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for Medical Professionals — ABCDEFs of Prevention and Safety

Historically Important Selected References

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About Delirium

Delirium in Older Persons.
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A research algorithm to improve detection of delirium in the intensive care unit.
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Hospitals battle an insidious complication: delirium in ICU patients, once thought temporary can inflict lasting damage.
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Subsyndromal delirium in the ICU: evidence for a disease spectrum.
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Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients.
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Characteristics associated with delirium in older patients in a medical intensive care unit.
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The importance of diagnosing and managing ICU delirium.
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Delirium in older people.
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Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients.
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Delirium superimposed on dementia versus delirium in the absence of dementia: Phenomenological differences.
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Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes.
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Delirium in the nursing home emergency department patient.
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Delirium and sedation in the intensive care unit: survey of behaviors and attitudes of 1384 healthcare professionals.
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The diagnosis of delirium among elderly patients presenting to the emergency department of an acute hospital.
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Subsyndromal delirium in the ICU: evidence for a disease spectrum.
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The incidence of delirium associated with orthopedic surgery: a meta-analytic review.
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Preoperative risk assessment for delirium after noncardiac surgery: a systematic review.
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Assessing neurocognitive outcomes after critical illness: are delirium and long-term cognitive impairments related?
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Long-term neurocognitive function after critical illness.
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Does delirium need immediate medical referral in a frail, homebound elder?
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Delirium and its motoric subtypes: a study of 614 critically ill patients.
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Delirium: acute cognitive dysfunction in the critically ill.
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Postoperative delirium in the older patient.
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Monitoring delirium in critically ill patients. Using the confusion assessment method for the intensive care unit.
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Delirium in the elderly patient.
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Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care.
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Delirium in the intensive care unit: an under-recognized syndrome of organ dysfunction.
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Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals.
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Delirium and Clinical Outcomes

Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study.
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Outcomes of older people admitted to postacute facilities with delirium.
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Delirium accelerates cognitive decline in Alzheimer disease.
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Informed consent in the critically ill: A two-step approach incorporating delirium screening*
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The 6- and 12-month outcomes of older medical inpatients who recover from subsyndromal delirium
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Delirium superimposed on dementia predicts 12-month survival in elderly patients discharged from a postacute rehabilitation facility: a comment
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One-year health care costs associated with delirium in the elderly population
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Outcomes associated with delirium in older patients in surgical ICUs
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Days of delirium are associated with 1-year mortality in an older intensive care unit population
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Delirium recognition and sedation practices in critically ill patients: A survey on the attitudes of 1015 Brazilian critical care physicians
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Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial.
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Phenomenology of delirium. Assessment of 100 adult cases using standardised measures.
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Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem.
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Delirium assessment in the critically ill.
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The importance of diagnosing and managing ICU delirium.
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Outcomes of older people admitted to postacute facilities with delirium.
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Association between delirium resolution and functional recovery among newly admitted postacute facility patients.
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An 18-month prospective cohort study of functional outcome of delirium in elderly patients: activities of daily living.
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Influence of prior cognitive impairment on the severity of delirium symptoms among older patients.
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Post-operative delirium is associated with poor cognitive outcome and dementia.
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The impact of delirium on the survival of mechanically ventilated patients.
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Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit.
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Costs associated with delirium in mechanically ventilated patients.
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A prospective study of delirium in hospitalized elderly.
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The impact of delirium in the intensive care unit on hospital length of stay.
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Delirium in the intensive care unit: occurrence and clinical course in older patients.
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The risk of dementia and death after delirium.
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Delirium predicts 12-month mortality.
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Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients.
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Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study.
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The spectrum of septic encephalopathy. Definitions, etiologies, and mortalities.
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A multicomponent intervention to prevent delirium in hospitalized older patients.
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Pathophysiology of Delirium

