#Frailty is associated with #delirium and mortality after transcatheter aortic valve implantation
http://openheartbeta.bmj.com/content/3/2/e000478.short?rss=1&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%25253A+openheart%25252Fcurrent+%252528Open+Heart+current+issue%252529&g=w_openheart_current_tab
Delirium frequently occurs after TAVI. Variables from frailty assessment are associated with delirium and mortality, independent of cardiological assessment. Thus, frailty assessment may have additional value in the prediction of delirium and mortality after TAVI.
http://openheartbeta.bmj.com/content/3/2/e000478.short?rss=1&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%25253A+openheart%25252Fcurrent+%252528Open+Heart+current+issue%252529&g=w_openheart_current_tab
Delirium frequently occurs after TAVI. Variables from frailty assessment are associated with delirium and mortality, independent of cardiological assessment. Thus, frailty assessment may have additional value in the prediction of delirium and mortality after TAVI.
Open Heart
Frailty is associated with delirium and mortality after transcatheter aortic valve implantation
Objective We hypothesised that frailty assessment is of additional value to predict delirium and mortality after transcatheter aortic valve implantation (TAVI).
Methods Observational study in 89 consecutive patients who underwent TAVI. Inclusion from November…
Methods Observational study in 89 consecutive patients who underwent TAVI. Inclusion from November…
#Delirium, #Dementia, and Decline
http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2598160
Delirium can accelerate the rate of cognitive decline, suggesting that an episode of delirium can result in a more rapid progression of dementia symptoms, leading to earlier functional disability, increased caregiver burden, and rising health care costs. As the population ages, there has been a rapid increase in the incidence and prevalence of delirium and dementia
http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2598160
Delirium can accelerate the rate of cognitive decline, suggesting that an episode of delirium can result in a more rapid progression of dementia symptoms, leading to earlier functional disability, increased caregiver burden, and rising health care costs. As the population ages, there has been a rapid increase in the incidence and prevalence of delirium and dementia
Jamanetwork
Delirium, Dementia, and Decline
Delirium and dementia are common causes of cognitive impairment in older populations. Although each may occur independently, delirium and dementia frequently coexist. Dementia is a leading risk factor for delirium, and there is an increased incidence of new…
Long-term prognostic value of #delirium in elderly patients with acute #cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS)
http://journals.sagepub.com/doi/10.1177/2048872617695235
Delirium is a common complication in elderly CICU patients, and is associated with a longer and more complicated hospital stay and increased short and long-term mortality. Our findings suggest the usefulness of a protocol for the early identification of delirium in the CICU.
http://journals.sagepub.com/doi/10.1177/2048872617695235
Delirium is a common complication in elderly CICU patients, and is associated with a longer and more complicated hospital stay and increased short and long-term mortality. Our findings suggest the usefulness of a protocol for the early identification of delirium in the CICU.
Intraoperative #ketamine for prevention of postoperative #delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31467-8/fulltext
Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium. The primary purpose of this trial was to assess the effectiveness of ketamine for prevention of postoperative delirium in older adults. Interpretation
A single subanaesthetic dose of ketamine did not decrease delirium in older adults after major surgery, and might cause harm by inducing negative experiences.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31467-8/fulltext
Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium. The primary purpose of this trial was to assess the effectiveness of ketamine for prevention of postoperative delirium in older adults. Interpretation
A single subanaesthetic dose of ketamine did not decrease delirium in older adults after major surgery, and might cause harm by inducing negative experiences.
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#Haloperidol and Ziprasidone for Treatment of #Delirium in Critical Illness
https://www.nejm.org/doi/full/10.1056/NEJMoa1808217
Delirium developed in 566 patients (48%), of whom 89% had hypoactive delirium and 11% had hyperactive delirium. Of the 566 patients, 184 were randomly assigned to receive placebo, 192 to receive haloperidol, and 190 to receive ziprasidone. The median duration of exposure to a trial drug or placebo was 4 days (interquartile range, 3 to 7). The median number of days alive without delirium or coma was 8.5 (95% confidence interval [CI], 5.6 to 9.9) in the placebo group, 7.9 (95% CI, 4.4 to 9.6) in the haloperidol group, and 8.7 (95% CI, 5.9 to 10.0) in the ziprasidone group (P=0.26 for overall effect across trial groups). The use of haloperidol or ziprasidone, as compared with placebo, had no significant effect on the primary end point (odds ratios, 0.88 [95% CI, 0.64 to 1.21] and 1.04 [95% CI, 0.73 to 1.48], respectively). There were no significant between-group differences with respect to the secondary end points or the frequency of extrapyramidal symptoms.
The use of haloperidol or ziprasidone, as compared with placebo, in patients with acute respiratory failure or shock and hypoactive or hyperactive delirium in the ICU did not significantly alter the duration of delirium.
