A reorientation strategy for reducing delirium in the critically ill. Results of an interventional study.

Abstract:

BACKGROUND:A wide variability in the approach towards delirium prevention and treatment in the critically ill results from the dearth of prospective randomised studies. METHODS:We launched a two-stage prospective observational study to assess delirium epidemiology, risk factors and impact on patient outcome, by enrolling all patients admitted to our Intensive Care Unit (ICU) over a year. The first step - from January to June 2008 was the observational phase, whereas the second one from July to December 2008 was interventional. All the patients admitted to our ICU were recruited but those with pre-existing cognitive disorders, dementia, psychosis and disability after stroke were excluded from the data analysis. Delirium assessment was performed according with Confusion Assessment Method for the ICU twice per day after sedation interruption. During phase 2, patients underwent both a re-orientation strategy and environmental, acoustic and visual stimulation. RESULTS:We admitted a total of respectively 170 (I-ph) and 144 patients (II-ph). The delirium occurrence was significantly lower in (II-ph) 22% vs. 35% in (I-ph) (P=0.020). A Cox's Proportional Hazard model found the applied reorientation strategy as the strongest protective predictors of delirium: (HR 0.504, 95% C.I. 0.313-0.890, P=0.034), whereas age (HR 1.034, 95% CI: 1.013-1.056, P=0.001) and sedation with midazolam plus opiate (HR 2.145, 95% CI: 2.247-4.032, P=0.018) were negative predictors. CONCLUSION:A timely reorientation strategy seems to be correlated with significantly lower occurrence of delirium.

journal_name

Minerva Anestesiol

journal_title

Minerva anestesiologica

authors

Colombo R,Corona A,Praga F,Minari C,Giannotti C,Castelli A,Raimondi F

subject

Has Abstract

pub_date

2012-09-01 00:00:00

pages

1026-33

issue

9

eissn

0375-9393

issn

1827-1596

pii

R02127478

journal_volume

78

pub_type

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    authors: Abbal B,Choquet O,Gourari A,Bouic N,Massone A,Biboulet P,Bringuier S,Capdevila X

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  • [Mixed venous oxygen saturation as optimization of the therapeutic response in low output syndrome].

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  • Insulin differentially influences brain glucose and lactate in traumatic brain injured patients.

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  • [Intravenous anesthesia with perfused propofol combined with loco-regional spinal anesthesia].

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  • Sensory assessment and block duration of transmuscular quadratus lumborum block at L2 versus L4 in volunteers: a randomized controlled trial.

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    doi:

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  • [Continuous intravenous infusion with patient-controlled anesthesia for postoperative analgesia in cesarean section: morphine versus buprenorphine].

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    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

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  • [Althesin in general surgery].

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    doi:

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    更新日期:1980-02-01 00:00:00

  • [Postoperative cerebral edema. Physiopathology of the edema and medical therapy].

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    pub_type: 杂志文章,评审

    doi:

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    更新日期:1992-04-01 00:00:00

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    pub_type: 杂志文章,随机对照试验

    doi:

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