Elucidating the pathophysiology of delirium and the interrelationship of delirium and dementia.
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Serum biomarkers for delirium.
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C-reactive protein levels predict the incidence of delirium and recovery from it.
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Sepsis-associated delirium.
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Pathophysiology of delirium in the intensive care unit.
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Low tryptophan levels are associated with postoperative delirium in the elderly.
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Neuroimaging studies of delirium: A systematic review.
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Time-course of Cytokines During Delirium in Elderly Patients with Hip Fractures.
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Sepsis-associated delirium: the pro and con of C5a blockade.
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Plasma tryptophan and tyrosine levels are independent risk factors for delirium in critically ill patients.
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The role of neuroimaging in elucidating delirium pathophysiology.
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Cerebral perfusion changes in older delirious patients using 99mTc HMPAO SPECT.
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Elucidating the pathophysiology of delirium and the interrelationship of delirium and dementia.
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Isoflurane-induced apoptosis: a potential pathogenic link between delirium and dementia.
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Risk Factors for Delirium

A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics.
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A clinical prediction rule for delirium after elective noncardiac surgery.
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The relationship of postoperative delirium with psychoactive medications.
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An Intervention Integrated into Daily Clinical Practice Reduces the Incidence of Delirium During Hospitalization in Elderly Patients.
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Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients.
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Apolipoprotein E e4 Allele Increases the Risk of Early Postoperative Delirium in Older Patients Undergoing Noncardiac Surger.
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Incidence and precipitating factors of delirium after coronary artery bypass grafting.
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Risk factors for the development of early-onset delirium and the subsequent clinical outcome in mechanically ventilated patients.
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Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients.
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Risk factors for intensive care delirium: a systematic review.
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Symptoms of depression and anxiety after delirium.
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Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture.
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Postoperative delirium in the elderly: risk factors and outcomes.
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The Role of Genetics in Delirium in the Elderly Patient.
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Incidence, risk factors and consequences of ICU delirium.
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Characteristics associated with delirium in older patients in a medical intensive care unit.
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Does educational attainment contribute to risk for delirium? A potential role for cognitive reserve.
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Risk factors and prediction of postoperative delirium in elderly hip-surgery patients: implementation and validation of a medical risk factor model.
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Serum biomarkers for delirium.
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Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients.
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Impaired executive function is associated with delirium after coronary artery bypass graft surgery.
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Impaired oxidative metabolism precipitates delirium: a study of 101 ICU patients.
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Postoperative delirium: the importance of pain and pain management.
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Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients.
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A clinical prediction rule for delirium after elective noncardiac surgery.
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Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability.
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The relationship of postoperative delirium with psychoactive medications.
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Delirium risk factors in elderly hospitalized patients.
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Preoperative risk factors for postoperative delirium.
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Incidence and risk factors for delirium and other adverse outcomes in older adults after coronary artery bypass graft surgery.
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Risk factors for delirium in hospitalized elderly.
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Delirium in an intensive care unit: a study of risk factors.
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Predisposing factors for delirium in the surgical intensive care unit.
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CAM-ICU Validation Studies and Other Delirium Instruments

Clarifying Confusion: the confusion assessment method. A new method for detection of delirium.
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Large-scale implementation of sedation and delirium monitoring in the intensive care unit: a report from two medical centers.
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Clarifying confusion: the confusion assessment method. A new method for detection of delirium.
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Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU).
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Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).
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Intensive Care Delirium Screening Checklist: evaluation of a new screening tool.
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Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium.
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Concordance between DSM-IV and DSM-5 Criteria for Delirium Diagnosis.
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Pain Scales

CPOT Validation Document
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BPS Validation Document:
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Sedation Scales and Sedation Protocols

Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial.
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Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients.
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The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients.
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Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS).
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Validating the Sedation-Agitation Scale with the Bispectral Index and Visual Analog Scale in adult ICU patients after cardiac surgery.
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Confirming the reliability of the sedation-agitation scale administered by ICU nurses without experience in its use.
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Motor Activity Assessment Scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit.
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Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation.
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Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation.
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Assessing distress in pediatric intensive care environments: the COMFORT scale.
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Sedation and Delirium Clinical Practice Guidelines (2002)

Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population
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Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.
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Implementation of Delirium Monitoring