#Haloperidol and Ziprasidone for Treatment of #Delirium in Critical Illness
https://www.nejm.org/doi/full/10.1056/NEJMoa1808217
Delirium developed in 566 patients (48%), of whom 89% had hypoactive delirium and 11% had hyperactive delirium. Of the 566 patients, 184 were randomly assigned to receive placebo, 192 to receive haloperidol, and 190 to receive ziprasidone. The median duration of exposure to a trial drug or placebo was 4 days (interquartile range, 3 to 7). The median number of days alive without delirium or coma was 8.5 (95% confidence interval [CI], 5.6 to 9.9) in the placebo group, 7.9 (95% CI, 4.4 to 9.6) in the haloperidol group, and 8.7 (95% CI, 5.9 to 10.0) in the ziprasidone group (P=0.26 for overall effect across trial groups). The use of haloperidol or ziprasidone, as compared with placebo, had no significant effect on the primary end point (odds ratios, 0.88 [95% CI, 0.64 to 1.21] and 1.04 [95% CI, 0.73 to 1.48], respectively). There were no significant between-group differences with respect to the secondary end points or the frequency of extrapyramidal symptoms.
The use of haloperidol or ziprasidone, as compared with placebo, in patients with acute respiratory failure or shock and hypoactive or hyperactive delirium in the ICU did not significantly alter the duration of delirium.
New England Journal of Medicine
Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness | NEJM
Original Article from The New England Journal of Medicine — Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness
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Association of #Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium
A Network Meta-analysis
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2726605?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamapsychiatry.2018.4276
A network meta-analysis demonstrated that #haloperidol plus #lorazepam provided the best response rate for delirium treatment (odds ratio [OR], 28.13; 95% CI, 2.38-333.08) compared with placebo/control. For delirium prevention, the ramelteon, olanzapine, risperidone, and dexmedetomidine hydrochloride groups had significantly lower delirium occurrence rates than placebo/control
None of the pharmacological treatments were significantly associated with a higher risk of all-cause mortality compared with placebo/control.
Conclusions and Relevance This network meta-analysis demonstrated that haloperidol plus lorazepam might be the best treatment and ramelteon the best preventive medicine for delirium. None of the pharmacological interventions for treatment or prophylaxis increased the all-cause mortality.
Association of #Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium
A Network Meta-analysis
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2726605?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamapsychiatry.2018.4276
A network meta-analysis demonstrated that #haloperidol plus #lorazepam provided the best response rate for delirium treatment (odds ratio [OR], 28.13; 95% CI, 2.38-333.08) compared with placebo/control. For delirium prevention, the ramelteon, olanzapine, risperidone, and dexmedetomidine hydrochloride groups had significantly lower delirium occurrence rates than placebo/control
None of the pharmacological treatments were significantly associated with a higher risk of all-cause mortality compared with placebo/control.
Conclusions and Relevance This network meta-analysis demonstrated that haloperidol plus lorazepam might be the best treatment and ramelteon the best preventive medicine for delirium. None of the pharmacological interventions for treatment or prophylaxis increased the all-cause mortality.
Jamanetwork
Pharmacologic Intervention for the Treatment and Prevention of Delirium
Delirium is among the most prevalent and difficult psychiatric problems encountered in hospitals and other medical institutions. Pharmacologic treatment has bee
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#Antipsychotics for Preventing #Delirium in Hospitalized Adults: A Systematic Review
https://annals.org/aim/fullarticle/2749494/antipsychotics-preventing-delirium-hospitalized-adults-systematic-review
Delirium is an acute disorder marked by impairments in attention and cognition, caused by an underlying medical problem. Antipsychotics are used to prevent delirium, but their benefits and harms are unclear.
Little to no evidence was found to determine the effect of haloperidol on cognitive function, delirium severity (insufficient SOE), inappropriate continuation, and sedation (insufficient SOE). There is limited evidence that second-generation antipsychotics may lower delirium incidence in the postoperative setting. There is little evidence that short-term use of antipsychotics was associated with neurologic harms. In some of the trials, potentially harmful cardiac effects occurred more frequently with antipsychotic use.
Current evidence does not support routine use of haloperidol or second-generation antipsychotics for prevention of delirium. There is limited evidence that second-generation antipsychotics may lower the incidence of delirium in postoperative patients, but more research is needed. Future trials should use standardized outcome measures.
#Antipsychotics for Preventing #Delirium in Hospitalized Adults: A Systematic Review
https://annals.org/aim/fullarticle/2749494/antipsychotics-preventing-delirium-hospitalized-adults-systematic-review
Delirium is an acute disorder marked by impairments in attention and cognition, caused by an underlying medical problem. Antipsychotics are used to prevent delirium, but their benefits and harms are unclear.
Little to no evidence was found to determine the effect of haloperidol on cognitive function, delirium severity (insufficient SOE), inappropriate continuation, and sedation (insufficient SOE). There is limited evidence that second-generation antipsychotics may lower delirium incidence in the postoperative setting. There is little evidence that short-term use of antipsychotics was associated with neurologic harms. In some of the trials, potentially harmful cardiac effects occurred more frequently with antipsychotic use.
Current evidence does not support routine use of haloperidol or second-generation antipsychotics for prevention of delirium. There is limited evidence that second-generation antipsychotics may lower the incidence of delirium in postoperative patients, but more research is needed. Future trials should use standardized outcome measures.
