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Delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale (RASS): Inattention and visuo-spatial impairment as potential screening domains

Published online by Cambridge University Press:  19 September 2019

Soenke Boettger Open the ORCID record for Soenke Boettger [Opens in a new window] ,
Rafael Meyer ,
André Richter ,
Alain Rudiger ,
Maria Schubert ,
Josef Jenewein  and
David Garcia Nuñez
Soenke Boettger*
Affiliation:
Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland
Rafael Meyer
Affiliation:
Department Geronto- and Neuropsychiatry, Psychiatry Services Aargau AG (PDAG), Husmatt 1, 5405Dättwil, Switzerland
André Richter
Affiliation:
Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland
Alain Rudiger
Affiliation:
Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland
Maria Schubert
Affiliation:
School of Health Professions, Zurich University of Applied Science, Technikumstrasse 81, 8401Winterthur, Switzerland
Josef Jenewein
Affiliation:
Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland
David Garcia Nuñez
Affiliation:
Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland University Hospital Basel, University of Basel, Spitalstrasse 21, 8046Basel, Switzerland
*
Author for correspondence: Soenke Boettger, Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland. E-mail: soenke.boettger@usz.ch
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Abstract

Objective

In the intensive care setting, delirium is a common occurrence; however, the impact of the level of alertness has never been evaluated. Therefore, this study aimed to assess the delirium characteristics in the drowsy, as well as the alert and calm patient.

Method

In this prospective cohort study, 225 intensive care patients with Richmond Agitation and Sedation Scale (RASS) scores of −1 — drowsy and 0 — alert and calm were evaluated with the Delirium Rating Scale-Revised-1998 (DRS-R-98) and the Diagnostic and Statistical Manual 4th edition text revision (DSM-IV-TR)-determined diagnosis of delirium.

Results

In total, 85 drowsy and 140 alert and calm patients were included. Crucial items for the correct identification of delirium were sleep–wake cycle disturbances, language abnormalities, thought process alterations, psychomotor retardation, disorientation, inattention, short- and long-term memory, as well as visuo-spatial impairment, and the temporal onset. Conversely, perceptual disturbances, delusions, affective lability, psychomotor agitation, or fluctuations were items, which identified delirium less correctly. Further, the severities of inattentiveness and visuo-spatial impairment were indicative of delirium in both alert- or calmness and drowsiness.

Significance of results

The impairment in the cognitive domain, psychomotor retardation, and sleep–wake cycle disturbances correctly identified delirium irrespective of the level alertness. Further, inattentiveness and — to a lesser degree — visuo-spatial impairment could represent a specific marker for delirium in the intensive care setting meriting further evaluation.

Keywords

DeliriumInattentionVisuo-spatial impairmentScreening domainsDRS-R-98

Information

Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 2 , April 2020 , pp. 148 - 157
Copyright
Copyright © Cambridge University Press 2019

