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1.
Minerva Anestesiol ; 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-32000470

RESUMO

BACKGROUND: Presurgical cognitive impairment (PreCI) is frequently seen in older age, but the influence on postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) remains unclear. The present study sought to determine the association between PreCI, POD and POCD with special focus to different PreCI domains. METHODS: We analyzed 934 patients with complete baseline neurocognitive assessment. PreCI was determined as cognitive performance of at least 2 standard deviation (SD) below the mean performance of non-surgical controls. POD was assessed according to the Diagnostic and Statistical Manual of Mental Disorders 4 (DSM-4). POCD at 3 months follow-up was calculated by the reliable change index (RCI). Associations between PreCI and POD or POCD were assessed using multivariable logistic regression models adjusted for age, sex, randomization, ASA status, type of anesthesia and type of surgery. RESULTS: PreCI was significantly associated with POD [OR 1.936 (95%CI 1.119 to 3.348); p=0.015] and POCD [OR 3.091 (95%CI 1.287 to 7.426); p=0.012]. Patients with coincident PreCI and POD were significantly more likely to develop POCD [OR 6.131 (95%CI 1.476 to 22.364); p=0.007]. Differentiation between no PreCI, amnestic and non-amnestic PreCI revealed a sole influence of amnestic PreCI on POD and POCD. CONCLUSIONS: Patients ≥ 60 years with PreCI were more likely to develop POD and POCD, respectively. The odds for POCD were highest in patients with PreCI whom also suffered from POD. Amnestic rather than non-amnestic PreCI might play a key role in the development of POD and POCD. These results warrant further pathophysiological investigations and demand preventive strategies.

2.
Acta Anaesthesiol Scand ; 63(10): 1282-1289, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31283835

RESUMO

BACKGROUND: Post-operative delirium (POD) and post-operative neurocognitive disorder (NCD) are frequently seen in the elderly. Development of biomarkers for pre-operative risk prediction is of major relevance. As inflammation present before surgery might predispose to POD and post-operative NCD development, we aim to determine associations between pre-operative C-reactive protein (CRP) and the incidence of POD and post-operative NCD. METHODS: In this observational study, we analyzed 314 patients enrolled in the SuDoCo trial, who had a pre-operative CRP measurement the day before surgery. Primary outcomes were POD assessed according DSM-4 from day 1 until day 7 after surgery and post-operative NCD assessed 3 months after surgery. We conducted multivariable logistic regression analysis adjusted for age, sex, randomization, body mass index, MMSE, ASA status, infection/autoimmune disease/malignoma and types of surgery to determine associations between CRP with POD and post-operative NCD, respectively. RESULTS: Pre-operative CRP was independently associated with POD [OR 1.158 (95% CI 1.040, 1.291); P = .008]. Patients with CRP values ≥5 mg/dL had a 4.8-fold increased POD risk [OR 4.771 (95% CI 1.765, 12.899; P = .002)] compared to patients with lower CRP values. However, no association was seen between pre-operative CRP and post-operative NCD [OR 0.552 (95% CI 0.193, 1.581); P = .269]. CONCLUSIONS: Pre-operative CRP levels were independently associated with POD but not post-operative NCD after three months. Moreover, higher pre-operative CRP levels showed higher risk for POD. This strengthens the role of inflammation in the development of POD. Assessment of CRP before surgery might allow risk stratification of POD. TRIAL REGISTRATION: This study was registered with ISRCTN Register 36437985 on 02 March 2009.

4.
Dement Geriatr Cogn Disord ; 46(3-4): 193-206, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30326480

RESUMO

BACKGROUND/AIMS: Older people undergoing surgery are at risk of developing postoperative cognitive dysfunction (POCD), but little is known of risk factors predisposing patients to POCD. Our objective was to estimate the risk of POCD associated with exposure to preoperative diabetes, hypertension, and obesity. METHODS: Original data from 3 randomised controlled trials (OCTOPUS, DECS, SuDoCo) were obtained for secondary analysis on diabetes, hypertension, baseline blood pressure, obesity (BMI ≥30 kg/m2), and BMI as risk factors for POCD in multiple logistic regression models. Risk estimates were pooled across the 3 studies. RESULTS: Analyses totalled 1,034 patients. POCD occurred in 5.2% of patients in DECS, in 9.4% in SuDoCo, and in 32.1% of patients in OCTOPUS. After adjustment for age, sex, surgery type, randomisation, obesity, and hypertension, diabetes was associated with a 1.84-fold increased risk of POCD (OR 1.84; 95% CI 1.14, 2.97; p = 0.01). Obesity, BMI, hypertension, and baseline blood pressure were each not associated with POCD in fully adjusted models (all p > 0.05). CONCLUSION: Diabetes, but not obesity or hypertension, is associated with increased POCD risk. Consideration of diabetes status may be helpful for risk assessment of surgical patients.


