Delirium primary prevention
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Delirium Microchapters |
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Diagnosis |
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Treatment |
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Delirium On the Web |
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American Roentgen Ray Society Images of Delirium |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishal Khurana, M.B.B.S., M.D. [2]
Overview
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
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[2]