Intussusception of the transverse colon in adults is commonly associated with a malignant lead point. Timely diagnosis and surgery are particularly important in weak patients with many comorbidities. An 84-year-old man presented with a 5-day history of vomiting, abdominal distension, and generalized weakness. He had severe frailty (Clinical Frailty Scale [CFS] score 7) and multiple comorbidities including Parkinson's disease, hypertension, chronic kidney disease, and anemia. Laboratory investigations revealed metabolic acidosis, leukocytosis, and acute kidney injury. Contrast-enhanced CT of the abdomen and pelvis demonstrated bowel obstruction with pneumoperitoneum; however, perforation and an underlying malignant lead point were not identified on imaging. Emergency laparotomy revealed a perforated transverse colon intussusception with a 5 × 5 cm mucinous adenocarcinoma as the lead point. Palliative transverse colectomy with end ileostomy was performed owing to hemodynamic instability. Postoperatively, the patient developed hypoactive delirium, Parkinson-related rigidity attributable to the inability to administer oral dopaminergic medication preoperatively and a delay in initiating the transdermal rotigotine patch postoperatively, hypoglycemia, and sepsis. Despite intensive care support, his condition deteriorated and he died on postoperative day 12. This case highlights the limitations of preoperative CT imaging in identifying perforation and malignancy in colonic intussusception, the complexity of perioperative management in frail patients with multiple comorbidities, and the importance of early multidisciplinary decision-making in geriatric surgical emergencies.

Hospital-associated complications (HACs), including delirium, falls, pressure ulcers, urinary incontinence, and functional decline, frequently co-occur in hospitalized older adults. However, these complications have typically been studied as isolated events. This study aimed to identify latent phenotypes of HACs and examine their associations with admission geriatric characteristics and short-term mortality. In this multicenter observational cohort study, 1599 older adults admitted to acute care hospitals were included. HACs during hospitalization were assessed, and latent class analysis was used to identify phenotypes. Associations with admission-level frailty, functional status, cognitive function, and nutritional status were examined. Discriminative performance was evaluated using receiver operating characteristic analysis, and three-month mortality after discharge was assessed. A three-class latent structure was identified, although separation between the two lower-risk classes was limited. One subgroup, comprising 19% of participants, was characterized by high probabilities of multiple co-occurring complications, particularly functional decline and delirium, and was designated the global HAC phenotype. Admission frailty, functional impairment, and cognitive dysfunction were significantly associated with this phenotype (area under the curve = 0.755). Three-month mortality was significantly higher in the global HAC phenotype compared with other phenotypes (22.2%vs 5.2%), and this association remained significant after multivariable adjustment (adjusted odds ratio 2.24, 95% confidence interval 1.25-4.03). HACs cluster into clinically meaningful phenotypes reflecting multidimensional vulnerability. A global HAC phenotype can be identified from admission assessments and is associated with increased short-term mortality, supporting phenotype-based risk stratification in hospitalized older adults.

Postoperative delirium is a prevalent neuropsychiatric complication after liver transplantation, affecting 13%-26% of recipients. It is associated with prolonged intensive care unit and hospital stays, increased medical costs, and significantly worse long-term prognosis. This article comprehensively reviews its pathogenesis, risk factors, assessment tools, management strategies and future directions, aiming to provide a theoretical basis for clinical prevention, intervention and subsequent research.

Delirium is an acute encephalopathic syndrome that is highly prevalent in critically ill adult patients. The occurrence of delirium carries serious negative implications for patient outcomes and is a frightening and distressing experience for patients. The significance of delirium occurrence as an indicator of acute illness severity and clinical deterioration is well recognised. This is reflected in the inclusion of altered mental status in a number of national illness severity scoring systems. An awareness and understanding of delirium in the critically ill adult is therefore of relevance to all adult nurses. This article provides an overview of delirium in the critically ill adult patient, discussing current knowledge and recommended practice across key areas. These include the definition and classification of delirium; the implications of delirium for patient outcomes and experience; the aetiology and pathophysiology of delirium; delirium assessment tools used with critically ill patients and recommended approaches to prevention and management. The article will enable practitioners to develop a current understanding of key areas relating to delirium in the critically ill adult patient and encourage a reflective approach to considering the implications for practice.

Encephalopathy is a common complication of sepsis, occurring in up to 70% of patients admitted to the intensive care unit. It is primarily characterized by a deterioration in condition, ranging from delirium to coma, but also by electroencephalographic changes and seizures. Sepsis-associated encephalopathy (SAE) is linked to increased mortality, which rises in proportion to the severity of both clinical manifestations and electroencephalographic abnormalities, and is frequently followed by long-term cognitive impairment and functional disability. The pathophysiology of SAE is complex and includes a disturbance in neurotransmission together with a dysfunction of different brain cells and functional complexes (blood-brain barrier, neurovascular coupling, synapses). Neuroinflammation and ischemia are its main processes. Its cellular mechanisms include bioenergetic failure and oxidative stress. The frontal cortex, hippocampus, limbic system, and brainstem are particularly vulnerable to these events. Currently, management relies primarily on controlling sepsis and applying recommendations for delirium, including the avoidance of neurotoxic agents. Developing a specific treatment would depend on a better understanding of its pathophysiology, through a relevant experimental model, as well as on the identification of biomarkers with diagnostic, pathophysiological, and/or prognostic value. This contemporary review synthesizes current data on the epidemiology, mechanisms, characteristics and complications of SAE, as well as priorities for therapeutic progress.

Children cared for in a pediatric intensive care unit (PICU) while experiencing delirium are a vulnerable group, at risk of undergoing traumatic experiences that may lead to negative outcomes post-discharge. Little is known about how children remember and experience their time in a PICU during severe illness, complicating the implementation of child-centered care that could potentially help them cope with these challenging times. Utilizing the photovoice method, this study aimed to explore the PICU experiences of children who had experienced delirium. Post-discharge, children revisited the ward to photograph their former rooms, thereby capturing and reflecting upon their memories from their time in the unit. The interviews, informed by the photographs taken by the children, were analyzed in conjunction with the images using reflexive thematic analysis. The analysis revealed two main themes, seven subthemes, and an overarching theme: "Sudden Deprivation," which serves as a unifying thread throughout the children's narratives, encompassing losses of control, agency, self-identity, physical autonomy, and reality perception. This deprivation was likely amplified by the delirium experienced by all participants. The two main themes, "The Bed: An Unsafe Haven" and "Anchors in the Chaos: Navigating Care and Constraint," capture the children's experiences throughout their care journey, with "Sudden Deprivation" permeating both themes. This deprivation is further underscored by the lack of effective child-centered care in the PICU; despite the intention to pursue such an approach, key aspects were often overlooked, particularly the need to engage children's agency in creating a supportive environment and involve them in decision-making processes.