Assuntos
Disfunção Cognitiva , Delírio , Diabetes Mellitus , Hipertensão , Obesidade , Complicações Pós-Operatórias , Idoso , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Delírio/diagnóstico , Delírio/etiologia , Delírio/fisiopatologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia , Medição de Risco/métodos , Fatores de Risco
5.
Clin Epidemiol ; 10: 853-862, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30100759

RESUMO

Background: Age-related cognitive impairment is rising in prevalence but is not yet fully characterized in terms of its epidemiology. Here, we aimed to elucidate the role of obesity, diabetes and hypertension as candidate risk factors. Methods: Original baseline data from 3 studies (OCTOPUS, DECS, SuDoCo) were obtained for secondary analysis of cross-sectional associations of diabetes, hypertension, blood pressure, obesity (body mass index [BMI] ≥30 kg/m2) and BMI with presence of cognitive impairment in log-binomial regression analyses. Cognitive impairment was defined as scoring more than 2 standard deviations below controls on at least one of 5-11 cognitive tests. Underweight participants (BMI<18.5 kg/m2) were excluded. Results were pooled across studies in fixed-effects inverse variance models. Results: Analyses totaled 1545 participants with a mean age of 61 years (OCTOPUS) to 70 years (SuDoCo). Cognitive impairment was found in 29.0% of participants in DECS, 8.2% in SuDoCo and 45.6% in OCTOPUS. In pooled analyses, after adjustment for age, sex, diabetes and hypertension, obesity was associated with a 1.29-fold increased prevalence of cognitive impairment (risk ratio [RR] 1.29; 95% CI 0.98, 1.72). Each 1 kg/m2 increment in BMI was associated with 3% increased prevalence (RR 1.03; 95% CI 1.00, 1.06). None of the remaining risk factors were associated with impairment. Conclusion: Our results show that older people who are obese have higher prevalence of cognitive impairment compared with normal weight and overweight individuals, and independently of co-morbid hypertension or diabetes. Prospective studies are needed to investigate the temporal relationship of the association.

6.
Minerva Anestesiol ; 82(7): 751-9, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27453295

RESUMO

BACKGROUND: Postoperative impairment of the cerebral function can appear immediately after general anesthesia and may be predictive for a postoperative delirium. We compared three tools assessing patients on recovery room admission in order to detect early signs of postoperative brain dysfunction: the Postanesthetic Recovery Score (PARS), the Richmond Agitation-Sedation Scale (RASS) and the Nursing Delirium Screening Scale (Nu-DESC). METHODS: Inclusion criteria of this secondary analysis of the randomized SuDoCo trial were: age ≥60 years, schedule for elective non-cardiac surgery with an anticipated duration of ≥60 minutes, general anesthesia, ability to communicate in German language. A total of 996 patients were analyzed. Investigated scores were assessed 10 minutes after recovery room admission and analyzed in terms of association with postoperative delirium, mortality and length of stay in the recovery room. Multivariate analysis: linear or logistic regression. RESULTS: Abnormal scores in patients: RASS (values ≤-2 and ≥1) 36.8%, Nu-DESC (≥2 points) 54.2%, PARS (≤7 points) 20.3%. Abnormal RASS values were associated with postoperative delirium (RASS values ≥1: odds ratio (OR) 3.1, 95% CI: 1.7-5.6, P<0.001; RASS values ≤-2: OR=2.1, 95% CI: 1.3-3.3, P=0.001). Abnormal Nu-DESC values were also associated with postoperative delirium (OR=2.4, 95% CI: 1.5-3.9, P<0.001). Abnormal PARS values were associated with a longer recovery room stay (in minutes, OR=16.6, 95% CI: 1.7-31.4, P=0.029). CONCLUSIONS: The RASS and Nu-DESC were independent predictors for a delirium within seven postoperative days. Very early assessment of the cerebral function may help to advance detection, prevention and treatment of postoperative delirium in elderly patients.


