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Delirium and Its Motoric Subtypes: A Study of 614 Critically Ill Patients
Abstract
OBJECTIVES: To describe the motoric subtypes of delirium in critically ill patients and compare patients aged 65 and older with a younger cohort. DESIGN: Prospective cohort study. SETTING: The medical intensive care unit (MICU) of a tertiary care academic medical center. PARTICIPANTS: Six hundred fourteen MICU patients admitted during a process improvement initiative to monitor levels of sedation and delirium. MEASUREMENTS: MICU nursing staff assessed delirium and level of consciousness in all MICU patients at least once per 12-hour shift using the Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation-Sedation Scale. Delirium episodes were categorized as hypoactive, hyperactive, and mixed type. RESULTS: Delirium was detected in 112 of 156 (71.8%) subjects aged 65 and older and 263 of 458 (57.4%) subjects younger than 65. Mixed type was most common (54.9%), followed by hypoactive delirium (43.5%) and purely hyperactive delirium (1.6%). Patients aged 65 and older experienced hypoactive delirium at a greater rate than younger patients (41.0% vs 21.6%, P<.001) and never experienced hyperactive delirium. Older age was strongly and independently associated with hypoactive delirium (adjusted odds ratio=3.0, 95% confidence interval=1.7-5.3), compared with no delirium in a model that adjusted for other important determinants of delirium including severity of illness, sedative medication use, and ventilation status. CONCLUSION: Older age is a strong predictor of hypoactive delirium in MICU patients, and this motoric subtype of delirium may be missed in the absence of active monitoring.
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“Hyperactive delirium most often comes to clinical attention, but the mixed and hypoactive presentations are far more common [7,59,60,61].”
From Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness (2022) · cites this paper as [59]
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Comparison of mental‐status scales for predicting mortality on the general wards
Zadravecz, F. J., Tien, L., Robertson‐Dick, B. J., Yuen, T. C., Twu, N. M., Churpek, M. M., & Edelson, D. P. (2015) · Journal of Hospital Medicine · doi:10.1002/jhm.2415 · Cited by 34
“One of the potential strengths of RASS over GCS and AVPU is its ability to measure agitation levels, in addition to depressed mentation, a feature that has been shown to be present in up to 60% of delirium episodes.(24) This may also explain why RASS was the most accurate predictor of mortality in our subset of younge…”
BackgroundRecognition of Delirium on Pediatric Hospital Services
Kelly, P., & Frosch, E. J. (2012) · Psychosomatics · doi:10.1016/j.psym.2012.04.012 · Cited by 34
Special Considerations for the Aging Brain and Perioperative Neurocognitive Dysfunction
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Impact of Delirium and Its Motor Subtypes on Stroke Outcomes
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Under-recognition of delirium in older adults by nurses in the intensive care unit setting
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“zodiazepines usually have a hypoactive rather than hyperactive component of delirium [25].”
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“Decreased independency in living situation n/N (%) 4/4 (100) 1/5 (20) 2/4 (50) 5/7 (71.”
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State of the science in pediatric ICU delirium: An integrative review
Kalvas, L. B., & Harrison, T. M. (2020) · Research in Nursing & Health · doi:10.1002/nur.22054 · Cited by 33
“These patterns of delirium motor subtypes in children mirror those experienced by adult ICU patients (Peterson et al., 2006).”
BackgroundRamnarain, D., Pouwels, S., Fernández‐Gonzalo, S., Navarra‐Ventura, G., & Balanzá‐Martínez, V. (2023) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13534 · Cited by 39
“Delirium can be classified into three subtypes: hyperactive, hypoactive, and mixed subtype.(37) Hyperactive delirium subtype is more easily identified due to its florid clinical presentation of agitation and restlessness.”
