- Delirium in the Cardiac Intensive Care Unit. [Review]
- JAJ Am Heart Assoc 2018 Feb 16; 7(4)
- Confusion still exists regarding postoperative delirium and its etiology after esophagectomy. [Editorial]
- JTJ Thorac Cardiovasc Surg 2018; 155(3):1331-1332
- Comparison of Self-Reported and Behavioral Pain Assessment Tools in Critically Ill Patients. [Journal Article]
- JIJ Intensive Care Med 2018 Jan 01; :885066618757450
- CONCLUSIONS: Self-reported pain scale and BPS cannot be used interchangeably. Current validated BPSs may not accurately reflect self-reported pain in critically ill patients.
- Development of the Japanese version of the Preschool Confusion Assessment Method for the ICU. [Journal Article]
- AMAcute Med Surg 2018; 5(1):102-105
- CONCLUSIONS: A Japanese version of the psCAM-ICU was developed.
- Development of the Japanese version of the Cornell Assessment of Pediatric Delirium. [Journal Article]
- AMAcute Med Surg 2018; 5(1):98-101
- CONCLUSIONS: The Japanese CAPD was developed and its effectiveness tested using a standardized procedure. Further study is required to test the validity and reliability of the Japanese version of the CAPD.
- Antipsychotics, Delirium, and Acute Respiratory Distress Syndrome: What is the Link? [Journal Article]
- PPharmacotherapy 2018 Feb 14
- Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS o...
Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, long-term cognitive impairment, and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidly and mortality. Antipsychotics are prescribed to decrease the severity and duration of ICU delirium, thus potentially decreasing their risk of morbidity and mortality. Antipsychotics, however, are associated with many adverse effects including respiratory failure. Given the long-term sequelae associated with the development of ICU delirium and the risks associated with antipsychotic use, clinicians must weigh the risks and benefits of antipsychotic use. The aim of this review is to investigate the interrelationship between ARDS, delirium, and antipsychotic use. In addition to discussing relevant studies evaluating antipsychotics for the prevention and treatment of delirium, we will investigate safety concerns with the use of antipsychotics, especially as they relate to ARDS. Using the data compiled in this review, clinicians can make an informed decision about the use of antipsychotics for the prevention or treatment of delirium, with special consideration for their patients with ARDS. Future studies are needed to critically evaluate antipsychotic timing, dose, and duration for the prevention and treatment of ICU delirium and specifically evaluate impact in special populations, particularly patients with ARDS. This article is protected by copyright. All rights reserved.
- Haloperidol for delirium in critically ill patients - protocol for a systematic review. [Journal Article]
- AAActa Anaesthesiol Scand 2018 Feb 14
- CONCLUSIONS: Our ambition with this systematic review is to provide reliable and powered evidence to better inform decision makers on the use of or future trials with haloperidol for the management of delirium in critically ill patients.
- Neuroleptic malignant syndrome: a case responding to electroconvulsive therapy plus bupropion. [Journal Article]
- CPClin Pract 2018 Jan 08; 8(1):1044
- Neuroleptic malignant syndrome (NMS) is a severe motor syndrome occurring as a consequence of neuroleptic treatment. We present a case of a 67-year-old Caucasian woman with a history of a major depre...
Neuroleptic malignant syndrome (NMS) is a severe motor syndrome occurring as a consequence of neuroleptic treatment. We present a case of a 67-year-old Caucasian woman with a history of a major depressive disorder with psychotic features. During her third hospital admission, symptoms of autonomic instability, hyperpyrexia, severe extrapyramidal side effects, and delirium appeared, suggesting NMS due to concomitant treatment with risperidone and quetiapine, among other drugs. Despite several consecutive pharmacological treatments (lorazepam, bromocriptine and amantadine) and prompt initiation of electroconvulsive therapy (ECT), clinical improvement was observed only after combining bupropion with ECT. The symptoms that had motivated the admission gradually remitted and the patient was discharged home. Bupropion increases dopaminergic activity in both the nucleus accumbens and the prefrontal cortex. Therefore, from a physiopathological standpoint, bupropion has a potential role in treating NMS. However, there is scarce evidence supporting this approach and therefore future cases should be carefully considered.
- Protocol for validation of the 4AT, a rapid screening tool for delirium: a multicentre prospective diagnostic test accuracy study. [Journal Article]
- BOBMJ Open 2018 02 10; 8(2):e015572
- Delirium is a severe neuropsychiatric syndrome of rapid onset, commonly precipitated by acute illness. It is common in older people in the emergency department (ED) and acute hospital, but greatly un...
Delirium is a severe neuropsychiatric syndrome of rapid onset, commonly precipitated by acute illness. It is common in older people in the emergency department (ED) and acute hospital, but greatly under-recognised in these and other settings. Delirium and other forms of cognitive impairment, particularly dementia, commonly coexist. There is a need for a rapid delirium screening tool that can be administered by a range of professional-level healthcare staff to patients with sensory or functional impairments in a busy clinical environment, which also incorporates general cognitive assessment. We developed the 4 'A's Test (4AT) for this purpose. This study's primary objective is to validate the 4AT against a reference standard. Secondary objectives include (1) comparing the 4AT with another widely used test (the Confusion Assessment Method (CAM)); (2) determining if the 4AT is sensitive to general cognitive impairment; (3) assessing if 4AT scores predict outcomes, including (4) a health economic analysis.
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- Is There a Characteristic Clinical Profile for Patients with Dementia and Sundown Syndrome? [Journal Article]
- JAJ Alzheimers Dis 2018; 62(1):335-346
- CONCLUSIONS: In our study, age, a higher score on the GDS, and the presence of insomnia or hypersomnia are differential clinical characteristics of patients with SS. We defined a nomogram that helps predicting the occurrence of SS in patients with dementia.