The Delphi Delirium Management Algorithms. A practical tool for clinicians, the result of a modified Delphi expert consensus approach

Thomas H Ottens^{1

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44}, Valerie Page³, Mark Oldham^{4

5}, Rakesh Arora^{6

7}, O Joseph Bienvenu 3rd⁸, Mark van den Boogaard⁹, Gideon Caplan^{10

11}, John W Devlin^{12

13}, Michaela-Elena Friedrich¹⁴, Willem A van Gool¹⁵, James Hanison¹⁶, Hans-Christian Hansen¹⁷, Sharon K Inouye^{18

19}, Barbara Kamholz^{1

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44}, Katarzyna Kotfis²⁰, Matthew B Maas^{21

22}, Alasdair M J MacLullich²³, Edward R Marcantonio²⁴, Alessandro Morandi²⁵, Barbara C van Munster²⁶, Ursula Müller-Werdan²⁷, Alessandra Negro²⁸, Karin J Neufeld²⁹, Peter Nydahl³⁰, Esther S Oh³¹, Pratik Pandharipande³², Finn M Radtke^{33

34}, Sylvie De Raedt^{35

36}, Lisa J Rosenthal^{22

37}, Robert Sanders³⁸, Claudia D Spies³⁹, Emma R L C Vardy^{40

41}, Eelco F Wijdicks⁴², Arjen J C Slooter^{2

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44}

Affiliations

¹ Intensive Care Unit, Haga Teaching Hospital.
² Intensive Care Medicine, University Medical Center Utrecht.
³ Critical Care, Watford General Hospital.
⁴ School of Medicine and Dentisty, University of Rochester.
⁵ Psychiatry, University of Rochester Medical Center.
⁶ Harrington Heart and Vascular Institute, University Hospitals of Cleveland.
⁷ Division of Cardiac Surgery, Case Western Reserve University.
⁸ School of Medicine, Johns Hopkins University.
⁹ Intensive Care Medicine, Radboud University Nijmegen Medical Centre.
¹⁰ School of Clinical Medicine, UNSW Sydney.
¹¹ Geriatric Medicine, Prince of Wales Hospital.
¹² Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital.
¹³ Bouve College of Health Sciences, Northeastern University.
¹⁴ Abteilung für Sozialpsychiatrie, Hollabrunn, Austria.
¹⁵ Neurology, Amsterdam University Medical Centers.
¹⁶ Anaesthesia, Manchester University NHS Foundation Trust.
¹⁷ Neurology, Friedrich-Ebert-Krankenhaus.
¹⁸ Beth Israel Deaconess Medical Center.
¹⁹ Harvard Medical School.
²⁰ Anaesthesia, Intensive Care and Acute Poisoning, Pomeranian Medical University.
²¹ Neurology, Northwestern Medicine.
²² Feinberg School of Medicine, Northwestern University.
²³ Usher Institute Ageing and Health, University of Edinburgh.
²⁴ Geriatric Medicine, Beth Israel Deaconess Medical Center.
²⁵ Rehabilitation, Fondazione Teresa Camplani.
²⁶ Geriatric Medicine, University Medical Center Groningen.
²⁷ Geriatrics, Charité - Universitätsmedizin Berlin.
²⁸ Intensive Care Unit, IRCCS Ospedale San Raffaele.
²⁹ Faculty of Health Sciences, McMaster University.
³⁰ Intensive Care Unit, University Hospital Schleswig-Holstein.
³¹ Geriatric Medicine and Gerontology, Johns Hopkins Medicine.
³² Anesthesiology and Critical Care Medicine, Vanderbilt University Medical Center.
³³ University of Southern Denmark.
³⁴ Anaesthesia and Intensive Care, Nykøbing F. Hospital.
³⁵ Vrije Universiteit Brussel.
³⁶ Neurology, Universitair Ziekenhuis Brussel.
³⁷ Psychiatry, Northwestern Memorial Hospital.
³⁸ Faculty of Medicine and Health, University of Sydney.
³⁹ Anaesthesiology and Intensive Care, Charité - Universitätsmedizin Berlin.
⁴⁰ Northern Care Alliance NHS Foundation Trust, Oldham, United Kingdom.
⁴¹ University of Manchester, Manchester, United Kingdom.
⁴² Neurology, Mayo Clinic.
⁴³ Psychiatry, University Medical Center Utrecht.
⁴⁴ Brain Center, University Medical Center Utrecht.

PMID: 38348284
PMCID: PMC10861222
DOI: 10.56392/001c.90652

The Delphi Delirium Management Algorithms. A practical tool for clinicians, the result of a modified Delphi expert consensus approach

Thomas H Ottens et al. Delirium (Bielef). 2024.

. 2024:2024:10.56392/001c.90652.

doi: 10.56392/001c.90652. Epub 2024 Jan 12.