Assuntos
Anestesia Geral/efeitos adversos , Delírio/diagnóstico , Diagnóstico Precoce , Complicações Pós-Operatórias/diagnóstico , Idoso , Procedimentos Cirúrgicos Eletivos , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Análise Multivariada , Sala de Recuperação
7.
Curr Opin Anaesthesiol ; 29(3): 384-90, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26905874

RESUMO

PURPOSE OF REVIEW: The aim of this study was to review current literature on identification of patients at risk for postoperative delirium (POD) and to summarize recent findings on prophylaxis and treatment. RECENT FINDINGS: Age and preoperative cognitive impairment are among the most important risk factors of POD. POD is the result of a complex interplay of predisposing and precipitating factors. Thus, both prophylaxis and treatment require multicomponent intervention programs. No single medication to prevent or treat POD is available. Avoiding too deep anesthesia, avoiding additional psychoactive substances including benzodiazepines and intravenous opioids, and effective pain management as well as early mobilization are essential. SUMMARY: An increase of the proportion of elderly patients undergoing surgery will lead to a higher incidence of POD. Preoperative assessment should facilitate identification of patients at high risk. Perioperative management should include monitoring depth of anesthesia, preference for nonopioid pain therapy, early regular delirium monitoring starting in the recovery room, avoiding ICU-sedation, early mobilization and exercise, and cognitive training.


Assuntos
Anestesia/efeitos adversos , Delírio do Despertar/diagnóstico , Delírio do Despertar/terapia , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/complicações , Delírio do Despertar/etiologia , Delírio do Despertar/fisiopatologia , Exercício , Fragilidade/complicações , Avaliação Geriátrica/métodos , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Unidades de Terapia Intensiva/normas , Monitorização Neurofisiológica Intraoperatória/métodos , Assistência Perioperatória/normas , Guias de Prática Clínica como Assunto , Fatores de Risco
8.
Eur J Anaesthesiol ; 32(3): 147-51, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24979586

RESUMO

BACKGROUND: Posttraumatic stress disorder (PTSD) may appear after hospitalisation for surgery with general anaesthesia in elderly patients. Prevalence and risk factors in this setting are unknown. Postoperative delirium could be a risk factor. OBJECTIVE: The purpose of this study was to identify the prevalence of, and risk factors for, PTSD 3 months after surgery with general anaesthesia in elderly patients. DESIGN: A prospective, clinical observational study. SETTING: This study was carried out between March 2009 and May 2010 in a German university hospital in Berlin and was part of a larger study focusing on depth of anaesthesia. INCLUSION CRITERIA: at least 60 years of age; noncardiac surgery with general anaesthesia. EXCLUSION CRITERIA: impaired preoperative cognitive function [mini-mental state examination (MMSE) score <24]; expected surgery time less than 1 h; nonproficiency in the German language. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Screening for PTSD 3 months after surgery using the screening instrument Post-Traumatic Stress Syndrome 14-Questions Inventory Score (PTSS-14). The following risk factors for PTSD 3 months after surgery were tested: age; American Society of Anesthesiologists physical status; sex; duration of anaesthesia; postoperative delirium; PTSS-14 score 7 days after surgery; postoperative vomiting and nausea; postoperative pain; and preoperative depression. STATISTICS: Univariate statistical analysis was performed with Fisher's exact test and Spearman correlation. A backward logistic regression was performed. RESULTS: A total of 559 out of 1277 patients were included. Sixty-six patients (12%) were identified with PTSD 3 months after surgery. Seventy-seven patients (14%) were identified with postoperative delirium. Independent associated factors in the backward logistic regression were postoperative delirium (risk factor) and preoperative depression (protective factor). CONCLUSION: The prevalence of PTSD 3 months after surgery in elderly patients was high using the screening instrument PTSS-14. Postoperative delirium is a risk factor for PTSD 3 months after surgery. TRIAL REGISTRATION: ISRCTN Register: 36437985. http://www.controlled-trials.com/ISRCTN36437985/


Assuntos
Anestesia Geral/efeitos adversos , Delírio/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Fatores Etários , Idoso , Cognição , Delírio/diagnóstico , Delírio/psicologia , Depressão/epidemiologia , Alemanha/epidemiologia , Hospitais Universitários , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prevalência , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
9.
PLoS One ; 9(11): e110935, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25398099

RESUMO

Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1) and 868 patients (part 2) were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%). In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524) and approved by the ethical committee.