Implementation, reliability testing, and compliance monitoring of the Confusion Assessment Method for the Intensive Care Unit in trauma patients.
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A research algorithm to improve detection of delirium in the intensive care unit.
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Delirium assessment in the critically ill.
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Phenomenology of delirium. Assessment of 100 adult cases using standardised measures.
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Assessment of delirium in the intensive care unit: nursing practices and perceptions.
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Defining delirium for the International Classification of Diseases, 11th Revision.
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Comparison of the confusion assessment method for the intensive care unit (CAM-ICU) with the Intensive Care Delirium Screening Checklist (ICDSC) for delirium in critical care patients gives high agreement rate(s).
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Are nurses recognizing delirium? A systematic review.
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Intensive care delirium monitoring and standardised treatment: a complete survey of Dutch Intensive Care Units.
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A comparison of the CAM-ICU and the Neecham Confusion Scale in intensive care delirium assessment: an observational study in non-intubated patients.
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Validity and Reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients.
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Occurrence of delirium is severely underestimated in the ICU during daily care.
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Comparison of delirium assessment tools in a mixed intensive care unit.
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Large-scale implementation of sedation and delirium monitoring in the intensive care unit: a report from two medical centers.
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Prevention and Treatment Delirium

A multicomponent intervention to prevent delirium in hospitalized older patients.
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Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial.
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Antipsychotics for delirium.
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Atypical Antipsychotics versus Haloperidol for Treatment of Delirium in Acutely Ill Patients.
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An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay.
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Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study.
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Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial.
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Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery.
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Prevalence of Delirium with Dexmedetomidine Compared with Morphine Based Therapy after Cardiac Surgery: A Randomized Controlled Trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study).
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A multicomponent intervention to prevent delirium in hospitalized older patients.
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A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients.
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Olanzapine vs haloperidol: treating delirium in a critical care setting.
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A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients.
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The effect of music listening on acute confusion and delirium in elders undergoing elective hip and knee surgery.
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A double-blind trial of risperidone and haloperidol for the treatment of delirium.
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Delirium: current trends in prevention and treatment.
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Atypical antipsychotics in the management of delirium: a review of the empirical literature.
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Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients.
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Effectiveness of interventions to prevent delirium in hospitalized patients: a systematic review.
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A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures.
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Reducing delirium after hip fracture: a randomized trial.
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Mechanical Ventilation

Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients.
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A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients.
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Mechanical ventilation in ARDS: a state-of-the-art review.
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Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study.
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Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously.
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Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning.
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Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine.
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Mechanical ventilator weaning protocols driven by nonphysician health-care professionals: evidence-based clinical practice guidelines.
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Cognitive, Psychological, and Quality of Life Outcomes Post-ICU Stay

Depressive symptoms and the risk of incident delirium in older hospitalized adults
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Delirium is associated with early postoperative cognitive dysfunction
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Persistent delirium in older hospital patients: a systematic review of frequency and prognosis
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Delirium accelerates cognitive decline in Alzheimer disease
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Delirium and long-term cognitive impairment
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Long-term cognitive, emotional, and functional outcomes in trauma intensive care unit survivors without intracranial hemorrhage.
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Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction.
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The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review.
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Brain dysfunction: another burden for the chronically critically ill.
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Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome.
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The association between delirium and cognitive decline: a review of the empirical literature.
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Research issues in the evaluation of cognitive impairment in intensive care unit survivors.
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Clinical identification of cognitive impairment in ICU survivors: insights for intensivists.
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Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome.
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Six-month neuropsychological outcome of medical intensive care unit patients.
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The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: results of an exploratory study.
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Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome.
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Psychological problems following ICU treatment.
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Aging in the ICU

Individual delirium symptoms: do they matter?
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Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit.
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Recovery rate and prognosis in older persons who develop acute lung injury and the acute respiratory distress syndrome.
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Optimizing outcomes for older patients treated in the intensive care unit.
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Pediatric Delirium

The paediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU): translation and cognitive debriefing for the German-speaking area.
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Case reports with a child psychiatric exploration of catatonia, autism, and delirium.
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Pediatric illness severity measures predict delirium in a pediatric intensive care unit.
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Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units.
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Delirium and Neuroimaging

Cerebral perfusion changes in older delirious patients using 99mTc HMPAO SPECT.
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The role of neuroimaging in elucidating delirium pathophysiology.
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White Matter Abnormalities as a Risk Factor for Postoperative Delirium Revealed by Diffusion Tensor Imaging.
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