Delirium, one of the most common manifestations of acute brain dysfunction, is a serious complication in patients receiving care throughout the hospital and a strong predictor of worse outcome. Although delirium monitoring is advocated in numerous evidence-based guidelines as part of routine clinical care, it is still not widely and consistently performed at the bedside in different patient care settings. In a debate on delirium monitoring in hospitalized patients at the 7th American Delirium Society meeting in Nashville, Tennessee, June 2017, areas related to the feasibility, acceptability, and effectiveness of routine delirium monitoring of hospitalized patients were identified, and arguments both for (pro) and against (con) the practice were presented. These arguments and others arising in the discussion were subsequently expanded. The goals were to present a conversation among clinicians and researchers from different settings and to identify the evidence-practice gaps for delirium monitoring for future research and organizational quality improvement programs. Further research is needed to determine whether or not delirium monitoring should become routine clinical care for every patient in every hospital setting.
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1 March 2019
Invited Review|
March 01 2019
Delirium Monitoring: Yes or No? That Is The Question
Annachiara Marra, MD, PhD;
Annachiara Marra is an anesthesiologist, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy. Katarzyna Kotfis is an assistant professor, Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland. Annmarie Hosie is a postdoctoral research fellow, IMPACCT–Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia. Alasdair M. J. MacLullich is a professor, Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, Scotland. Pratik P. Pandharipande is a professor, Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, and Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center. E. Wesley Ely is a professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Center for Health Services Research, Department of Medicine, and Center for Quality Aging, Vanderbilt University Medical Center, and associate director for research, Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, and CIBS Center, Vanderbilt University Medical Center. Brenda T. Pun is an advanced practice nurse, CIBS Center, Vanderbilt University Medical Center.
Corresponding author: Annachiara Marra, md, phd, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy (email: [email protected]).
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Katarzyna Kotfis, MD, PhD, DESA;
Katarzyna Kotfis, MD, PhD, DESA
Annachiara Marra is an anesthesiologist, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy. Katarzyna Kotfis is an assistant professor, Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland. Annmarie Hosie is a postdoctoral research fellow, IMPACCT–Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia. Alasdair M. J. MacLullich is a professor, Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, Scotland. Pratik P. Pandharipande is a professor, Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, and Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center. E. Wesley Ely is a professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Center for Health Services Research, Department of Medicine, and Center for Quality Aging, Vanderbilt University Medical Center, and associate director for research, Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, and CIBS Center, Vanderbilt University Medical Center. Brenda T. Pun is an advanced practice nurse, CIBS Center, Vanderbilt University Medical Center.
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Annmarie Hosie, PhD, RN;
Annmarie Hosie, PhD, RN
Annachiara Marra is an anesthesiologist, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy. Katarzyna Kotfis is an assistant professor, Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland. Annmarie Hosie is a postdoctoral research fellow, IMPACCT–Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia. Alasdair M. J. MacLullich is a professor, Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, Scotland. Pratik P. Pandharipande is a professor, Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, and Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center. E. Wesley Ely is a professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Center for Health Services Research, Department of Medicine, and Center for Quality Aging, Vanderbilt University Medical Center, and associate director for research, Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, and CIBS Center, Vanderbilt University Medical Center. Brenda T. Pun is an advanced practice nurse, CIBS Center, Vanderbilt University Medical Center.
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Alasdair M. J. MacLullich, PhD, MRCP;
Alasdair M. J. MacLullich, PhD, MRCP
Annachiara Marra is an anesthesiologist, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy. Katarzyna Kotfis is an assistant professor, Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland. Annmarie Hosie is a postdoctoral research fellow, IMPACCT–Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia. Alasdair M. J. MacLullich is a professor, Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, Scotland. Pratik P. Pandharipande is a professor, Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, and Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center. E. Wesley Ely is a professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Center for Health Services Research, Department of Medicine, and Center for Quality Aging, Vanderbilt University Medical Center, and associate director for research, Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, and CIBS Center, Vanderbilt University Medical Center. Brenda T. Pun is an advanced practice nurse, CIBS Center, Vanderbilt University Medical Center.
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Pratik P. Pandharipande, MD, MSCI;
Pratik P. Pandharipande, MD, MSCI
Annachiara Marra is an anesthesiologist, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy. Katarzyna Kotfis is an assistant professor, Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland. Annmarie Hosie is a postdoctoral research fellow, IMPACCT–Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia. Alasdair M. J. MacLullich is a professor, Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, Scotland. Pratik P. Pandharipande is a professor, Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, and Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center. E. Wesley Ely is a professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Center for Health Services Research, Department of Medicine, and Center for Quality Aging, Vanderbilt University Medical Center, and associate director for research, Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, and CIBS Center, Vanderbilt University Medical Center. Brenda T. Pun is an advanced practice nurse, CIBS Center, Vanderbilt University Medical Center.
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E. Wesley Ely, MD, MPH;
E. Wesley Ely, MD, MPH
Annachiara Marra is an anesthesiologist, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy. Katarzyna Kotfis is an assistant professor, Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland. Annmarie Hosie is a postdoctoral research fellow, IMPACCT–Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia. Alasdair M. J. MacLullich is a professor, Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, Scotland. Pratik P. Pandharipande is a professor, Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, and Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center. E. Wesley Ely is a professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Center for Health Services Research, Department of Medicine, and Center for Quality Aging, Vanderbilt University Medical Center, and associate director for research, Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, and CIBS Center, Vanderbilt University Medical Center. Brenda T. Pun is an advanced practice nurse, CIBS Center, Vanderbilt University Medical Center.
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Brenda T. Pun, DNP, RN
Brenda T. Pun, DNP, RN
Annachiara Marra is an anesthesiologist, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy. Katarzyna Kotfis is an assistant professor, Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland. Annmarie Hosie is a postdoctoral research fellow, IMPACCT–Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia. Alasdair M. J. MacLullich is a professor, Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, Scotland. Pratik P. Pandharipande is a professor, Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, and Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center. E. Wesley Ely is a professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Center for Health Services Research, Department of Medicine, and Center for Quality Aging, Vanderbilt University Medical Center, and associate director for research, Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, and CIBS Center, Vanderbilt University Medical Center. Brenda T. Pun is an advanced practice nurse, CIBS Center, Vanderbilt University Medical Center.
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Am J Crit Care (2019) 28 (2): 127–135.
Citation
Annachiara Marra, Katarzyna Kotfis, Annmarie Hosie, Alasdair M. J. MacLullich, Pratik P. Pandharipande, E. Wesley Ely, Brenda T. Pun; Delirium Monitoring: Yes or No? That Is The Question. Am J Crit Care 1 March 2019; 28 (2): 127–135. doi: https://doi.org/10.4037/ajcc2019874
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