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American Delirium Society Newsletter Vol. 3: February 2018

The American Delirium Society (ADS) invites you to attend its 8th Annual Meeting. Learn from colleagues from around the world and contribute to scientific ideas regarding delirium mechanisms, etiology, state-of-the-art clinical practice and groundbreaking research. Meet like-minded clinicians and scientists from many different disciplines and specialties; develop friendships and research partnerships. This is a great networking opportunity.

We received an unprecedented number of abstracts for this meeting and are looking forward to a great program. Hope you see you in San Francisco!

Early registration ends March 31st (presenters must register by this date)

@iDelirium_Aware: The second annual World Delirium Day Social Media Awareness campaign will take place on March 14th, 2018. More information about this initiative to bring delirium to the world stage is @: www.idelirium.org.

Australasian Delirium Association: Call for Abstracts

The Australasian Delirium Association (ADA) is a leading professional organization for health professionals from multidisciplinary backgrounds who are bringing together scientific evidence to improve clinical practice for delirium across a diverse range of specialties.

ADA now invites clinicians and researchers from Australia, and across the globe, to submit an abstract for this pre-eminent event. All submissions related to any aspect of delirium are welcome.

ADS Past President Karin J. Neufeld MD MPH Featured as the Keynote Speaker at the European Delirium Association Meeting

Four former Presidents of ADS attending the Nov 2017 European Delirium Association Annual Meeting Left to Right: Drs Pandharipande, Rudolph, Neufeld and Arora

Dr. Neufeld, former President of ADS gave the opening keynote address this past November at the 12th Annual Meeting of the European Delirium Association which was held in Oslo, Norway. Her talk was entitled “Delirium Care and Prevention – Where Have We Come From and Where to Next?” She reviewed the syndrome, its major risk factors and associated outcomes. She described the significant changes that the 2013 Society for Critical Care Pain, Agitation and Delirium Guidelines and soon-to-be-released 2018 update, have brought to the care of critically ill patients. These guidelines focus on screening for delirium, reducing exposure to sedation such that patients are awake and alert, and mobilizing patients early in their course. She argued that these changes have resulted in better patient engagement and more humane care.

An ICU patient undergoing physical rehabilitation while being mechanically ventilated…and getting some sunshine in the Johns Hopkins Hospital courtyard. www.hopkinsmedicine.org/OACIS

While currently there is no single pharmacologic intervention that can prevent, or shorten the course of a delirium, bundled non-pharmacologic strategies such as sedation reduction/cessation and adequate pain management, early rehabilitation and sleep promotion at night is associated with improved outcomes in the ICU.

Dr. Neufeld highlighted the following future directions for delirium research: 1) the identification and study of more etiologically homogeneous forms of the disorder, through use of biomarkers such as EEG, 2) study of more homogeneous vulnerable populations and 3) more hypothesis driven study of pharmacologic and non-pharmacologic interventions. 4) She also drew attention to the importance of delirium researchers becoming familiar with the relatively large literature on “encephalopathy”. Unfortunately, network analysis indicates that these two bodies of knowledge are quite separate and exist as siloes.

Finally, she called for more interdisciplinary and inter-specialty collaboration and presented the Johns Hopkins Delirium Consortium, as one such model that can propel the field forward through cross pollination by clinicians and scientists from multiple disciplines and specialties.

Multidisciplinary Collaboration to enhance delirium care

Presented by Drs Bill Bryant and BC Childress of Owensboro Health Owensboro, KY

Risk Factors and Outcomes among Delirium Subtypes in the Critically Ill: A Systematic Review

Karla D. Krewulak PhD, Henry T. Stelfox MD, PhD, Jeanna Parsons Leigh PhD, E. Wesley Ely, MD MPH, Kirsten M. Fiest PhD

Delirium is a common organ dysfunction in the ICU, affecting 33% (95% CI 27-40) of admitted patients (1). It can be categorized into three motoric subtypes: hyperactive (agitation, hallucinations), hypoactive (lethargy, motor slowness) and mixed (fluctuating between hyperactive and hypoactive). Hypoactive is the most common, accounting for 50% (95% CI 44-57) (1) of all delirium cases in the ICU. Using systematic review methodology, thirteen studies (which enrolled 19,495 patients; 2679 with delirium) reported on risk factors or outcomes for delirium subtypes. Each risk factor and outcome was assessed as having either a strong association (consistent findings in ≥2 high quality studies), moderate (consistent findings in 1 high quality study and ≥1 acceptable quality study), inconclusive (either inconsistent findings between studies or consistent findings in acceptable/low quality studies) or no evidence based on methodology described by Zaal and colleagues (2). Out of over 30 subtype-specific risk factors and outcomes, only one is supported by strong evidence, age. Older age (>65 years of age) is associated with hypoactive delirium and should be considered when informing delirium prevention and management strategies. The subtype-specific association for some risk factors (drug/alcohol abuse, hyperglycaemia, depression, APACHE-II score) and outcomes (duration of mechanical ventilation, length of ICU stay, mortality and inadvertent tube/line removal) remain inconclusive. This systematic review highlights the heterogeneous reporting of variables across studies, supporting the need for the standardization of delirium assessment and research methodology. This may include standardized reporting on age, hyperglycaemia, APACHE-II score, hours of mechanical ventilation, length of ICU stay, mortality and drug/alcohol abuse for each patient in any delirium study.

1. Krewulak, K.D., Stelfox, H.T., Parsons Leigh, Ely, E.W., Fiest, K.M. “The Prevalence and Incidence of Delirium Subtypes in the ICU: A Systematic Review and Meta-analysis” in preparation

2. Zaal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43(1):40-47.

Using simulated family presence to decrease agitation in older hospitalized delirious patients: A randomized controlled trial

Christine M. Waszynski, Kerry A. Milner, Ilene Staff, Sheila L. Molony International Journal of Nursing Studies: January 2018

Simulated family presence has been shown to be an effective nonpharmacological intervention to reduce agitation in persons with dementia in nursing homes. Hospitalized patients experiencing hyperactive or mixed delirium and receiving continuous observation were consecutively enrolled with 111 participants completing this study. Participants were randomized to one of the following: view a one minute family video message, view a one minute nature video, or usual care. Participants in experimental groups also received usual care. The Agitated Behavior Scale was used to measure the level of agitation prior to, during, immediately following, and 30 min following the intervention.

Median Agitation Behavioral Scale (ABS) scores for each of the three groups (family video, nature video, usual care) at each time point (pre-intervention, during intervention, immediately post-intervention, 30 min post-intervention.) Potential range of ABS score = 14–56.

This work provides preliminary support for the use of family video messaging as a nonpharmacological intervention that may decrease agitation in selected hospitalized delirious patients.

Ways to Get Involved

ADS is seeking electronic educational materials for patients and families or health care professionals.

Submit materials, along with author/creator information and any required permissions to: info@americandeliriumsociety.org.

ADS is seeking volunteers for:

• Member Services- creating member communities to get more from your membership.

• Education- develop and review delirium educational materials for dissemination.

Contact: info@americandeliriumsociety.org

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