Assuntos
Analgesia , Sedação Profunda , Delírio/terapia , Inquéritos Epidemiológicos , Unidades de Terapia Intensiva , Internacionalidade , Inquéritos e Questionários , Idoso , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Reprodutibilidade dos Testes
10.
Intensive Care Med ; 38(12): 1974-81, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22945432

RESUMO

PURPOSE: Systematic monitoring of sedation, pain and delirium in the ICU is of paramount importance in delivering adequate patient care. While the use of systematic monitoring instruments is widely agreed upon, these tools are infrequently implemented into daily ICU care. The aim of this study is to compare the effectiveness of two different training strategies (training according to the local standard vs. modified extended method) on the implementation rate of scoring instruments on the ICU. METHODS: In this experimental cohort study we analyzed the frequency of scoring on three surgical ICUs before and after training, and in a 1 year follow-up. A modified extended training included establishing a local support team helping to resolve immediate problems. In addition we evaluated the impact on patients' outcome. RESULTS: ICUs trained by the modified extended method showed increased documentation rates of all scores per patient and day. In a 1 year follow-up, increased scoring rates for all scores were maintained. Scoring rates with training according to the local standard training protocol did not increase significantly. Implementation of delirium and pain monitoring were associated with a decrease in mortality [odds ratio (OR) 0.451; 95 % confidence interval (CI): 0.22-0.924, and, respectively, OR 0.348; 95 % CI: 0.140-0.863]. Monitoring had no significant influence on ventilation time or ICU length of stay. CONCLUSIONS: A modified extended training strategy for ICU monitoring tools (sedation, pain, delirium) leads to higher intermediate and long-term implementation rates and is associated with improved patient outcome. However, these findings may have been biased by unmeasured confounders.


Assuntos
Delírio/prevenção & controle , Monitoramento de Medicamentos , Implementação de Plano de Saúde , Capacitação em Serviço/métodos , Medição da Dor , Feminino , Alemanha , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos
11.
Curr Opin Anaesthesiol ; 24(6): 670-5, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21971396

RESUMO

PURPOSE OF REVIEW: Delirium is an acute, potentially life-threatening organ dysfunction with an incidence reported to range from 10-70% after surgery. Postoperative delirium was found to be associated with persisting cognitive deficits, increased physical dependence and institutionalization, and increased mortality. It is a condition particularly relevant to patients with increasing age. RECENT FINDINGS: This study summarizes recent works of the past 2 years, giving a brief overview as well as background information with regard to risk factors, impact on outcome parameters, mechanisms of pathophysiology, current use of hospital medication, and prevention and treatment strategies of postoperative delirium. SUMMARY: Delirium may have an impact on patients' outcomes beyond their stay in hospital, depending on preoperative comorbidities. Delirium can be devastating for activity of daily living, cognitive performance and survival. Predisposing factors should be recognized preoperatively; precipitating factors such as preoperative fasting, deep sedation and choice of psychotropic drugs, including sedatives, should be reconsidered. Regular structured delirium screening is the precondition for early detection and treatment. Treatment options include cognitive training programmes, anti-inflammatory measures and antipsychotic drugs.


Assuntos
Período de Recuperação da Anestesia , Anestésicos/efeitos adversos , Delírio/induzido quimicamente , Fatores Etários , Idoso , Delírio/prevenção & controle , Humanos , Fatores de Risco
12.
Artigo em Alemão | MEDLINE | ID: mdl-21120766

RESUMO

BACKGROUND: Hospitalization may represent a stressor that can lead to Posttraumatic stress disorder (PTSD). METHODS: Translation of the UK-PTSS-14, conducted in accordance with ISPOR principles and validation with the PDS (86 patients). RESULTS: The ROC analysis showed that the German version of PTSS-14 is a valid instrument with high sensitivity (82%) and specificity (92%) with the optimum cut-off point at 40 points. The translation process was authorized by the author of the UK-PTSS-14. CONCLUSION: The validated German version of PTSS-14 is now ready for use as an efficient and reliable screening-tool for PTSD in a clinical setting.