BackgroundMethodDelirium in The Critically Ill Patient
Girard, T. D., & Ely, E. W. (2008) · Handbook of clinical neurology · doi:10.1016/s0072-9752(07)01703-4 · Cited by 33
“…and hypoactive delirium appear to occur with equal frequency among non-critically-ill patients (Liptzin and Levkoff, 1992), Peterson et al. found that purely hyperactive delirium was rare (<5% of patients) among 307 medical ICU patients assessed over 2029 patient-days (Peterson et al., 2006).”
When Should Sedation or Neuromuscular Blockade Be Used During Mechanical Ventilation?
Bennett, S., & Hurford, W. E. (2011) · Respiratory Care · doi:10.4187/respcare.01095 · Cited by 33
Tate, J. A., Sereika, S. M., DiVirgilio-Thomas, D., Nilsen, M. L., Demerci, J., Campbell, G. B., & Happ, M. B. (2013) · Journal of Gerontological Nursing · doi:10.3928/00989134-20130530-03 · Cited by 32
Agitation, Delirium, and Cognitive Outcomes in Intracerebral Hemorrhage
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“In Peterson’s study,(32) similar findings occurred including a mixed type, which was the most common type (54.”
ResultDelirium in Intensive Care Unit Patients
van Eijk, M. M. J., & Slooter, A. J. C. (2010) · Seminars in Cardiothoracic and Vascular Anesthesia · doi:10.1177/1089253210371495 · Cited by 32
Altering Intensive Care Sedation Paradigms to Improve Patient Outcomes
Riker, R. R., & Fraser, G. L. (2011) · Anesthesiology Clinics · doi:10.1016/j.anclin.2011.09.006 · Cited by 31
The Impact of a Delirium Educational Intervention With Intensive Care Unit Nurses
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“If nursing staff members are not aware of the risk factors and presentationof delirium, the conditionmaygounrecognized, allowing for the development of additional negative sequelae secondary to delirium’s presence.(1,11) One of the aims of this research study was to examine the preintervention delirium knowledge level…”
BackgroundDelirium in the Critically Ill Child: Assessment and Sequelae
Paterson, R., Kenardy, J. A., Young, A. D., Dow, B. L., & Long, D. A. (2017) · Developmental Neuropsychology · doi:10.1080/87565641.2017.1374961 · Cited by 33
“…alertness, withdrawal and unawareness, decreased amount and speed of activity, decreased amount, speed and volume of speech, apathy, and increased day sleeping (Lipowski, 1989), is the most common delirium presentation in both adults and children (Peterson et al., 2006; Smith et al., 2016).”
BackgroundOptimising the recognition of delirium in the intensive care unit
Devlin, J. W., Brummel, N. E., & Al‐Qadheeb, N. S. (2012) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2012.08.002 · Cited by 31
Relationship Between African-American Race and Delirium in the ICU
Khan, B. A., Perkins, A. J., Hui, S. L., Gao, S., Campbell, N. L., Farber, M. O., & Boustani, M. A. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001813 · Cited by 31
“Similar to other studies evaluating the subtypes of delirium (39, 40), we found a considerably higher number of hypoactive as opposed to hyperactive delirious cases on our first positive CAM-ICU screen.”
Brain dysfunction in critically ill patients--the intensive care unit and beyond.
Meyer, N. J., & Hall, J. B. (2006) · Critical Care · doi:10.1186/cc4980 · Cited by 31
The Pathophysiology and Biomarkers of Delirium
Smith, C. J., Hodge, D., Harrison, F. E., & Roberson, S. W. (2024) · Seminars in Neurology · doi:10.1055/s-0044-1791666 · Cited by 38
Nurses' perceptions of unpleasant symptoms and signs in ventilated and sedated patients
Randen, I., Lerdal, A., & Bjørk, I. T. (2013) · Nursing in Critical Care · doi:10.1111/nicc.12012 · Cited by 30
“A study of the subtypes of delirium, including hyperactive, hypoactive and mixed delirium, showed that the mixed and hypoactive types were most common (Peterson et al., 2006).”
