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Delirium in Mechanically Ventilated Adults

Delirium in Mechanically Ventilated Adults

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The study by Mehta et al. (2015) is a randomized trial carried out in sixteen medical and surgical ICUs in North America. The sample size included four hundred and thirty critically ill, mechanically ventilated individuals. All the participants had titration of opioid and benzodiazepine infusions using a validated sedation scale. Infusions were resumed at half of previous doses for patients in the interruption group. Screening of delirium was conducted on a daily routine with a score of 4 and above in the Intensive Care Delirium Screening, Checklist defined as positive.

The study compares the characteristics and outcomes of delirious and nondelirious patients admitted to a multicenter trial. As a result, Mehta et al. (2015) compared protocolized sedation with protocolized sedation and daily sedation interruption. The study deploys the SLEAP trial methods that describe study participants, the protocol of nurse-directed sedation and daily sedation interruption. The study, sought approval from the local institutional review board in Canada and United States. Participants were enrolled if they required mechanical ventilation for more than two days after enrollment as well as being under continuous IV opioid or benzodiazepine infusions. An automated telephone system was used by the researchers to perform randomization

Patient data was collected during enrollment including diverse information such as known psychiatric disorders, stroke, dementia, cardiac disease, and alcohol consumption. Besides acute physiology and chronic health evaluation II score were also recorded. The exposure of participants to psychoactive drugs in ICU and physical restraint was documented. The variables, both demographic and clinical, were summarized using descriptive statistics where continuous variables were described using standard deviation, mean and medians. To describe categorical variables, frequencies and proportions were used. All the data analysis was carried out using the SAS Enterprise Guide 4.2 and S-Plus version 7.0 in two-tailed tests. A p-value of 0.05 or less was considered as statistically significant in this study.

The study reports validity and reliability of its results as the generalizability of findings are emphasized. Some of the limitations of the survey include the inability to blind caregivers and that the screening of delirium was conducted only once a day thus the probability of missing out on episodes of delirium. Besides, screening was done by bedside nurses instead of research experts, and the management was not protocolized. Lastly, the study could not distinguish whether the antipsychotic drugs were started upon admission to the ICU or earlier.

In conclusion, delirium is common amongst mechanically ventilated adults and usually affiliated with longer periods of ventilation and hospitalization. Physical restraint is indicated as a key cause of delirium.

References

Mehta, S., Cook, D., Devlin, J.W., Skrobik, Y., Meade, M., Fergusson, D., Herridge, M., Steinberg, M., Granton, J., Ferguson, N., Tanios, M., Dodek, P., Fowler, R., Burns, K., Jacka, M., Olafson, K., Mallick, R., Reynolds, S., Keenan, S., and Burry, L. (2015). Prevalence, Risk Factors, and Outcomes of Delirium in Mechanically Ventilated Adults. Critical Care Medicine, 43(3), 557-565.


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