Assuntos
Hospitalização , Testes Neuropsicológicos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/psicologia , Idoso , Anestesia/efeitos adversos , Feminino , Alemanha , Humanos , Linguagem , Masculino , Curva ROC , Reprodutibilidade dos Testes , Transtornos de Estresse Pós-Traumáticos/etiologia , Estresse Psicológico/etiologia , Traduções
14.
J Anesth ; 24(4): 518-25, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20508953

RESUMO

PURPOSE: The incidence of postoperative cognitive dysfunction (POCD) depends on the test battery and calculation method used. The measurements may be performed with a paper and pencil test battery or with a computerized test battery. The objective of this study was to measure the incidence and congruence of POCD by comparing a computerized test battery with a paper and pencil test battery in the same patient population. METHODS: In total, 67 patients were included: 30 consecutive in-patients undergoing surgery under general anesthesia and 37 non-surgical out-patients as control. Patients were tested with a paper and pencil test battery and a computerized test battery on inclusion in the study and 7 days later. Both test batteries covered the cognitive domains: visual attention, visual learning, memory, and speed of processing. RESULTS: The computerized test battery classified 10.0% (95% CI 3.5-25.6%) of the patients as suffering from POCD whereas the paper and pencil test battery classified 30.0% (95% CI 16.7-47.9%) as suffering (95% CI for difference 3.9-36.5%, P = 0.03). The inter-rater reliability between both test batteries showed moderate agreement (Cohen's kappa of 0.41). All patients identified by use of the computerized test battery were also identified with the paper and pencil test battery. The paper and pencil test battery identified 6 additional cases. CONCLUSION: In our study we demonstrated that the incidence of POCD measured with computerized test battery and paper and pencil test battery showed moderate inter-rater reliability. Use of neuropsychological test batteries theoretically covering the same cognitive domains does not automatically lead to the same classification of POCD.


Assuntos
Transtornos Cognitivos/epidemiologia , Diagnóstico por Computador/métodos , Testes Neuropsicológicos , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico
16.
Artigo em Alemão | MEDLINE | ID: mdl-20155640

RESUMO

The reported incidence of delirium in critically ill patients ranges widely - from 11% to 87%. Both in the recovery room as well as in the intensive care unit postoperative delirium is the most common psychiatric disease. Patients with ICU delirium have a significant higher 6-month mortality rate. Recent studies could show that the use of a validated delirium assessment tool significantly improves the ability of physicians and nurses to detect delirium in ICU patients. The following article gives a review about different assessment tools of ICU delirium and focuses on the differences between validated delirium scores.


Assuntos
Delírio/diagnóstico , Delírio/psicologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/psicologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Confusão/etiologia , Confusão/psicologia , Cuidados Críticos/psicologia , Delírio/classificação , Delírio/epidemiologia , Delírio/enfermagem , Humanos , Monitorização Fisiológica , Assistência Perioperatória , Complicações Pós-Operatórias/epidemiologia , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes
17.
World J Surg ; 34(3): 487-94, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20066416

RESUMO

BACKGROUND: Postoperative delirium is associated with adverse outcome. The aim of this study was to find a valid and easy-to-use tool to screen for postoperative delirium on the surgical ward. METHODS: Data were collected from 88 patients who underwent elective surgery. Delirium screening was performed daily until the sixth postoperative day using the Confusion Assessment Method (CAM), the Nursing Delirium Screening Scale (Nu-DESC), and the Delirium Detection Score (DDS), and the DSM-IV criteria as the gold standard. RESULTS: Seventeen of 88 patients (19%) developed delirium on at least one of the postoperative days according to the gold standard. The DDS scored positive for 40 (45%) patients, the CAM for 15 (17%), and the Nu-DESC for 28 (32%) patients. Sensitivity and specificity were 0.71 and 0.87 for the DDS, 0.75 and 1.00 for the CAM, and 0.98 and 0.92 for the Nu-DESC. The interrater reliability was 0.83 for the Nu-DESC, 0.77 for the DDS, and 1.00 for the CAM. CONCLUSIONS: All scores showed high specificity but differed in their sensitivity. The Nu-DESC proved to be the most sensitive test for screening for a postoperative delirium on the surgical ward followed by the CAM and DDS when compared to the gold standard.


