|
|
| Line 5: |
Line 5: |
| ==Overview== | | ==Overview== |
| ===Primary Prevention=== | | ===Primary Prevention=== |
|
| |
| Delirium is more likely to be missed in the ICU. Physician detection rate is poor, reported sensitivity is 29%.
| |
|
| |
| Society of Critical Care Medicine (SCCM) and the
| |
| American Psychiatric Association (APA) recommends
| |
| daily monitoring of delirium in ICU patients to improve early diagnosis and treatment.
| |
|
| |
| the Confusion
| |
| Assessment Method for the ICU (CAM-ICU) showed
| |
| highest sensitivity in a research setting, ranging from
| |
| 64% to 97%.
| |
| 9,12
| |
| However, in routine, daily practice the
| |
| sensitivity of the CAM-ICU appeared to be much lower
| |
| (47%).
| |
|
| |
|
| |
| CAM-ICU are that it
| |
| cannot quantify delirium severity and that it assesses
| |
| delirium at a certain moment in time,
| |
| 12
| |
| whereas delirium
| |
| may fluctuate considerably over the day.
| |
| 1
| |
| These factors
| |
| impede recognition and thereby delay treatment. Delayed
| |
| treatment of delirium was found to be related to mortality.
| |
| 14
| |
| Therefore, an objective detection tool for continuous monitoring of delirium is needed
| |
|
| |
| <ref name="www.ncbi.nlm.nih.gov">{{Cite web | last = | first = | title = What are the opportunities f... [J Neuropsychiatry Clin Neurosci. 2012] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/23224454 | publisher = | date = | accessdate = }}</ref>
| |
|
| |
|
| |
| that the most successful approach to delirium prevention is to attenuate modifiable risk factors in individual
| |
| patients. This requires a complex intervention, and studies investigating such interventions in medical
| |
| patients and those who have had hip fracture have
| |
| reported significant reductions (of about a third) in
| |
| incidence of delirium and/or reduced severity and
| |
| duration of delirium. ustained adherence to
| |
| the clinical protocol is a key factor for successful delirium prevention.
| |
| 22
| |
| The effective Yale delirium prevention model of care
| |
| 19
| |
| has been translated into routine
| |
| practice as the hospital elder life program (HELP).
| |
| 23
| |
| This programme is now used in three countries and is
| |
| associated with a reduction in the rates and costs of
| |
| delirium.
| |
| w33
| |
| Effective strategies for delirium prevention include
| |
| orienting communication, therapeutic activities, early
| |
| mobilisation and walking, non-pharmacological
| |
| approaches to sleep and anxiety, maintaining nutrition
| |
| and hydration, adaptive equipment for vision and
| |
| hearing impairment, and pain management. Hospitals
| |
| have several inherent risks for the development of
| |
| delirium
| |
| 2
| |
| and early discharge to a home rehabilitation
| |
| service was associated with a significantly reduced incidence of delirium<ref>{{Cite web | last = | first = | title = Delirium in elderly people. [Lancet. 2013] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/23992774 | publisher = | date = | accessdate }}</ref>
| |
|
| |
|
|
| |
|