Rachel O'Mahony, PhD; Lakshmi Murthy, MSc; Anayo Akunne, PhD, MPH; John Young, MB BS, MSc; for the Guideline Development Group
Delirium is common, is often underrecognized, and is associated with poor outcomes and high costs. In July 2010, the National Institute for Health and Clinical Excellence released a guideline that addressed diagnosis, prevention, and management of delirium. This synopsis focuses on the main recommendations about prevention of delirium.
The National Clinical Guideline Centre developed these guidelines by using standard methodology of the National Institute for Health and Clinical Excellence. A multidisciplinary guideline development group posed review questions, discussed evidence, and formulated the recommendations. To underpin the guideline, a technical team from the National Clinical Guideline Centre systematically reviewed and graded pertinent evidence identified from literature searches of studies published in English to August 2009 and performed health economic modeling. Stakeholder and public comment informed guideline development and modifications.
Considering prevention a feasible and cost-effective health strategy, the guideline development group made 13 specific recommendations that addressed the stability of the care environment (both the care team and location) and the provision of a multicomponent intervention package tailored for persons at risk for delirium. The multicomponent intervention package included assessment and modification of key clinical factors that may precipitate delirium, including cognitive impairment or disorientation, dehydration or constipation, hypoxia, infection, immobility or limited mobility, several medications, pain, poor nutrition, sensory impairment, and sleep disturbance.
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Mark A. LaPorta
Mark Antony LaPorta MD FACP, Roseland FL
June 13, 2011
Excellence in Delerium
With the understanding that I could have missed a citation,
I was disappointed not to have seen adequate reference to the current problem -- at any age -- of alcohol, illegal or illicit drug use, or surreptious abuse of prescriptions in patients who will not admit it -- or be able to.And I did not see any reference in this article to acute withdrawal from same, which can take place and prolonged intervals from substance cessation.
These are empirically extremely important and underappreciated causative and confounding factors.
On the other hand it was a good review of pathophysiologic states, even mild ones, that can induce altered mental status through a variety of processes. The brown-bag session cannot be repeated too often.
Last question: only slightly facetious: Are not many people in a state of "subsyndromal delerium" as they go about their daily affairs?
Not in the usual sense!
O'Mahony R, Murthy L, Akunne A, Young J, for the Guideline Development Group. Synopsis of the National Institute for Health and Clinical Excellence Guideline for Prevention of Delirium. Ann Intern Med. 2011;154:746-751. doi: 10.7326/0003-4819-154-11-201106070-00006
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Published: Ann Intern Med. 2011;154(11):746-751.
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