drug therapy
• Delirium/prevention & control
• Evidence-Based Practice
• Humans
• Intensive Care Units
• Length of Stay
• Thiamine/therapeutic use

• Antipsychotics
• Delirium
• Hyperactive
• Hypoactive
• Mortality

Background

This study aimed to evaluate the role of disturbed circadian rhythm in potentiating intensive care unit (ICU)-acquired delirium.Previous studies have demonstrated bright light therapy (BLT) as an effective modality to improve sleeping patterns and cognitive function in non-critically ill patients. However, its benefit in the ICU has not been clearly established. In this study, we aimed to evaluate the application of daily high-intensity phototherapy at the bedside to deter ICU delirium incidence and duration.

Methodology

This was a single center, prospective study conducted in ICUs at the Carilion Roanoke Memorial Hospital in Roanoke, VA. Adults patients admitted to the ICU from July 9, 2018 to March 20, 2020 were included in the study. The patients were subjected to 30-minute BLT session (10,000 lux) at the bedside starting at 0700 while in the ICU. Patients were randomized into either the control group (standard hospital lighting) or phototherapy group. Data were analyzed using Wilcoxon rank sum test for continuous variables, Pearson chi-square test for categorical variables, and logistic regression for multivariable analysis that examined significant risk factors for ICU delirium.

Results

Delirium incidence between BLT (18%) and control (17.5%) groups was non-significant. Total number of delirium-free, coma-free days, as determined by Confusion Assessment Method for the ICU, demonstrated no differences between groups with a median of 28 days (p = 0.516). In multivariable analysis, patients with a Sequential Organ Failure Assessment Score >3 also showed no significant change in ICU delirium incidence when provided bedside BLT compared to those with standard hospital lighting (odds ratio: 0.08; 95% confidence interval: 0.002-1.40; p = 0.867).

Conclusions

In this randomized control pilot study, daily morning 10,000 lux BLT of 30-minute duration alone was not associated with a significant decrease in ICU-acquired delirium incidence or duration compared to standard hospital lighting. Future studies should consider a nuanced approach to better elucidate the role of disturbed circadian rhythm in influencing ICU-acquired delirium by not only undertaking BLT during the day but also minimizing nighttime light exposure.

• bright light therapy
• circadian rhythm
• delirium in icu
• icu delirium
• prolonged mechanical ventilation
• quality improvement and patient safety

To evaluate the incidence and modifiable risk factors of delirium in surgical intensive care unit (SICU) of tertiary care hospital in a low-income and middle-income country.

We conducted a single cohort observational study in patients over 18 years of age who were admitted to the SICU for >24 hours in Aga Khan University Hospital from January to December 2016. Patients who had pre-existing cognitive dysfunction were excluded. Intensive Care Delirium Screening Checklist was used to assess delirium. Incidence of delirium was computed, and univariate and multivariable analyses were performed to observe the relationship between outcome and associated factors.

The average patient age was 43.29±17.38 and body mass index was 26.25±3.57 kg/m². Delirium was observed in 19 of 87 patients with an incidence rate of 21.8%. Multivariable analysis showed chronic obstructive pulmonary disease, pain score >4 and hypernatremia were strong predictors of delirium. Midazolam (adjusted OR (aOR)=7.37; 95% CI 2.04 to 26.61) and propofol exposure (aOR=7.02; 95% CI 1.92 to 25.76) were the strongest independent predictors of delirium while analgesic exposures were not statistically significant to predict delirium in multivariable analysis.

Delirium is a significant risk factor of poor outcome in SICU. There was an independent association between pain, sedation, COPD, hypernatremia and fever in developing delirium.

IV.

• brain
• morbidity
• observational study
• risk factor

Delirium is one of the prevalent complications of post open heart surgery. The present research aimed to assess the effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients.

In this quasi-experimental study, 96 patients under open heart surgery were selected using convenience sampling and divided into a control and an intervention group. The interventions included the patients’ preoperative education, nurses’ education, and in-ward environmental interventions. The demographic information and Mini-Mental State Examination (MMSE) questionnaires were completed a day before surgery. The patients in both groups were also surveyed after extubation until the fourth day post operation using Delirium Observation Screening (DOS) scale considering the incidence, severity, and duration of delirium. The data were analyzed using the SPSS statistical software, version 20.

The incidence rate of delirium was 14.6 and 6.2% in the control and intervention groups, respectively (p > 0.05). Besides, the mean severity of delirium was 0.53 in the control group and 0.40 in the intervention group (p > 0.05). Finally, the mean duration of delirium was 4.5 and 3.25 h in the two groups, respectively (p > 0.05).

