Delirium Clinical Trial
— ICUOfficial title:
A Multidisciplinary Delirium Prevention Strategy Involving Psychiatry in the Intensive Care Unit (ICU): Effects on Delirium Incidence and Outcomes
NCT number | NCT03550495 |
Other study ID # | HS-17-00617 |
Secondary ID | |
Status | Completed |
Phase | N/A |
First received | |
Last updated | |
Start date | April 16, 2018 |
Est. completion date | June 1, 2019 |
Verified date | March 2020 |
Source | University of Southern California |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Delirium affects up to 80% of intensive care unit (ICU) patients and is associated with longer hospital stays, increased morbidity and mortality, and increased costs. There is no FDA-approved treatment for delirium; the most effective strategy is prevention by nonpharmacological methods. The investigators propose to study a comprehensive delirium prevention bundle that has been effective against delirium in preliminary studies in elderly in-hospital patients and elderly ICU patients. This delirium prevention bundle includes the novel addition of psychiatrists to daily ICU rounds, as these professionals are specially trained to screen for latent mental illness and provide treatment for these illnesses. The effects of daily psychiatric evaluation of ICU patients has never been systematically studied, as ICU professionals are well-equipped to manage ICU delirium. Psychiatric consultation is reserved for severe and/or refractory cases of delirium. The investigators hypothesize that a multidisciplinary rounding approach including psychiatry within the ICU team will help diagnose psychiatric components that may contribute to delirium at an earlier time point, and thus can reduce the incidence and duration of delirium. The investigators also hypothesize that the proposed multidisciplinary approach will shorten hospital and ICU lengths of stay, duration of mechanical ventilation, and decrease in-hospital mortality.
Status | Completed |
Enrollment | 104 |
Est. completion date | June 1, 2019 |
Est. primary completion date | April 30, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion criteria are: 1. Patients who are =18 years of age 2. Patients admitted to the surgical ICU for >48 hours OR 3. Patients admitted to the ICU <24 hours who have been in the hospital >48 hours OR 4. Patients who return to the ICU after being discharged from the ICU to the floor due a complication or need for higher acuity care. 5. Patients admitted to any surgical service who are receiving care in the 7 West surgical ICU, who are either medically or conservatively managed (non-surgical) or surgically managed as part of their care Exclusion criteria are: 1. Patients in whom CAM-ICU cannot be performed (severe dementia, stroke or other neurological condition, encephalopathy, mental retardation, severe psychiatric disorder, vegetative state, severe traumatic brain injury, deaf/blind, etc.) 2. Patients who don't speak or understand English 3. Current alcohol or substance abuse 4. Patients who already have delirium within 24-48 hours of their ICU admission [Defined as a positive CAM-ICU test, or based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-V) diagnostic criteria: - Disturbance in attention (ie, reduced ability to direct, focus, sustain, and shift attention) and awareness. - Change in cognition (eg, memory deficit, disorientation, language disturbance, perceptual disturbance) that is not better accounted for by a preexisting, established, or evolving dementia. - The disturbance develops over a short period (usually hours to days) and tends to fluctuate during the course of the day. - There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by a direct physiologic consequence of a general medical condition, an intoxicating substance, medication use, or more than one cause.] |
Country | Name | City | State |
---|---|---|---|
United States | Keck School of Medicine of the University of Southern California | Los Angeles | California |
Lead Sponsor | Collaborator |
---|---|
University of Southern California |
United States,
Abelha FJ, Luís C, Veiga D, Parente D, Fernandes V, Santos P, Botelho M, Santos A, Santos C. Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery. Crit Care. 2013 Oct 29;17(5):R257. doi: 10.1186/cc — View Citation
