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Topic: Promoting Physiologic Stability in High-Risk Infants: A Cardiac ICU Environmental Care Bundle
Abstract: The proposed interventional study will evaluate the impact of a nurse-managed intensive care unit environmental care bundle that includes cycled day-night lighting, noise reduction, and contained infant positioning on physiologic stability in neonates postcardiac surgery. This study will serve as the foundation for future multicenter randomized controlled trials to evaluate the effectiveness of an ICU environmental care bundle on improving clinical outcomes.
Topic: Detection of Delirium in Neurological Intensive Care: Validity of Two Tools and Neurointensive Examination for Delirium Screening and Monitoring
Abstract: Delirium is a common and serious condition that affects 64% to 80% of ICU patients. This neurologic derangement is associated with death, longer ventilator days, increased length of stay, and cognitive impairment at hospital discharge. Validated ICU delirium assessment scales are available, but investigation in delirium detection and management in patients with primary neurological injury (PNI) and critical illness is negligible. The purposes of this study are to examine if delirium can be detected in patients with primary neurological injury and to assess three methods of detecting delirium (two delirium scales and the neurointensivist's subjective impression) to determine if they are valid assessment tools for diagnosis and ongoing monitoring of delirium in patients treated in an NICU setting. Nurses are key personnel in providing ongoing care that prevents or minimizes the occurrence of delirium. A valid, reliable assessment tool for detecting delirium in patients with PNI will allow neuroscience nurses to provide nurse-directed delirium prevention and management strategies in critically ill patients treated in a medical or neuroscience ICU.
Topic: Epigenetic Contributions to Delirium in Mechanically Ventilated Patients
Abstract: This study will explore whether an association exists between thiamine deficiency, delirium, and biologically related candidate gene polymorphisms in critically ill mechanically ventilated ICU patients. This is a translational research study. The phenotype of thiamine deficiency is applied to physiologically stressed ICU patients, some of whom may be genetically vulnerable to metabolic disruption of cerebral glucose pathways (from low thiamine) with a consequent increase in delirium in ICU.
Topic: Apolipoprotein E, Inflammatory Markers, and Delirium in ICU Patients
Abstract: Delirium, a disturbance in consciousness with inattention accompanied by a change in cognition or perceptual disturbances, is a common occurrence in hospitalized patients in and out of the ICU. Factors increasing risk for the development of delirium include increasing age, metabolic disturbances, electrolyte imbalances, drug (alcohol) withdrawal, infection, seizures, dehydration, hyperthermia, head trauma, vascular disorders, intracranial space-occupying lesions, and others. Delirium in the ICU has been associated with prolonged ICU stay, prolonged hospital stay, and poorer outcome. Currently, there are no biomarkers available to predict delirium onset or duration in ICU patients. Recent research has identified a potential association between presence of the apolipoprotein E (APOE) 4 allele, a gene with known influence on neurologic recovery and disease, and delirium in ICU patients. The current study will explore the relationship between APOE 4 allele presence, serum APOE protein levels, serum cytokine levels (IL-1, IL-6, IL-8, and IL-10) and development and duration of delirium in ICU patients. Subjects will be identified upon admission to the ICU and consent will be obtained by a clinical nurse collaborating with the research team. Blood will be drawn upon enrollment and daily for the first 5 days of admission. DNA will be extracted from the first blood sample drawn. Serum will be extracted from each sample for APOE protein and cytokine quantification. Delirium will be assessed daily by the clinical nurse using the Confusion Assessment Method-ICU (CAM-ICU). Chi-square analysis and repeat measures analysis of variance will be used to explore associations between APOE 4 allele presence and development/duration of delirium. Hierarchical linear and nonlinear modeling will be used to explore the relationship between APOE genotype, APOE protein level, and cytokine level and delirium development/duration. Identification of a genetic biomarker for individuals at risk for delirium would aid in focusing nursing care on individuals at risk and formation of individualized care to improve outcome. The results of the proposed study will inform future studies.