Since prevention of delirium can play a considerable role in the patients’ recovery after heart surgery, it is necessary to carry out some measures to prevent such complications. Even though the interventions performed in this study did not cause significant changes in this regard, the results suggested that prevention interventions should be performed with stronger and more integrated planning for achieving better outcomes.

• Delirium
• Multi-component interventions
• Nursing
• Open heart surgery

• Antipsychotic Agents/therapeutic use
• Coronary Care Units
• Delirium/diagnosis
• Delirium/prevention & control
• Delirium/therapy
• Dementia/diagnosis
• Depression/diagnosis
• Dexmedetomidine/therapeutic use
• Diagnosis, Differential
• Humans
• Hypnotics and Sedatives/therapeutic use
• Psychotic Disorders/diagnosis
• Risk Assessment

• Intensive care unit
• One-way speaking valve
• Passy-Muir valve
• Physiological changes
• Safety
• Tracheostomy

Delirium is a syndrome characterized by acute brain failure resulting in neurocognitive disturbances affecting attention, awareness, and cognition. It is highly prevalent among critically ill patients and is associated with increased morbidity and mortality. A core domain of delirium is represented by behavioral disturbances in sleep-wake cycle probably related to circadian rhythm disruption. The relationship between sleep, circadian rhythm and intensive care unit (ICU)-acquired delirium is complex and likely bidirectional. In this review, we explore the proposed pathophysiological mechanisms of sleep disruption and circadian dysrhythmia as possible contributing factors in transitioning to delirium in the ICU and highlight some of the most relevant caveats for understanding the relationship between these complex phenomena. Specifically, we will (1) review the physiological consequences of poor sleep quality and efficiency; (2) explore how the neural substrate underlying the circadian clock functions may be disrupted in delirium; (3) discuss the role of sedative drugs as contributors to delirium and chrono-disruption; and, (4) describe the association between abnormal sleep-pathological wakefulness, circadian dysrhythmia, delirium and critical illness. Opportunities to improve sleep and readjust circadian rhythmicity to realign the circadian clock may exist as therapeutic targets in both the prevention and treatment of delirium in the ICU. Further research is required to better define these conditions and understand the underlying physiologic relationship to develop effective prevention and therapeutic strategies.

• ICU acquired delirium
• circadian rhythm
• intervention
• mechanisms
• sleep

Delirium is the most common neuropsychiatric challenge in cancer patients, particularly in the critically ill population. Without a screening method and constant vigilance by providers, delirium is often misdiagnosed. The purpose of our pilot study was to determine if an educational program targeting critical care medicine advanced practice providers (APPs) and fellows in an oncologic intensive care unit would increase APP knowledge of delirium and their level of comfort with delirium screening and management. Thirty-one APPs and fellows participated in the program. Scores on knowledge-based delirium assessments increased significantly after the intervention and at the 3-month follow-up (p < .0001 and p < .0225, respectively). Providers’ comfort with delirium screening and management also improved after the intervention (p = .0020 and p < .0001, respectively) and decreased slightly at the 3-month follow-up (p = .1764 and p = .9840, respectively). A brief and focused APP-led educational initiative successfully improved knowledge of delirium and comfort with screening and management.

Coronavirus disease-19 (COVID-19) pandemic is causing a worldwide humanitarian crisis. Old age, comorbid conditions, end-stage organ impairment, and advanced cancer, increase the risk of mortality in serious COVID-19. A subset of serious COVID-19 patients with serious acute respiratory illness may be triaged not to receive aggressive intensive care unit (ICU) treatment and ventilation or may be discontinued from ventilation due to their underlying conditions. Those not eligible for aggressive ICU measures should receive appropriate symptom management. Early warning scores (EWS), oxygen saturation, and respiratory rate, can facilitate categorizing COVID-19 patients as stable, unstable, and end of life. Breathlessness, delirium, respiratory secretions, and pain, are the key symptoms that need to be assessed and palliated. Palliative sedation measures are needed to manage intractable symptoms. Goals of care should be discussed, and advance care plan should be made in patients who are unlikely to benefit from aggressive ICU measures and ventilation. For patients who are already in an ICU, either ventilated or needing ventilation, a futility assessment is made. If there is a consensus on futility, a family meeting is conducted either virtually or face to face depending on the infection risk and infection control protocol. The family should be sensitively communicated about the futility of ICU measures and foregoing life-sustaining treatment. Family meeting outcomes are documented, and consent for foregoing life-sustaining treatment is obtained. Appropriate symptom management enables comfort at the end of life to all serious COVID-19 patients not receiving or not eligible to receive ICU measures and ventilation.