Assuntos
Delírio/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Idoso , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Variações Dependentes do Observador , Sensibilidade e Especificidade
18.
Crit Care Med ; 38(2): 409-18, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20029345

RESUMO

OBJECTIVE: To compare validity and reliability of three instruments for detection and assessment of delirium in intensive care unit (ICU) patients. Delirium in critically ill patients is associated with higher mortality, prolonged duration of ICU stay, and greater healthcare costs. Currently, there are several assessment tools available for detection of delirium, but only a few of these assessment systems are developed specifically to screen for delirium in ICU patients. DESIGN: Prospective cohort study. SETTING: ICU at a university hospital. PATIENTS: A total of 156 surgical patients aged > or = 60 yrs consecutively admitted to the ICU, with a length of stay of at least 24 hrs. MEASUREMENTS AND MAIN RESULTS: This study was approved by the institutional ethics committee. Trained staff members performed daily and independently the Confusion Assessment Method for the ICU (CAM-ICU), the Nursing Delirium Screening Scale (Nu-DESC), and the Delirium Detection Score (DDS). These evaluations were compared against the reference standard conducted by a delirium expert (blinded to the study), who used delirium criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Of 156 patients, 63 (40%) were identified as delirious by the reference standard during the study. Using the CAM-ICU and the Nu-DESC, we measured comparable sensitivities (CAM-ICU, 81%; Nu-DESC, 83%). The specificity of the CAM-ICU was significantly higher than that of the Nu-DESC (96% vs. 81%, p < .01). In contrast, the DDS showed poor sensitivity (30%), whereas the specificity was significantly higher compared with the Nu-DESC (DDS, 91%; Nu-DESC, 81%, p < .05). The interrater reliability was "almost perfect" for the CAM-ICU (kappa = 0.89) and "substantial" for DDS and Nu-DESC (kappa = 0.79, 0.68). CONCLUSION: The CAM-ICU showed the best validity of the evaluated scales to identify delirium in ICU patients. The Nu-DESC might be an alternative tool for detection of ICU delirium. The DDS should not be used as a screening tool.


Assuntos
Delírio/diagnóstico , Unidades de Terapia Intensiva , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Escalas de Graduação Psiquiátrica/normas , Reprodutibilidade dos Testes , Resultado do Tratamento
19.
Eur J Anaesthesiol ; 27(5): 411-6, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-19887950

RESUMO

BACKGROUND AND OBJECTIVE: Most therapeutic options for postoperative delirium are only symptom oriented; therefore, the best approach remains prevention. The aim of this study was to identify predisposing and precipitating factors for early postoperative delirium. METHODS: A total of 1002 patients were screened for delirium in an observational, cohort study. Nine hundred and ten patients were observed in the recovery room and 862 patients on the first postoperative day in the ward at the Charité-Universitaetsmedizin, Berlin. Delirium was measured with the nursing delirium screening scale. Risk factors were analysed in a multivariate analysis. RESULTS: Delirium was seen in 11.0% of the patients in the recovery room and in 4.2% of the patients on the ward. Delirium in the recovery room was associated with delirium on the ward (McNemar's test P = <0.001). Apart from age and site of surgery, we found the duration of preoperative fluid fasting to be a modifiable precipitating factor for delirium in the recovery room (odds ratio 2.69, 95% confidence interval 1.4-5.2) and on the ward (odds ratio 10.57, 95% confidence interval 1.4-78.6) and the choice of intraoperative opioid for delirium on the ward (odds ratio 2.27, 95% confidence interval 1.0-5.1). CONCLUSION: Duration of preoperative fluid fasting and the choice of intraoperative analgesic are risk factors for postoperative delirium, and their modification provides a promising approach to reduce the incidence of postoperative delirium.


Assuntos
Analgésicos Opioides/uso terapêutico , Delírio/prevenção & controle , Jejum/fisiologia , Complicações Pós-Operatórias/prevenção & controle , Sala de Recuperação/estatística & dados numéricos , Berlim/epidemiologia , Estudos de Coortes , Delírio/epidemiologia , Delírio/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Quartos de Pacientes/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Artigo em Alemão | MEDLINE | ID: mdl-19199171

RESUMO

BACKGROUND: Although Delirium is the most common psychiatric disease in ICU settings, it is recognized late or not at all in up to 84 % of all cases. METHODS: Translation of the ICDSC, in accordance with ISPOR guidelines and validation by conducting a screening of 68 ICU patients. RESULTS: The translation process was authorized by the original author. The final German translation of the ICDSC showed a sensitivity and specificity of 89 % and 57 % respectively. CONCLUSION: The ICDSC is suitable for delirium screening by nurses even on ventilated patients. Besides a high sensitivity another advantage is the possibility to screen for a subsyndromal delirium.


Assuntos
Delírio/classificação , Delírio/diagnóstico , Delírio/enfermagem , Diagnóstico Diferencial , Humanos , Unidades de Terapia Intensiva , Programas de Rastreamento/métodos , Guias de Prática Clínica como Assunto , Reprodutibilidade dos Testes
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