2012, Article / Letter to editor (Critical Care Medicine, vol. 2012, iss. 40, (2012), pp. 112-119)Prospective 18-month follow-up study to examine the impact of delirium during intensive care unit stay on long-term health-related quality of life and cognitive function in intensive care unit survivors.
2011, Article / Letter to editor (Critical Care, vol. 15, iss. 6, (2011), pp. R297)Delirium occurs frequently in critically ill patients and is associated with disease severity and infection. Although several pathways for delirium have been described, biomarkers associated with delirium in intensive care unit (ICU) patients is not well studied. We examined plasma biomarkers in delirious and nondelirious patients and the role of these biomarkers on long-term cognitive function.
2011, Article / Letter to editor (International Journal of Older People Nursing, vol. 6, iss. 2, (2011), pp. 102-109)In cases of cognitive decline not due to delirium, the daily observation of cognitive function by nurses has not been standardised in hospital wards specialised in the care of older people. A qualitative study with purposive sampling and semi-structured interviews. Methods. Data were obtained by interviewing 10 Dutch nursing experts in the field of cognitive function in older patients. The interviews were recorded, transcribed and analysed by two independent researchers. All the respondents stated that daily observation of cognitive function yields valuable information. The concept of cognitive function was operationalised differently by institute and by nurse. Observation and reporting methods varied, as did the goals set by the nurses. Nurses reported using many days of observation to reach final judgements. Observations of cognitive functioning should include several cognitive domains, be restricted to a few days of observation and aim to both contribute to medical diagnoses and guide nursing interventions.
2011, Article / Letter to editor (International Journal of Nursing Studies, vol. 49, iss. 7, (2011), pp. 775-783)Delirium is a serious and frequent psycho-organic disorder in critically ill patients. Reported incidence rates vary to a large extent and there is a paucity of data concerning delirium incidence rates for the different subgroups of intensive care unit (ICU) patients and their short-term health consequences. The delirium incidence in a mixed ICU population is high and differs importantly between ICU admission diagnoses and the subtypes of delirium. Patients with delirium had a significantly higher incidence of short-term health problems, independent from their severity of illness and this was most pronounced in the mixed subtype of delirium. Delirium is significantly associated with worse short-term outcome.
2011, Article / Letter to editor (American Journal of Respiratory Critical Care Care Medicine, vol. 184, iss. 3, (2011), pp. 340-344)Delirium is often unrecognized in ICU patients and associated with poor outcome. Screening for ICU delirium is recommended by several medical organizations to improve early diagnosis and treatment. The Confusion Assessment Method for the ICU (CAM-ICU) has high sensitivity and specificity for delirium when administered by research nurses. However, test characteristics of the CAM-ICU as performed in routine practice are unclear.
2011, Article / Letter to editor (Netherlands Journal of Medicine, vol. 69, iss. 6, (2011), pp. 292-298)To reduce unintentional and avoidable adverse events in patients in hospitals in the Netherlands, a patient safety agency (VMS) programme was launched in 2008. Among the VMS topics, the programme optimal therapy in severe sepsis, according to the international Surviving Sepsis Campaign (SSC), aims to improve early diagnosis and treatment of sepsis to reduce sepsis mortality by 15% before the end of 2012. We analysed compliance data submitted to the international SSC database from the Netherlands and compared these data with published international SS C results. Data of 863 patients, representing 6% of the international data (n=14,209), were used for analysis. In the Netherlands, the resuscitation bundle compliance improved significantly from 7% at baseline to 27% after two years (p=0.002). Internationally, the resuscitation bundle compliance increased significantly from 11 to 31%
2011, Article / Letter to editor (Proteome Science, vol. 9, iss. 13, (2011))Suitable biomarkers associated with the development of delirium are still not known. Urinary proteomics has successfully been applied to identify novel biomarkers associated with various disease states, but its value has not been investigated in delirium patients. In a prospective explorative study hyperactive delirium patients after cardiac surgery were included for urinary proteomic analyses. Delirium patients were matched with non-delirium patients after cardiac surgery on age, gender, severity of illness score, LOS-ICU, Euro-score, C-reactive protein, renal function and aorta clamping time. Urine was collected within 24 hours after the onset of delirium. Matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF MS) was applied to detect differences in the urinary proteome associated with delirium in these ICU patients. We included 10 hyperactive delirium and 10 meticulously matched non-delirium post-cardiac surgery patients. No relevant differences in the urinary excretion of proteins could be observed.