How to cite this article: Salins N, Mani RK, Gursahani R, Simha S, Bhatnagar S. Symptom Management and Supportive Care of Serious COVID-19 Patients and their Families in India. Indian J Crit Care Med 2020;24(6):435–444.

• COVID-19
• Palliative care
• Supportive care
• Symptom management

Delirium is the most frequent manifestation of acute brain dysfunction in intensive care unit (ICU). Although antipsychotics are widely used to treat this serious complication, recent evidence has emphasized that these agents did not reduce ICU delirium (ICU-D) prevalence and did not improve survival, length of ICU or hospital stay after its occurrence. Of note, no pharmacological strategy to prevent or treat delirium has been identified, so far. In this scenario, new scientific evidences are urgently needed. Investigations on specific ICU-D subgroups, or focused on different clinical settings, and studies on medications other than antipsychotics, such as dexmedetomidine or melatonin, may represent interesting fields of research. In the meantime, because there is some evidence that ICU-D can be effectively prevented, the literature suggests strengthening all the strategies aimed at prevention through no-pharmacological approaches mostly focused on the correction of risk factors. The more appropriate strategy useful to treat established delirium remains the use of antipsychotics managed by choosing the right doses after a careful case-by-case analysis. While the evidence regarding the use of dexmedetomidine is still conflicting and sparse, this drug offers interesting perspectives for both ICU-D prevention and treatment. This paper aims to provide an overview of current pharmacological approaches of evidence-based medicine practice. The state of the art of the on-going clinical research on the topic and perspectives for future research are also addressed.

• Delirium
• Intensive care
• Haloperidol
• Antipsychotic agents
• Major tranquilizers
• Cognitive decline
• Dexmedetomidine

• ED Extubation
• Emergency Department Critical Care
• Resuscitation

• critical care
• delirium
• intensive care unit
• prevention
• risk factors

• ICU
• cardiosurgery
• delirium
• environment
• patient
• predictors

• Aged
• Aged, 80 and over
• Cardiac Surgical Procedures/adverse effects
• Delirium/etiology
• Female
• Humans
• Intensive Care Units/statistics & numerical data
• Male
• Postoperative Complications/etiology

• delirium
• older people
• prevalence
• primary care
• risk factors

• Aged
• Aged, 80 and over
• Anticonvulsants/adverse effects
• Benzodiazepines/adverse effects
• Case-Control Studies
• Delirium/diagnosis
• Delirium/epidemiology
• Delirium/psychology
• Dementia/epidemiology
• Dementia/psychology
• Female
• General Practice
• Germany/epidemiology
• Homes for the Aged/statistics & numerical data
• Humans
• Male
• Nursing Homes/statistics & numerical data
• Parkinson Disease/epidemiology
• Parkinson Disease/psychology
• Polypharmacy
• Prevalence
• Primary Health Care
• Seizures/epidemiology
• Seizures/psychology

• Delirium
• Humans
• Intensive Care Units

Delirium is a primary adverse event in ventilated patients who receive long-term monosedative treatment. Sequential sedation may reduce these adverse effects. This study evaluated risk factors for delirium in sequential sedation patients.

A total of 141 patients who underwent sequential sedation were enrolled. Delirium was diagnosed using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale. Univariate and multivariate Cox proportional hazards regressions were used to predict risk factors.

Older age (≥51) (RR = 2.432, 95% CL 1.316–4.494, p = 0.005), higher SOFA score (≥14) (RR = 2.022, 95% CL 1.076–3.798, p = 0.029), regular smoking (RR = 2.366, 95% CL 1.277–4.382, p = 0.006), and higher maintenance dose of midazolam (RR = 1.052, 95% CL 1.000–1.107, p = 0.049) and fentanyl (RR = 1.045, 95% CL 1.019–1.072, p = 0.001) when patients met sequential criteria, were independent risk factors of delirium. Sequential sedation with dexmedetomidine (RR = 0.448, 95% CL 0.209–0.963, p = 0.040) was associated with a lower risk of delirium.

Older age, higher SOFA score, regular smoking, and higher maintenance dose of midazolam and fentanyl when patients met sequential criteria were independent risk factors of delirium in sequential sedation patients. Sequential sedation with dexmedetomidine reduced risk of delirium.