BackgroundLived Experience of the Intensive Care Unit for Patients Who Experienced Delirium
Whitehorne, K. M. C., Gaudine, A. P., Meadus, R. J., & Solberg, S. M. (2015) · American Journal of Critical Care · doi:10.4037/ajcc2015435 · Cited by 29
Intensive Care Unit Nurses’ Beliefs About Delirium Assessment and Management
Oosterhouse, K. J., Vincent, C., Foreman, M. D., Gruss, V. A., Corte, C. M., & Berger, B. E. (2016) · AACN Advanced Critical Care · doi:10.4037/aacnacc2016535 · Cited by 29
“The rationale for depicting the young adult with the mixed variant subtype of delirium was based on the findings that this subtype was the most prevalent delirium subtype in younger adults.(72) The vignettes were validated for content by research and gerontology experts(69,73) and revised on the basis of experts’ feed…”
Prevention, Recognition, and Management of Delirium in the Intensive Care Unit
Allen, J. M., & Alexander, E. (2012) · AACN Advanced Critical Care · doi:10.1097/nci.0b013e31822c3633 · Cited by 29
Collet, M. O., Thomsen, T., & Egerod, I. (2018) · Australian Critical Care · doi:10.1016/j.aucc.2018.07.001 · Cited by 36
Post-traumatic Stress Disorder Following Acute Delirium
Bolton, C. J., Thilges, S., Lane, C., Lowe, J., & Mumby, P. B. (2019) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-019-09689-1 · Cited by 33
Medikamentöse Behandlung des Delirs bei Palliativpatienten
Perrar, K. M., Golla, H., & Voltz, R. (2013) · Der Schmerz · doi:10.1007/s00482-013-1293-2 · Cited by 28
Changes of geriatric syndromes in older adults survived from Intensive Care Unit
Hsin-Ju, T., Tang, H.-Y. J., Hu, F., & Chen, C. (2016) · Geriatric Nursing · doi:10.1016/j.gerinurse.2016.10.011 · Cited by 28
Why don’t intensive care nurses perform routine delirium assessment? A discussion of the literature
Wells, L. G. (2012) · Australian Critical Care · doi:10.1016/j.aucc.2012.03.002 · Cited by 29
Barbateskovic, M., Larsen, L. K., Collet, M. O., Jakobsen, J. C., Perner, A., & Wetterslev, J. (2016) · Systematic Reviews · doi:10.1186/s13643-016-0391-5 · Cited by 28
“Hypoactive and mixed form delirium are the most common within the ICU patients [18, 19], and hypoactive delirium has been suggested to be more deleterious than the mixed form with worse outcomes and more longterm harmful effects [4].”
BackgroundReducing delirium and cognitive dysfunction after off-pump coronary bypass: A randomized trial
Szwed, K. A., Pawliszak, W., Szwed, M., Tomaszewska, M., Anisimowicz, L., & Borkowska, A. (2019) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2019.09.081 · Cited by 27
Zhou, W. J., Zheng, Q., Huang, M., Zhang, C., Zhang, H., Li, Y., Wu, T., & Gan, X. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1017283 · Cited by 27
Early Pharmacological Treatment of Delirium May Reduce Physical Restraint Use
Michaud, C. J., Thomas, W. L., & McAllen, K. J. (2013) · Annals of Pharmacotherapy · doi:10.1177/1060028013513559 · Cited by 29
Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness
Nibras, S., Kentor, R., Masood, Y., Price, K., Schneider, N. M., Tenenbaum, R. B., & Calarge, C. (2022) · Children · doi:10.3390/children9071051 · Cited by 25
Classification of daily mental status in critically ill patients for research purposes
Zaal, I. J., Tekatli, H., van der Kooi, A. W., Klijn, F. A., Koek, H. L., van Dijk, D., & Slooter, A. J. C. (2014) · Journal of Critical Care · doi:10.1016/j.jcrc.2014.10.031 · Cited by 26
Postoperative Complications: Delirium
Allen, S. R., & Frankel, H. L. (2012) · Surgical Clinics of North America · doi:10.1016/j.suc.2012.01.012 · Cited by 26
“However, should delirium occur, early identification and treatment are paramount to reduce the associated complications and long-term morbidity and mortality.(7)”
BackgroundMethodUtility of Clinical Features for the Diagnosis of Seizures in the Intensive Care Unit
Schmitt, S. E. (2016) · Journal of Clinical Neurophysiology · doi:10.1097/wnp.0000000000000335 · Cited by 26
Choi, J.-Y., Campbell, M., Gélinas, C., Happ, M. B., Tate, J. A., & Chlan, L. L. (2017) · Heart & Lung · doi:10.1016/j.hrtlng.2017.04.002 · Cited by 30
Linkaitė, G., Riauka, M., Bunevičiūtė, I., & Vosylius, S. (2018) · Acta medica Lituanica · doi:10.6001/actamedica.v25i1.3699 · Cited by 26
“Additionally, we distinguished three different types of delirium according to psychomotor symptoms indicated by the Richmond Agitation Sedation Scale (RASS) score: hyperactive (RASS > 0, hyperalert, agitated), hypoactive (RASS ≤ 0, hypoalert, lethargic), and mixed (RASS score varied) (17, 18).”
MethodGaspardo, P., Peressoni, L., Comisso, I., Mistraletti, G., Ely, E. W., & Morandi, A. (2014) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2014.05.002 · Cited by 25
“free from delirium), while prevalent delirium was defined as a positive CAM-ICU assessment during the first non-comatose mental status evaluation (Pandharipande et al., 2007; Peterson et al., 2006).”
MethodPrescribing Practices of Valproic Acid for Agitation and Delirium in the Intensive Care Unit
Quinn, N. J., Hohlfelder, B., Wanek, M. R., Duggal, A., & Torbic, H. (2020) · Annals of Pharmacotherapy · doi:10.1177/1060028020947173 · Cited by 25
“This was a median of 3 (1-7) days after their first delirium day for a total duration of 6 (3-11) days (Figure s1, available online).”
BackgroundMethodInfluentialRengel, K. F., Hayhurst, C. J., Jackson, J. C., Boncyk, C. S., Patel, M. B., Brummel, N. E., Shi, Y., Shotwell, M. S., Ely, E. W., Pandharipande, P. P., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000004920 · Cited by 27
Sedation and Analgesia in Critically Ill Neurologic Patients
Makii, J. M., Mirski, M. A., & Lewin, J. J. (2010) · Journal of Pharmacy Practice · doi:10.1177/0897190010372339 · Cited by 25
“Delirium is categorized into subtypes according to psychomotor behavior which can range from hypoactive (decreased responsiveness, withdrawn, and apathetic) to hyperactive (agitation, restlessness, and emotional lability), with many patients presenting in its hypoactive or mixed forms.(12) The ICU environment has seve…”
BackgroundData-derived subtypes of delirium during critical illness
Potter, K. M., Kennedy, J. N., Onyemekwu, C. A., Prendergast, N. T., Pandharipande, P. P., Ely, E. W., Seymour, C. W., & Girard, T. D. (2024) · EBioMedicine · doi:10.1016/j.ebiom.2023.104942 · Cited by 25
Delirium in the Intensive Care Unit
Pun, B. T., & Boehm, L. M. (2011) · AACN Advanced Critical Care · doi:10.1097/nci.0b013e318220c173 · Cited by 24
Denk, A., Müller, K., Schlosser, S., Heißner, K., Gülow, K., Müller, M., & Schmid, S. A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0276914 · Cited by 24
Selim, A., Kandeel, N. A., El-Okl, M., Khater, M. S., Saleh, A. N., Bustami, R. T., & Ely, E. W. (2017) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2017.12.011 · Cited by 23
Delirium in the intensive care unit
Choi, J. G. (2013) · Korean Journal of Anesthesiology · doi:10.4097/kjae.2013.65.3.195 · Cited by 23
“Reports [2,4,5] that the hypoactive form is more common in the elderly and is associated with worse prognosis, but may be easily missed, underscore the impor tance of regular screening of the level of sedation and delirium using valid and reliable tools.”
BackgroundMethodFitzgerald, J. (2017) · Aging & Mental Health · doi:10.1080/13607863.2017.1310802 · Cited by 22
“In the ICU setting, it has been found that hypoactive motor subtypes were found to be associated with being older and a strong predictor for a longer ICU stay and a prolonged period of mechanical ventilation (Peterson et al., 2006; Stransky et al., 2011).”
BackgroundPage, V. J., & Ely, E. W. (2015) · Cambridge University Press eBooks · doi:10.1017/cbo9781139924184 · Cited by 22
Delirium Superimposed on Dementia
Flanagan, N. M., & Fick, D. M. (2010) · Journal of Gerontological Nursing · doi:10.3928/00989134-20100930-03 · Cited by 22
Ista, E., Trogrlić, Z., Bakker, J., Osse, R. J., van Achterberg, T., & van der Jagt, M. (2014) · Implementation Science · doi:10.1186/s13012-014-0143-7 · Cited by 21
“Delirium is especially common in over 65-year-old patients [3,4].”
BackgroundScholtens, R. M., Munster, B. C. V., Adamis, D., de Jonghe, A., Meagher, D. J., & de Rooij, S. E. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14582 · Cited by 21
“Some have found that symptoms, such as hypoactivity, remained stable across assessments;(3,8) others reported that most assessments had mixed features.(7) A study of individuals with hip fracture(9) found substantial variability in motor subtypes, as evidenced by changing subtype profile in 86% of participants.”
ResultPreventive Intervention to Prevent Delirium in Patients Hospitalized in Intensive Care Unit.
Ghaeli, P., Shahhatami, F., Zade, M. M., Mohammadi, M., & Arbabi, M. (2018) · Europe PMC (PubMed Central) · Cited by 20
Twelve-Month Mortality Among Delirium Subtypes
DeCrane, S. K., Culp, K. R., & Wakefield, B. J. (2011) · Clinical Nursing Research · doi:10.1177/1054773811419497 · Cited by 20
“…research has varied in method and instruments for classifying psychomotor delirium subtypes, differences in clinical symptoms suggest variation in etiologic pathway, prognosis, and therapeutic differences in presentation of delirium (Karnik, Joshi, Paterno, & Shaw, 2007; Peterson et al., 2006).”
MethodFuture directions of delirium research and management
Hughes, C. G., Brummel, N. E., Vasilevskis, E. E., Girard, T. D., & Pandharipande, P. P. (2012) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2012.08.004 · Cited by 20
Aparanji, K. P., Kulkarni, S., Metzke, M. E., Schmudde, Y., White, P., & Jaeger, C. (2018) · BMJ Open Quality · doi:10.1136/bmjoq-2017-000239 · Cited by 20
“Identification of hypoactive delirium, which comprises around 44% of delirium cases, can be difficult because patients may appear calm and relaxed.(7) Delirium is associated with increased hospital and ICU stay.”
BackgroundRisk factors for delirium: are therapeutic interventions part of it?
Xing, J., Yuan, Z., Jie, Y., Liu, Y., Wang, M., & Sun, Y. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s192836 · Cited by 20
Assessing and Managing Delirium in Surgical and Internal Medicine: an Overview
Kırpınar, İ. (2016) · Bezmialem Science · doi:10.14235/bs.2016.508 · Cited by 19
“Among intensive care patients, mixed and hypoactive delirium cases are observed the most (24-27).”