Authors

Affiliations

¹ Intensive Care Unit, Haga Teaching Hospital.
² Intensive Care Medicine, University Medical Center Utrecht.
³ Critical Care, Watford General Hospital.
⁴ School of Medicine and Dentisty, University of Rochester.
⁵ Psychiatry, University of Rochester Medical Center.
⁶ Harrington Heart and Vascular Institute, University Hospitals of Cleveland.
⁷ Division of Cardiac Surgery, Case Western Reserve University.
⁸ School of Medicine, Johns Hopkins University.
⁹ Intensive Care Medicine, Radboud University Nijmegen Medical Centre.
¹⁰ School of Clinical Medicine, UNSW Sydney.
¹¹ Geriatric Medicine, Prince of Wales Hospital.
¹² Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital.
¹³ Bouve College of Health Sciences, Northeastern University.
¹⁴ Abteilung für Sozialpsychiatrie, Hollabrunn, Austria.
¹⁵ Neurology, Amsterdam University Medical Centers.
¹⁶ Anaesthesia, Manchester University NHS Foundation Trust.
¹⁷ Neurology, Friedrich-Ebert-Krankenhaus.
¹⁸ Beth Israel Deaconess Medical Center.
¹⁹ Harvard Medical School.
²⁰ Anaesthesia, Intensive Care and Acute Poisoning, Pomeranian Medical University.
²¹ Neurology, Northwestern Medicine.
²² Feinberg School of Medicine, Northwestern University.
²³ Usher Institute Ageing and Health, University of Edinburgh.
²⁴ Geriatric Medicine, Beth Israel Deaconess Medical Center.
²⁵ Rehabilitation, Fondazione Teresa Camplani.
²⁶ Geriatric Medicine, University Medical Center Groningen.
²⁷ Geriatrics, Charité - Universitätsmedizin Berlin.
²⁸ Intensive Care Unit, IRCCS Ospedale San Raffaele.
²⁹ Faculty of Health Sciences, McMaster University.
³⁰ Intensive Care Unit, University Hospital Schleswig-Holstein.
³¹ Geriatric Medicine and Gerontology, Johns Hopkins Medicine.
³² Anesthesiology and Critical Care Medicine, Vanderbilt University Medical Center.
³³ University of Southern Denmark.
³⁴ Anaesthesia and Intensive Care, Nykøbing F. Hospital.
³⁵ Vrije Universiteit Brussel.
³⁶ Neurology, Universitair Ziekenhuis Brussel.
³⁷ Psychiatry, Northwestern Memorial Hospital.
³⁸ Faculty of Medicine and Health, University of Sydney.
³⁹ Anaesthesiology and Intensive Care, Charité - Universitätsmedizin Berlin.
⁴⁰ Northern Care Alliance NHS Foundation Trust, Oldham, United Kingdom.
⁴¹ University of Manchester, Manchester, United Kingdom.
⁴² Neurology, Mayo Clinic.
⁴³ Psychiatry, University Medical Center Utrecht.
⁴⁴ Brain Center, University Medical Center Utrecht.

PMID: 38348284
PMCID: PMC10861222
DOI: 10.56392/001c.90652

Abstract

Delirium is common in hospitalised patients, and there is currently no specific treatment. Identifying and treating underlying somatic causes of delirium is the first priority once delirium is diagnosed. Several international guidelines provide clinicians with an evidence-based approach to screening, diagnosis and symptomatic treatment. However, current guidelines do not offer a structured approach to identification of underlying causes. A panel of 37 internationally recognised delirium experts from diverse medical backgrounds worked together in a modified Delphi approach via an online platform. Consensus was reached after five voting rounds. The final product of this project is a set of three delirium management algorithms (the Delirium Delphi Algorithms), one for ward patients, one for patients after cardiac surgery and one for patients in the intensive care unit.

Keywords: Clinical practice algorithm; Delirium; Expert consensus; cardiac surgery; hospital medicine; intensive care.

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Conflict of interest statement

DISCLOSURES The authors have no conflicts of interest to disclose.

Figures

See this image and copyright information in PMC

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing; 2013. doi:10.1176/appi.books.9780890425596 - DOI
1. Slooter AJC, Otte WM, Devlin JW, et al. Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Med. 2020;46(5):1020–1022. doi:10.1007/s00134-019-05907-4 - DOI - PMC - PubMed
1. Wilcox ME, Girard TD, Hough CL. Delirium and long term cognition in critically ill patients. BMJ. 2021;373:n1007. doi:10.1136/bmj.n1007 - DOI - PubMed
1. Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168(1):27–32. doi:10.1001/archinternmed.2007.4 - DOI - PMC - PubMed
1. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018;46(9):e825–e873. doi:10.1097/ccm.0000000000003299 - DOI - PubMed

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R13 AG072860/AG/NIA NIH HHS/United States

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The Delphi Delirium Management Algorithms. A practical tool for clinicians, the result of a modified Delphi expert consensus approach

Affiliations

The Delphi Delirium Management Algorithms. A practical tool for clinicians, the result of a modified Delphi expert consensus approach

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding