Intensive Care Unit Delirium
Conditions
Brief summary
Delirium is a severe acute brain dysfunction characterised by sudden confusion, inattention and fluctuating level of consciousness, which mainly affects intubated intensive care patients. It increases the risk of self-extubation, prolongs ICU stay and increases mortality. The incidence of delirium in ICUs varies, with approximately 33.3% of patients affected, and rates of new-onset and pre-existing delirium range from 4% to 89%. Accurate diagnosis is challenging, with 60-80% of patients remaining undiagnosed. Early detection is critical for intervention and improved outcomes. To address these issues, the PREdiction of DELIRium (PRE-DELIRIC) model incorporates 10 risk factors and predicts delirium within 24 hours of ICU admission, allowing risk stratification into low to very high risk categories. It recalibrates predictive values with a sensitivity of 91.3% and specificity of 64.4% using a cut-off score of 27%. However, its integration into delirium management is underexplored. Delirium risk stratification supports efficient resource allocation, cost control, workload reduction and ethical care, while promptly identifying high-risk patients. In this study, Investigators evaluate the integration of the PRE-DELIRIC model into a comprehensive delirium management approach called PRE-DELIRIC-guided SMART/SmART care. SMART care includes improving familiarity, assessing pain and anxiety, reducing equipment discomfort and cognitive stimulation. Patients with PRE-DELIRIC scores \>30% receive SMART care and multidisciplinary involvement, based on the American Delirium Society.
Interventions
None listed
Sponsors
National Taiwan University Hospital
Study design
Observational model
CASE_CONTROL
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Inclusion criteria
1\. SICU patients are over 18 years old. 2. received surgery intervention
Exclusion criteria
1. Clinical diagnosis of mental disorders 2. Underwent neurosurgical procedures, 3. Discharged from the ICU within 24 hours of admission 4. Transitioned to active life support withdrawal or comfort care only within 24 hours of ICU admission
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the incidence of delirium | duration of ICU stay (postoperative 30 days) | The incidence of delirium which was assessed by each shift primary ICU nurse by using the ICDSC. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| cumulative dose of sedatives | duration of ICU stay (postoperative 30 days) | Sedatives cumulative drugs include midazolam, propofol and dexmedetomidine record 24hours |
| duration of ventilator use | duration of ICU stay( (postoperative 30 days) | duration of ventilator use |
| rate of unplanned self-extubation | duration of intubation( (postoperative 30 days) | indicates the proportion of patients who unintentionally remove their endotracheal tubes (Yes/No) |
| day of physical restraint | duration of ICU stay (postoperative 30 days) | day of physical restraint |
| level of mobility | duration of ICU stay (postoperative 30 days) | level 0-10 of mobility |
Countries
Taiwan
Outcome results
None listed