BackgroundPrognostic Value of Delirium in Patients With Acute Heart Failure in the Intensive Care Unit
Iwata, E., Kondo, T., Kato, T., Okumura, T., Nishiyama, I., Kazama, S., Ishihara, T., Kondo, S., Hiraiwa, H., Tsuda, T., et al. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.01.006 · Cited by 20
Use of the Acute Confusion Protocol
Kratz, A. M. P. (2008) · Journal of Nursing Care Quality · doi:10.1097/01.ncq.0000336673.02725.ec · Cited by 19
Can the critical-care pain observation tool (CPOT) be used to assess pain in delirious ICU patients?
Rijkenberg, S., & van der Voort, P. H. J. (2016) · Journal of Thoracic Disease · doi:10.21037/jtd.2016.03.32 · Cited by 19
Nu-DESC DK: the Danish version of the nursing delirium screening scale (nu-DESC)
Hägi‐Pedersen, D., Thybo, K. H., Hedegaard, H. T., Jensen, J. J., Gaudreau, J., & Radtke, F. M. (2017) · BMC Nursing · doi:10.1186/s12912-017-0271-x · Cited by 19
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Salerno, D. A., Marik, P. E., Daskalakis, C., Kolm, P., & Leone, F. T. (2009) · Journal of Intensive Care Medicine · doi:10.1177/0885066609344940 · Cited by 19
Zhao, X., Li, J., Xie, X., Fang, Z., Feng, Y., Zhong, Y., Chen, C., Huang, K., Ge, C., Shi, H., et al. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111553 · Cited by 18
Delirium in the critically ill patient
Brummel, N. E., & Girard, T. D. (2019) · Handbook of clinical neurology · doi:10.1016/b978-0-12-804766-8.00019-4 · Cited by 23
Fick, D. M., Kolanowski, A. M., Hill, N. L., Yevchak, A. M., DiMeglio, B., & Mulhall, P. M. (2013) · PubMed · Cited by 18
Casamento, A. J., Neto, A. S., Lawrence, M., Chudleigh, L., Browne, E., Taplin, C., Eastwood, G. M., & Bellomo, R. (2023) · Journal of Critical Care · doi:10.1016/j.jcrc.2023.154343 · Cited by 17
Encuesta iberoamericana sobre delirium en pacientes críticos
Ceraso, D., Castell, C. R. D., Raimondi, N., Celis, É., Carrillo, R., Ubiergo, S. U., & Rodríguez, F. (2010) · Medicina Intensiva · doi:10.1016/j.medin.2010.04.003 · Cited by 17
Kang, B., Kim, Y. J., Suh, S. W., Son, K., Ahn, G. S., & Park, H. Y. (2018) · Psycho-Oncology · doi:10.1002/pon.4926 · Cited by 17
“As in a previous study, hyperactive delirium was defined by a positive score, and hypoactive delirium was defined by a negative score on the Richmond Agitation and Sedation Scale, a subpart of the CAM.(20) Delirium severity was rated by consulting psychiatrists, who were blinded to the MDAS scores, using the Delirium…”
MethodOccurrence and Practices for Pain, Agitation, and Delirium in Intensive Care Unit Patients.
Arroyo-Novoa, C. M., Figueroa-Ramos, M. I., & Puntillo, K. (2019) · PubMed · Cited by 17
Delirium in critically ill patients: current knowledge and future perspectives
van den Boogaard, M., & Slooter, A. J. C. (2019) · BJA Education · doi:10.1016/j.bjae.2019.09.004 · Cited by 17
“The subtypes of delirium are categorised according to psychomotor alterations into hypoactive, hyperactive, and mixed motor subtypes, of which the mixed subtype is the most frequent type.(13) The hypoactive subtype is particularly underdiagnosed and is characterised by reduced alertness, motor activity, and speech.”
BackgroundLi, Y., Li, H.-J., Li, H.-J., Feng, Y., Yao, Y., Guo, X., Li, Y., Zhao, B.-J., Hu, X.-Y., Zuo, M., et al. (2015) · BMC Anesthesiology · doi:10.1186/s12871-015-0118-5 · Cited by 17
“Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).”
