Zugl.: Berlin, Charité, Univ.-Med., Diss., 2007. / Hergestellt on demand. Originaltitel: Neuropsychologische und psychopathologische Differenzierung des Delirsyndroms.

INTRODUCTION: Postoperative delirium (POD) is a subtype of delirium that commonly occurs within the first three days after a surgical procedure. Common risk factors for POD include advanced age, dementia, visual and hearing impairment, alcohol abuse, illicit drug use, and previous history of delirium.This study aimed to investigate the risk factors associated with POD in elderly surgical patients following elective surgical procedures. METHODS: This is a prospective observational study. Demographic information and clinical data were collected for adult patients over 65 years old who underwent elective surgical procedures that required general anesthesia at Boston Medical Center (BMC) between May 2021 and November 2022. POD was assessed using the Confusion Assessment Method, which was administered by the nursing staff as part of usual care protocols at BMC. Univariate analysis was utilized to assess potential risk factors. A multivariate logistic regression with odds ratio (OR) and 95% confidence interval (CI) was conducted in order to identify independent risk factors. RESULTS: A total of 89 patients were enrolled in this study, including 43 male and 46 female patients. Four patients presented with POD following their surgical procedure, making the incidence of POD in this study 4.5%. There was a statistically significant difference regarding frequency of alcohol use, with 50% of POD patients classified as having frequent alcohol use compared to 7.1% of patients without POD (p = 0.029). POD patients had significantly lower incidence of increased blood pressure fluctuations during surgery compared to patients without POD (50% versus 95.3%, p = 0.012). Increased blood pressure fluctuation during surgery was also identified as a significant protective factor in elderly patients without POD (OR: 0.002, p = 0.015) POD was also significantly associated with administration of postoperative olanzapine (25% versus 0%, p = 0.027) and quetiapine (25% versus 0%, p = 0.027). CONCLUSIONS: POD in elderly patients after elective surgery procedures with general anesthesia is significantly associated with frequent alcohol use, postoperative administration of quetiapine, and postoperative administration of olanzapine. Increased blood pressure fluctuations was significantly greater in patients without POD, which suggests it may be an important protective factor against POD. Future study should consider focusing on the effects of hemodynamics in the development of POD.

Zugl.: Berlin, Charité, Univ.-Med., Diss., 2007 u.d.T.: Gabriel, Alexander: Neuropsychologische und psychopathologische Differenzierung des Delirsyndroms / Hergestellt on demand

Diss.--Medicin und Chirurgie--Berlin--Friedrich-Wilhelms-Universität, 1895.

Th.--Méd.--Paris, 1898-1899. / Paris, 1898-1899 tome 35, n ° 231.

Delirium är vanligt förekommande bland intensivvårdspatienter. Forskning visar att upp till 87 % av patienterna inom intensivvården drabbas av delirium. Delirium förekommer i tre olika former, hyperaktivt, hypoaktivt och en mixad form. Delirium innebär ett stort lidande inte bara för patienten utan också för de närstående. Intensivvårdssjuksköterskan har en viktig uppgift i att identifiera och lindra delirium. Kända riskfaktorer för att utveckla delirium är, hög ålder, genomgången hjärtkirurgi, smärta och sederande läkemedel. Det finns ett flertal bedömningsinstrument som hjälp för intensivvårdssjuksköterskan att screena patienter för delirium. Delirium är en allvarlig komplikation som kan ge förlängd vårdtid och ökad risk för mortalitet. Syftet med litteraturstudien är att beskriva omvårdnadsåtgärder som kan minska lidandet hos patienter som drabbas av delirium i samband med intensivvård. Vetenskapliga artiklar har granskats genom en litteraturstudie. Vid analys av artiklarna utkristalliserades två huvudteman, Icke farmakologiska omvårdnadsåtgärder  och förebyggande omvårdnadsåtgärder.  Intensivvårdssjuksköterskan kan genom att anpassa vårdmiljön runt patienten med reducering av ljud, ljus och andra störmoment reducera förekomst av delirium. Mobilisering, reorientering och kognitiv stimulans är andra omvårdnadsåtgärder som kan lindra delirium. Att ständigt arbeta med att fortbilda vårdpersonal i delirium och att arbeta utifrån evidensbaserad omvårdnad är av stor vikt ur både patientperspektiv och samhällsperspektiv.

The circadian rhythm is an internal body cadence, responsible for regulation of sleep in all mammals. In humans, this clock is altered by several factors, including light and secretion of the hormone melatonin. Within the intensive care unit (ICU) population, it is well evidenced that patients suffer from circadian dysregulation, often for long periods of time. Additionally, many parallels have been noted between severely fragmented sleep and delirium, an acute neurological condition frequently observed in ICU patients. A prospective cohort pilot study of five subjects was undertaken to enable a greater understanding of both sleep in the ICU and the relationship between circadian rhythm and delirium. From a total of thirty-six urine samples per subject, excretion of 6-sulphatoxymelatonin (aMT6s), the urinary metabolite of melatonin was analyzed. T-test comparison (p=0.05) of mean aMT6s (ng/mL) revealed significant differences in the nighttime excretion between subjects in this study and healthy individuals. No significant differences were observed with t-test comparison of mean aMT6s of the first 24 hours from the current study to ICU subjects in previous literature. No subjects were identified as delirious in the study and therefore no relationship could be found between circadian rhythmicity, as evidenced by melatonin excretion and delirium in this study population. / February 2017

Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry-© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.

Bakgrund: Delirium är ett vanligt tillstånd hos patienter på intensivvårdsavdelning (IVA) och kännetecknas av en akut förändring eller variation i patientens mentala status. Tillståndet är mycket underdiagnostiserat, trots vedertagna bedömningsinstrument. Flertalet riskfaktorer är identifierade och innefattar patientens tidigare sjukdomar och levnadsvanor, aktuellt sjukdomstillstånd och den omgivande miljön. Delirium leder till ett lidande för patienten och har även negativa konsekvenser för samhället. Syfte: Att studera vilka omvårdnadsåtgärder som visats vara effektiva för att förebygga delirium och därmed kunna lindra lidande. Metod: Litteraturstudie. Resultat: De omvårdnadsåtgärder som visades kunna förebygga delirium resulterade i tre huvudområden. Inom "Sömn, ljud och ljus" ledde åtgärder som reducerade ljud- och ljusnivåer samt samordning av omvårdnadsåtgärder nattetid till förbättring av patienternas nattsömn och lägre incidens och duration av delirium. Att vårdas på enkelrum och tillgång till dagsljus ledde till lägre incidens och duration av delirium. Inom området "Vakenhet" ledde minskad sedering och införande av så kallade sederingsprotokoll till lägre incidens och duration av delirium. Tidig mobilisering ledde till lägre duration av delirium. Inom det sista området "Orientering och närstående" visades att reorientering av patienterna ledde till lägre incidens och duration av delirium och att involvera närstående i omvårdnaden ledde till att patienterna hade en bättre psykisk återhämtning vid utskrivning från IVA. Slutsats: Det har framkommit att omvårdnadsåtgärder kan förebygga delirium på en intensivvårdsavdelning. Dessa åtgärder är kliniskt tillämpbara och kan gynna såväl patienter som samhället.

Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.