#Antipsychotics for Treating #Delirium in Hospitalized Adults: A Systematic Review
https://annals.org/aim/fullarticle/2749495/antipsychotics-treating-delirium-hospitalized-adults-systematic-review
Delirium is common in hospitalized patients and is associated with worse outcomes. Antipsychotics are commonly used; however, the associated benefits and harms are unclear.
There was no difference in delirium severity (moderate SOE) and cognitive functioning (low SOE) for haloperidol versus second-generation antipsychotics, with insufficient or no evidence for antipsychotics versus placebo. For direct comparisons of different second-generation antipsychotics, there was no difference in mortality and insufficient or no evidence for multiple other outcomes. There was little evidence demonstrating neurologic harms associated with short-term use of antipsychotics for treating delirium in adult inpatients, but potentially harmful cardiac effects tended to occur more frequently.
Current evidence does not support routine use of haloperidol or second-generation antipsychotics to treat delirium in adult inpatients.
https://annals.org/aim/fullarticle/2749495/antipsychotics-treating-delirium-hospitalized-adults-systematic-review
Delirium is common in hospitalized patients and is associated with worse outcomes. Antipsychotics are commonly used; however, the associated benefits and harms are unclear.
There was no difference in delirium severity (moderate SOE) and cognitive functioning (low SOE) for haloperidol versus second-generation antipsychotics, with insufficient or no evidence for antipsychotics versus placebo. For direct comparisons of different second-generation antipsychotics, there was no difference in mortality and insufficient or no evidence for multiple other outcomes. There was little evidence demonstrating neurologic harms associated with short-term use of antipsychotics for treating delirium in adult inpatients, but potentially harmful cardiac effects tended to occur more frequently.
Current evidence does not support routine use of haloperidol or second-generation antipsychotics to treat delirium in adult inpatients.
Decreasing #Delirium Through #Music: A Randomized Pilot Trial
https://2medical.news/2020/03/24/decreasing-delirium-through-music-a-randomized-pilot-trial/
To determine the feasibility and acceptability of personalized music (PM), slow-tempo music (STM), and attention control (AC) in patients receiving mechanical ventilation in an intensive care unit, and to estimate the effect of music on delirium.. ..Of the 1589 patients screened, 117 (7.4%) were eligible. Of those, 52 (44.4%) were randomized, with a recruitment rate of 5 patients per month. Adherence was higher in the …
https://2medical.news/2020/03/24/decreasing-delirium-through-music-a-randomized-pilot-trial/
To determine the feasibility and acceptability of personalized music (PM), slow-tempo music (STM), and attention control (AC) in patients receiving mechanical ventilation in an intensive care unit, and to estimate the effect of music on delirium.. ..Of the 1589 patients screened, 117 (7.4%) were eligible. Of those, 52 (44.4%) were randomized, with a recruitment rate of 5 patients per month. Adherence was higher in the …
#Delirium In Severe Acute Respiratory Syndrome- #Coronavirus -2 Infection: A Point Of View
https://2medical.news/2020/11/07/delirium-in-severe-acute-respiratory-syndrome-coronavirus-2-infection-a-point-of-view/
Coronavirus disease 2019 was for the first time reported in December 2019 in China, and has since spread throughout the world as a pandemic. In this point of view, we aim to discuss the occurrence of central nervous system symptomatology, and delirium, in patients suffering coronavirus disease 2019. To date, most of the research done around this infectious disease caused by severe acute respiratory syndrome …
https://2medical.news/2020/11/07/delirium-in-severe-acute-respiratory-syndrome-coronavirus-2-infection-a-point-of-view/
Coronavirus disease 2019 was for the first time reported in December 2019 in China, and has since spread throughout the world as a pandemic. In this point of view, we aim to discuss the occurrence of central nervous system symptomatology, and delirium, in patients suffering coronavirus disease 2019. To date, most of the research done around this infectious disease caused by severe acute respiratory syndrome …
Efficacy of #quetiapine for #delirium prevention in hospitalized older medical patients: a randomized double-blind controlled trial
https://2medical.news/2021/04/08/efficacy-of-quetiapine-for-delirium-prevention-in-hospitalized-older-medical-patients-a-randomized-double-blind-controlled-trial/
Delirium is a common disorder among hospitalized older patients and results in increased morbidity and mortality. The prevention of delirium is still challenging in older patient care. The role of antipsychotics in delirium prevention has been limited. Therefore, we conducted a trial to investigate the efficacy of quetiapine use to prevent delirium in hospitalized older medical patients. Methods This study was a randomized double-blind controlled …
https://2medical.news/2021/04/08/efficacy-of-quetiapine-for-delirium-prevention-in-hospitalized-older-medical-patients-a-randomized-double-blind-controlled-trial/
Delirium is a common disorder among hospitalized older patients and results in increased morbidity and mortality. The prevention of delirium is still challenging in older patient care. The role of antipsychotics in delirium prevention has been limited. Therefore, we conducted a trial to investigate the efficacy of quetiapine use to prevent delirium in hospitalized older medical patients. Methods This study was a randomized double-blind controlled …