BackgroundMethodInfluentialHeart Rate Variability in Intensive Care Unit Patients With Delirium
Zaal, I. J., van der Kooi, A. W., van Schelven, L. J., Oey, P. L., & Slooter, A. J. C. (2014) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.13090213 · Cited by 17
Park, H., Kim, K. W., & Yoon, I. (2016) · The Canadian Journal of Psychiatry · doi:10.1177/0706743716652401 · Cited by 18
“Next, the patients with delirium were classified into hypoactive and hyperactive delirium subtypes as in previous studies.(22,23) Hyperactive delirium was defined as a positive score and hypoactive delirium was defined as a negative score on the RASS.”
MethodResultPostoperative delirium in the PACU and intensive care unit
Theuerkauf, N. U., Guenther, U., & Putensen, C. (2012) · Trends in Anaesthesia and Critical Care · doi:10.1016/j.tacc.2012.03.002 · Cited by 19
Delirium and cognitive dysfunction in the intensive care unit
Miller, R. R., & Ely, E. W. (2007) · Current Psychiatry Reports · doi:10.1007/s11920-007-0006-x · Cited by 17
Screening methods for delirium: don't get confused!
Polderman, K. H. (2006) · Intensive Care Medicine · doi:10.1007/s00134-006-0400-6 · Cited by 17
Park, W. R., Kim, H. R., Park, J. Y., Kim, H. E., Cho, J. H., & Oh, J. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11175073 · Cited by 16
“Symptoms of hypoactive delirium include reduced activity, apathy, decreased amount or speed of speech, decreased alertness, reduced awareness, and hypersomnolence [8].”
BackgroundRengel, K. F., Boncyk, C. S., DiNizo, D., & Hughes, C. G. (2022) · Seminars in Cardiothoracic and Vascular Anesthesia · doi:10.1177/10892532221127812 · Cited by 16
“Hypoactive delirium may be difficult to differentiate from oversedation or emergence from anesthesia and is commonly missed by providers.(18) Patients with mixed delirium have features of both hyperactive and hypoactive in the same day and there is speculation that treatment of hyperactive features with pharmacologic…”
BackgroundAltered mental status in the neurocritical care unit
Behrouz, R., Godoy, D. A., Azarpazhooh, M. R., & Napoli, M. D. (2015) · Journal of Critical Care · doi:10.1016/j.jcrc.2015.07.021 · Cited by 16
“In addition, there is a Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) specifically designed for diagnosis of delirium in critically ill patients (Table 3) [21].”
BackgroundMethodWøien, H., BALSLIEMKE, S., & Stubhaug, A. (2012) · Acta Anaesthesiologica Scandinavica · doi:10.1111/j.1399-6576.2012.02793.x · Cited by 16
DELIRIUM EN EL ADULTO MAYOR HOSPITALIZADO
Tobar, E. A., & Álvarez, E. (2020) · Revista Médica Clínica Las Condes · doi:10.1016/j.rmclc.2019.11.008 · Cited by 22
Voils, S. A., Shoulders, B. R., Singh, S., Solberg, L. M., Garrett, T. J., & Frye, R. F. (2020) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.2392 · Cited by 17
Effect of Nonsedation on Cognitive Function in Survivors of Critical Illness
Nedergaard, H. K., Jensen, H. I., Stylsvig, M., Olsen, H. T., Korkmaz, S., Strøm, T., & Toft, P. (2020) · Critical Care Medicine · doi:10.1097/ccm.0000000000004573 · Cited by 16
“Delirium was defined as at least one positive CAM-ICU score during ICU admission and subtyped as hypoactive (RASS 0 to –3), agitated (RASS ≥ +1), or mixed (16, 17).”
MethodDeliriumduring Weaning from Mechanical Ventilation
Leite, M. A., Osaku, É. F., Costa, C. R. L. D. M., Cândia, M. F., Toccolini, B. F., Covatti, C., Costa, N. L., Nogueira, S. T., Ogasawara, S. M., de Albuquerque, C. E., et al. (2014) · Critical Care Research and Practice · doi:10.1155/2014/546349 · Cited by 16
“diagnosis and management of hypoactive delirium, which is associated with a worse prognosis [20].”
BackgroundDelir – eine interdisziplinäre Herausforderung
Kappenschneider, T., Meyer, M., Maderbacher, G., Parik, L., Leiß, F., Quintana, L. P., & Grifka, J. K. (2022) · Der Orthopäde · doi:10.1007/s00132-021-04209-2 · Cited by 15
“Insgesamt ist jedoch der Mischtyp von allen drei genannten Subtypen am häufigsten vertreten [18, 35, 38, 41].”
BackgroundAikawa, Y., Ogata, S., Honda, S., Nagai, T., Murata, S., Morii, I., Anzai, T., Nishimura, K., & Noguchi, T. (2024) · International Journal of Cardiology · doi:10.1016/j.ijcard.2024.131776 · Cited by 15
Kneihsl, M., Berger, N., Sumerauer, S., Asenbaum-Nan, S., Höger, F. S., Gattringer, T., Enzinger, C., Aigner, M., Ferrari, J., & Lang, W. (2024) · Therapeutic Advances in Neurological Disorders · doi:10.1177/17562864241258788 · Cited by 16
“45,46 Vegetative symptoms like sweating and a gradual rise in blood pressure may signal its onset, especially in the vulnerable phase of stroke.”
BackgroundDelirium in Older Cardiac Surgery Patients
Clarke, S. P., McRae, M. E., Signore, S. D., Schubert, M., & Styra, R. G. (2010) · Journal of Gerontological Nursing · doi:10.3928/00989134-20100930-05 · Cited by 16
Diagnosing delirium in very elderly intensive care patients
Heriot, N., Levinson, M., Mills, A., Khine, T. T., Gellie, A. L., & Sritharan, G. (2016) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2016.07.002 · Cited by 15
Novel Markers for Predicting Type 2 Neurologic Complications of Coronary Artery Bypass Grafting
Szwed, K. A., Słomka, A., Pawliszak, W., Szwed, M., Anisimowicz, L., Żekanowska, E., & Borkowska, A. (2019) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2019.10.071 · Cited by 15
Risk Factors for Acute Delirium in Critically Ill Adult Patients: A Systematic Review
Mattar, I., Chan, M. F., & Childs, C. (2013) · ISRN Critical Care · doi:10.5402/2013/910125 · Cited by 15
Metadata
- Authors
- Peterson, J. F., Pun, B. T., Dittus, R. S., Thomason, J. W. W., Jackson, J. C., Shintani, A. K., & Ely, E. W.
- Affiliations
- Vanderbilt University Medical Center (US)
- VA Tennessee Valley Healthcare System (US)
- Corresponding author
- Peterson, Josh F.
- Ely, E. Wesley
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2006-03
- Volume
- 54
- Issue
- 3
- Pages
- 479-484
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W1505808688
- Cited by
- 660
- References
- 31
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 32 · 2023: 37 · 2022: 21 · 2021: 33 · 2020: 32 · 2019: 45 · 2018: 44 · 2017: 41 · 2016: 48 · 2015: 37 · 2014: 29 · 2013: 42 · 2012: 44
- FWCI
- 27.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Pfizer
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Clinical Neurology › Alcoholism and Thiamine Deficiency
- Keywords
- delirium, hypoactive delirium, hyperactive delirium, mixed delirium, critically ill patients, older adults, intensive care unit, age as predictor, sedation, level of consciousness, delirium monitoring
- MeSH terms
- Age Factors, Aged, Critical Care, Delirium, Female, Follow-Up Studies, Humans, Male, Motor Activity, Prognosis, Prospective Studies, Severity of Illness Index, Incidence, Prevalence, Critical Illness
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