Angel C, Brooks K, Fourie J. Standardizing Management of Adults with Delirium Hospitalized on Medical-Surgical Units. Perm J. 2016 Fall;20(4):16-002. doi: 10.7812/TPP/16-002. Epub 2016 Sep 9. — View Citation
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care — View Citation
Beach SR, Chen DT, Huffman JC. Educational impact of a psychiatric liaison in the medical intensive care unit: effects on attitudes and beliefs of trainees and nurses regarding delirium. Prim Care Companion CNS Disord. 2013;15(3). pii: PCC.12m01499. doi: — View Citation
Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Crit Care Clin. 2013 Jan;29(1):51-65. doi: 10.1016/j.ccc.2012.10.007. Review. — View Citation
Collinsworth AW, Priest EL, Campbell CR, Vasilevskis EE, Masica AL. A Review of Multifaceted Care Approaches for the Prevention and Mitigation of Delirium in Intensive Care Units. J Intensive Care Med. 2016 Feb;31(2):127-41. doi: 10.1177/0885066614553925. — View Citation
Davydow DS. Symptoms of depression and anxiety after delirium. Psychosomatics. 2009 Jul-Aug;50(4):309-16. doi: 10.1176/appi.psy.50.4.309. Review. — View Citation
Desan PH, Zimbrean PC, Weinstein AJ, Bozzo JE, Sledge WH. Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team. Psychosomatics. 2011 Nov-Dec;52(6):513-20. doi: 10.1016/j.psym.2011.06.002. — View Citation
Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004 Apr 14;291(14):1753-62. — View Citation
Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009 Apr;5(4):210-20. doi: 10.1038/nrneurol.2009.24. Review. — View Citation
Hayhurst CJ, Pandharipande PP, Hughes CG. Intensive Care Unit Delirium: A Review of Diagnosis, Prevention, and Treatment. Anesthesiology. 2016 Dec;125(6):1229-1241. Review. — View Citation
Holmes A, Hodgins G, Adey S, Menzel S, Danne P, Kossmann T, Judd F. Trial of interpersonal counselling after major physical trauma. Aust N Z J Psychiatry. 2007 Nov;41(11):926-33. — View Citation
Jackson P, Khan A. Delirium in critically ill patients. Crit Care Clin. 2015 Jul;31(3):589-603. doi: 10.1016/j.ccc.2015.03.011. Epub 2015 May 4. Review. — View Citation
Kalabalik J, Brunetti L, El-Srougy R. Intensive care unit delirium: a review of the literature. J Pharm Pract. 2014 Apr;27(2):195-207. doi: 10.1177/0897190013513804. Epub 2013 Dec 10. Review. — View Citation
Khan BA, Lasiter S, Boustani MA. CE: critical care recovery center: an innovative collaborative care model for ICU survivors. Am J Nurs. 2015 Mar;115(3):24-31; quiz 34, 46. doi: 10.1097/01.NAJ.0000461807.42226.3e. — View Citation
Leslie DL, Inouye SK. The importance of delirium: economic and societal costs. J Am Geriatr Soc. 2011 Nov;59 Suppl 2:S241-3. doi: 10.1111/j.1532-5415.2011.03671.x. — View Citation
Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF Bundle in Critical Care. Crit Care Clin. 2017 Apr;33(2):225-243. doi: 10.1016/j.ccc.2016.12.005. Review. — View Citation
Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW; BRAIN-ICU Study Investigators. Long-term cognitiv — View Citation
Papathanassoglou ED. Psychological support and outcomes for ICU patients. Nurs Crit Care. 2010 May-Jun;15(3):118-28. doi: 10.1111/j.1478-5153.2009.00383.x. Review. — View Citation
Peris A, Bonizzoli M, Iozzelli D, Migliaccio ML, Zagli G, Bacchereti A, Debolini M, Vannini E, Solaro M, Balzi I, Bendoni E, Bacchi I, Trevisan M, Giovannini V, Belloni L. Early intra-intensive care unit psychological intervention promotes recovery from p — View Citation
Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009 Dec 1;180(11):1092-7. doi: 10.1164/rccm.200904-0537OC. Epub 2 — View Citation
Ringdal GI, Ringdal K, Juliebø V, Wyller TB, Hjermstad MJ, Loge JH. Using the Mini-Mental State Examination to screen for delirium in elderly patients with hip fracture. Dement Geriatr Cogn Disord. 2011;32(6):394-400. doi: 10.1159/000335743. Epub 2012 Feb — View Citation
Roberts DJ, Goralski KB, Renton KW, Julien LC, Webber AM, Sleno L, Volmer DA, Hall RI. Effect of acute inflammatory brain injury on accumulation of morphine and morphine 3- and 6-glucuronide in the human brain. Crit Care Med. 2009 Oct;37(10):2767-74. doi: — View Citation
Rymaszewska J, Kiejna A, Hadrys T. Depression and anxiety in coronary artery bypass grafting patients. Eur Psychiatry. 2003 Jun;18(4):155-60. — View Citation