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References

REFERENCES

American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th ed. Text Revision. Washington, DC: American Psychiatric Association, pp. 124–127.Google Scholar
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association, pp. 124–127.Google Scholar
Balas, MC, Happ, MB, Yang, W, et al. (2009) Outcomes associated with delirium in older patients in surgical ICUs. Chest 135, 18–25.CrossRefGoogle ScholarPubMed
Bergeron, N, Dubois, MJ, Dumont, M, et al. (2001) Intensive care delirium screening checklist: Evaluation of a new screening tool. Intensive Care Medicine 27, 859–864.CrossRefGoogle ScholarPubMed
Bickel, H, Gradinger, R, Kochs, E, et al. (2008) High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dementia and Geriatric Cognitive Disorders 26, 26–31.CrossRefGoogle ScholarPubMed
Boettger, S, Nunez, DG, Meyer, R, et al. (2017a) Delirium in the intensive care setting and the Richmond Agitation and Sedation Scale (RASS): Drowsiness increases the risk and is subthreshold for delirium. Journal of Psychosomatic Research 103, 133–139.CrossRefGoogle Scholar
Boettger, S, Nunez, DG, Meyer, R, et al. (2017b) Delirium in the intensive care setting: A reevaluation of the validity of the CAM-ICU and ICDSC versus the DSM-IV-TR in determining a diagnosis of delirium as part of the daily clinical routine. Palliative and Supportive Care 15, 675–683.CrossRefGoogle Scholar
Bucht, G, Gustafson, Y and Sandberg, O (1999) Epidemiology of delirium. Dementia and Geriatric Cognitive Disorders 10, 315–318.CrossRefGoogle ScholarPubMed
Devlin, JW, Fong, JJ, Schumaker, G, et al. (2007) Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients. Critical Care Medicine 35, 2721–2724.CrossRefGoogle ScholarPubMed
Ely, EW, Inouye, SK, Bernard, GR, et al. (2001) Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). Journal of the American Medical Association 286, 2703–2710.CrossRefGoogle Scholar
Ely, EW, Shintani, A, Truman, B, et al. (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Journal of the American Medical Association 291, 1753–1762.CrossRefGoogle ScholarPubMed
Fong, TG, Tulebaev, SR and Inouye, SK (2009) Delirium in elderly adults: Diagnosis, prevention and treatment. Nature Reviews. Neurology 5, 210–220.CrossRefGoogle Scholar
Gottesman, RF, Grega, MA, Bailey, MM, et al. (2010) Delirium after coronary artery bypass graft surgery and late mortality. Annals of Neurology 67, 338–344.Google ScholarPubMed
Gupta, N, de Jonghe, J, Schieveld, J, et al. (2008) Delirium phenomenology: What can we learn from the symptoms of delirium? Journal of Psychosomatic Research 65, 215–222.CrossRefGoogle ScholarPubMed
Heymann, A, Radtke, F, Schiemann, A, et al. (2010) Delayed treatment of delirium increases mortality rate in intensive care unit patients. The Journal of International Medical Research. 38, 1584–1595.CrossRefGoogle ScholarPubMed
Inouye, SK, Westendorp, RG and Saczynski, JS (2014) Delirium in elderly people. Lancet 383, 911–922.CrossRefGoogle ScholarPubMed
Koster, S, Hensens, AG and van der, PJ (2009) The long-term cognitive and functional outcomes of postoperative delirium after cardiac surgery. The Annals of Thoracic Surgery 87, 1469–1474.CrossRefGoogle ScholarPubMed
Lahariya, S, Grover, S, Bagga, S, et al. (2016) Phenomenology of delirium among patients admitted to a coronary care unit. Nordic Journal of Psychiatry 70, 626–632.CrossRefGoogle ScholarPubMed
Landis, JR and Koch, GG (1977) The measurement of observer agreement for categorical data. Biometrics 33, 159–174.CrossRefGoogle ScholarPubMed
Luetz, A, Heymann, A, Radtke, FM, et al. (2010) Different assessment tools for intensive care unit delirium: Which score to use? Critical Care Medicine 38, 409–418.CrossRefGoogle ScholarPubMed
Norkiene, I, Ringaitiene, D, Misiuriene, I, et al. (2007) Incidence and precipitating factors of delirium after coronary artery bypass grafting. Scandinavian Cardiovascular Journal: SCJ 41, 180–185.CrossRefGoogle ScholarPubMed
O'Regan, NA, Ryan, DJ, Boland, E, et al. (2014) Attention! A good bedside test for delirium? Journal of Neurology, Neurosurgery, and Psychiatry 85, 1122–1131.CrossRefGoogle ScholarPubMed
O'Regan, NA, Maughan, K, Liddy, N, et al. (2017) Five short screening tests in the detection of prevalent delirium: diagnostic accuracy and performance in different neurocognitive subgroups. International Journal of Geriatric Psychiatry 32, 1440–1449.CrossRefGoogle ScholarPubMed
Ouimet, S, Kavanagh, BP, Gottfried, SB, et al. (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Medicine 33, 66–73.CrossRefGoogle ScholarPubMed
Pun, BT and Ely, EW (2007) The importance of diagnosing and managing ICU delirium. Chest 132, 624–636.CrossRefGoogle ScholarPubMed
Rosen, SF, Clagett, GP, Valentine, RJ, et al. (2002) Transient advanced mental impairment: An underappreciated morbidity after aortic surgery. Journal of Vascular Surgery 35, 376–381.CrossRefGoogle ScholarPubMed
Santos, FS, Velasco, IT and Fraguas, R Jr. (2004) Risk factors for delirium in the elderly after coronary artery bypass graft surgery. International Psychogeriatrics/IPA 16, 175–193.CrossRefGoogle ScholarPubMed
Sessler, CN, Gosnell, MS, Grap, MJ, et al. (2002) The Richmond Agitation-Sedation Scale: Validity and reliability in adult intensive care unit patients. American Journal of Respiratory and Critical Care Medicine 166, 1338–1344.CrossRefGoogle ScholarPubMed
Sharma, A, Malhotra, S, Grover, S, et al. (2012) Incidence, prevalence, risk factor and outcome of delirium in intensive care unit: a study from India. General Hospital Psychiatry 34, 639–646.CrossRefGoogle ScholarPubMed
Stagno, D, Gibson, C and Breitbart, W (2004) The delirium subtypes: a review of prevalence, phenomenology, pathophysiology, and treatment response. Palliative and Supportive Care 2, 171–179.CrossRefGoogle ScholarPubMed
Trzepacz, PT, Baker, RW and Greenhouse, J (1988) A symptom rating scale for delirium. Psychiatry Research 23, 89–97.CrossRefGoogle ScholarPubMed
Trzepacz, PT, Breitbart, W, Franklin, J, et al. (1999) Practice guideline for the treatment of patients with delirium. American Psychiatric Association. The American Journal of Psychiatry 156, 1–20.Google Scholar
Trzepacz, PT, Mittal, D, Torres, R, et al. (2001) Validation of the Delirium Rating Scale-revised-98: Comparison with the delirium rating scale and the cognitive test for delirium. The Journal of Neuropsychiatry and Clinical Neurosciences 13, 229–242.CrossRefGoogle ScholarPubMed