Practice Patterns and Opinions on Current Clinical Practice Guidelines Regarding the Management of Delirium in the Intensive Care Unit

Abstract

Objective:

The aim of this study was to determine current delirium practices in the intensive care unit (ICU) setting and evaluate awareness and adoption of the 2013 Pain, Agitation, and Delirium (PAD) guidelines with emphasis on delirium management.

Design, Setting, and Participants:

A large-scale, multidisciplinary, online survey was administered to physician, pharmacist, nurse, and mid-level practitioner members of the Society of Critical Care Medicine (SCCM) between September 2014 and October 2014. A total of 635 respondents completed the survey.

Measurements and Main Results:

Nonpharmacologic interventions such as early mobilization were used in most ICUs (83%) for prevention of delirium. A majority of respondents (97%) reported using pharmacologic agents to treat hyperactive delirium. Ninety percent of the respondents answered that they were aware of the 2013 PAD guidelines, and 75% of respondents felt that their delirium practices have been changed as a result of the new guidelines. In addition, logistic regression analysis of this study showed that respondents who use delirium screening tools were twice more likely to be fully aware of key components of the updated guidelines (odds ratio [OR] = 2.07, 95% confidence interval [CI] = 1.20-3.60).

Conclusions:

Most critical care practitioners are fully aware and knowledgeable of key recommendations in the new guidelines and have changed their delirium practices accordingly.

Keywords

delirium survey critical care intensive care unit prevention treatment

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References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-5. Fifth Ed. Washington, DC: American Psychiatric Association; 2013.

Maldonado

. Delirium in the acute care setting: characteristics, diagnosis and treatment. Crit Care Clin. 2008;24(4):657–722.

Girard

Pandharipande

Ely

. Delirium in the intensive care unit. Crit Care Lond Engl. 2008;12(suppl 3):s3.

Ouimet

Kavanagh

Gottfried

. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med. 2007;33(1):66–73.

Pandharipande

Shintani

Peterson

. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006;104(1):21–26.

Pandharipande

Cotton

Shintani

. Prevalence and risk factors for development of delirium in surgical and trauma ICU patients. J Trauma. 2008;65(1):34–41.

Lat

McMillian

Taylor

. The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med. 2009;37(6):1898–1905.

Ely

Gautaman

Margolin

. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001;27(12):1892–1900.

Barr

Fraser

Puntillo

. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306.

10.

Jacobi

Fraser

Coursin

. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30(1):119–141.

11.

Devlin

Bhat

Roberts

. Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight states. Ann Pharmacother. 2011;45(10):1217–1229.

12.

Ely

Stephens

Jackson

. Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med. 2004;32(1):106–112.

13.

Devlin

Roberts

Fong

. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med. 2010;38(2):419–427.

14.

Girard

Pandharipande

Carson

. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med. 2010;38(2):428–437.

15.

Kamdar

King

Collop

. The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU. Crit Care Med. 2013;41(3):800–809.

16.

Balas

Vasilevskis

Olsen

. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(10):1024–1036.

17.

Dale

Kannas

Fan

. Improved analgesia, sedation, and delirium protocol associated with decreased duration of delirium and mechanical ventilation. Ann Am Thorac Soc. 2014;11(3):367–374.

18.

Patel

Gambrell

Speroff

. Delirium and sedation in the intensive care unit: survey of behaviors and attitudes of 1384 healthcare professionals. Crit Care Med. 2009;37(3):825–832.

19.

Peterson

Pun

Dittus

. Delirium and its motoric subtypes: a study of 614 critically Ill patients. J Am Geriatr Soc. 2006;54(3):479–484.