Salluh JI, Latronico N. Making advances in delirium research: coupling delirium outcomes research and data sharing. Intensive Care Med. 2015 Jul;41(7):1327-9. doi: 10.1007/s00134-015-3864-4. Epub 2015 Jun 3. — View Citation
Slooter AJ, Van De Leur RR, Zaal IJ. Delirium in critically ill patients. Handb Clin Neurol. 2017;141:449-466. doi: 10.1016/B978-0-444-63599-0.00025-9. Review. — View Citation
Turnbull AE, Neufeld KJ, Needham DM. Contradictory findings on one-year mortality following ICU delirium. Crit Care. 2015 Jan 30;19:29. doi: 10.1186/s13054-015-0747-6. — View Citation
van den Boogaard M, Schoonhoven L, Evers AW, van der Hoeven JG, van Achterberg T, Pickkers P. Delirium in critically ill patients: impact on long-term health-related quality of life and cognitive functioning. Crit Care Med. 2012 Jan;40(1):112-8. doi: 10.1 — View Citation
van Eijk MM, van Marum RJ, Klijn IA, de Wit N, Kesecioglu J, Slooter AJ. Comparison of delirium assessment tools in a mixed intensive care unit. Crit Care Med. 2009 Jun;37(6):1881-5. doi: 10.1097/CCM.0b013e3181a00118. — View Citation
Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Elseviers M, Bossaert L. Long term outcome after delirium in the intensive care unit. J Clin Nurs. 2009 Dec;18(23):3349-57. doi: 10.1111/j.1365-2702.2009.02933.x. Epub 2009 Sep 4. — View Citation
Zhang H, Lu Y, Liu M, Zou Z, Wang L, Xu FY, Shi XY. Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials. Crit Care. 2013 Mar 18;17(2):R47. doi: 10.1186/cc12566. Review. — View Citation
* Note: There are 31 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Age | in years | Average of one year. | |
Other | Gender | male or female | Average of one year. | |
Other | Body mass index (BMI) | weight and height will be used to calculate BMI in kg/m^2 | Average of one year. | |
Other | History of alcohol or substance abuse | any remote history; patients must be sober 6 months prior to study enrollment | Average of one year. | |
Other | Admitting diagnosis | Verbal admitting diagnosis (not using ICD codes) | Average of one year. | |
Other | Dementia | yes or no | Average of one year. | |
Other | Comorbid conditions | verbal list of other medical conditions | Average of one year. | |
Other | admitting Sequential Organ Failure Assessment (SOFA) score | Use MDCalc to calculate score using: admitting PaO2 (mmHg), FiO2 (%), platelets (x10^3/mcL), glasgow coma scale (points 3-15), bilirubin (mg/dL), level of hypotension (0-4 point scale based on mean arterial pressure value in mmHg, and the number and doses of vasopressors the patient is on), Creatinine (point assigned from 0-4 based on creatinine values ranging from Cr<1.2 mg/dL to Cr>5mg/dL) | Average of one year. | |
Other | Use of deliriogenic medications | List of medications which are known to be deliriogenic as described in literature and the 2018 American Geriatric Society Beers criteria which are administered to the participant. | Average of one year. | |
Other | Treatment of delirium | Description of intervention used to treat delirium (i.e. non pharmacological measures like family involvement) or medications (i.e. haloperidol). It will also be specified if the treatment was initiated by the ICU or psychiatry team. | Average of one year. | |
Other | Number of days from hospital admission to study enrollment | In days | Average of one year. | |
Other | height | measured in meters-used for BMI calculation | Average of one year. | |
Other | weight | Measured in kilograms (kg)-used for BMI calculation. | Average of one year. | |
Primary | Incidence of ICU delirium. | primary outcome measure is the incidence of ICU delirium. | Average of one year. | |
Secondary | Duration of delirium. | Total days of delirium (even if they are non-consecutive). | Average of one year. | |
Secondary | Hospital length of stay | Total days of hospital length of stay. | Average of one year. | |
Secondary | Total days of mechanical ventilation. | In days. | Average of one year. | |
Secondary | In-hospital mortality | In-hospital mortality | Average of one year. | |
Secondary | ICU length of stay | Total days of ICU length of stay. | Average of one year. |
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