2010, Article / Letter to editor (Critical Care, vol. 7, iss. 6, (2010), pp. 12-15)Bij patiënten die gereanimeerd zijn, wordt standaard gecontroleerde, milde hypothermie (streeftemperatuur 32-34oC) toegepast bij om verdere hersenschade te beperken. Het koelen gaat gepaard met perifere vasoconstrictie waardoor de huid en de subcutis minder doorbloed zijn. Onderzocht is of de beperkte doorbloeding – in combinatie met een verminderde toepassing van wisselhouding in verband met het beoogd waarborgen van de hemodynamiek – leidt tot meer decubitius en wat eraan gedaan kan worden.
2010, Article / Letter to editor (Netherlands Journal of Critical Care, vol. 14, iss. 1, (2010), pp. 10-15)A psycho-organic disorder such as delirium is a frequently occurring and serious disorder especially on Intensive Care units. Nowadays, more attention is paid to this problem by physicians, nurses and by researchers, but assessment of delirium in all ICU patients is still not common practice. If patients are not screened for delirium in a standard manner, once or several times a day, the delirium diagnose will be missed. In this systematic review we describe and analyse six delirium screening instruments available from the literature: the Cognitive Test for Delirium (CTD), the abbreviated CTD, Intensive Care Delirium Screening Checklist (ICDSC), Delirium Detection Score (DDS), NEECHAM confusion scale and the Confusion Assessment Method-ICU (CAM-ICU). Each assessment tool its characteristics, reliability and validity testing is briefly described. We conclude that important delirium criteria are not integrated into some screening tools (CTD and aCTD, DDS), or an important group of ICU patients cannot be tested (NEECHAM). The ICDSC and the CAM-ICU appear to represent the most feasible instruments for delirium screening in the ICU. Of these two tests, the CAM-ICU prevails because of the validated Dutch version and its reported high sensitivity and specificity.
2010, Article / Letter to editor (Intensive Care Medicine, vol. 2010, iss. 36, (2010), pp. suppl.-2 s221)Delirium occurs frequently in critically ill patients, and especially in severely ill and in infectious patients. Although several causal pathways for delirium have been described, the role of biomarkers in ICU patients is unknown. We investigated potential differences in various serum biomarkers between delirious and non-delirious ICU patients with and without an infection.
2010, Article / Letter to editor (Netherlands Journal of Critical Care, vol. 2010, iss. 14, (2010), pp. suppl-1 s167)While delirium is a serious and frequent disorder in intensive care patients, a prediction model is currently not available. We developed and validated a delirium prediction model for adult intensive care patients and determined its additional value compared to the prediction of the caregivers.
2010, Article / Letter to editor (Intensive Care Medicine, vol. 36, iss. suppl. 2, (2010), pp. s341)Delirium is a frequent disorder in the ICU associated with poor outcome. Several organizations, including the SCCM and the APA, therefore recommend standard screening for delirium to improve early diagnosis and treatment. The CAM-ICU is the most frequently used delirium detection tool in the Netherlands. Numerous studies to validate the CAM-ICU always yielded excellent sensitivity and specificity, but were all performed by a limited number of research nurses.
2010, Article / Letter to editor (Critical Care, vol. 2010, iss. 14, (2010), pp. R81)Effects of systemic inflammation on cerebral function are not clear, as both inflammation-induced encephalopathy as well as stress-hormone mediated alertness have been described. Experimental endotoxemia (2 ng/kg Escherichia coli lipopolysaccharide [LPS]) was induced in 15 subjects, whereas 10 served as controls. Cytokines (TNF-a, IL-6, IL1-RA and IL-10), cortisol, brain specific proteins (BSP), electroencephalography (EEG) and cognitive function tests (CFTs) were determined. Short-term systemic inflammation does not provoke or explain the occurrence of septic encephalopathy, but primarily results in an inflammation-mediated increase in cortisol and alertness.
2009, Part of book or chapter of book (, pp. 197-203)Intensive care-geneeskunde maakt de laatste jaren een stormachtige ontwikkeling door. Steeds meer mensen komen er in hun dagelijkse werk mee in aanraking en daardoor ontstaat er een groeiende behoefte aan literatuur over dit onderwerp. Technische, maar met name ook praktijkgerichte literatuur. Venticare geeft onder de naam Capita Selecta ieder jaar een interessante verzameling artikelen uit op het gebied van de intensive care-geneeskunde. Alle artikelen zijn geschreven door deskundigen uit het vakgebied. De nadruk ligt op de praktische toepasbaarheid van de beschreven stof.
2009, Article / Letter to editor (Netherlands Journal of Critical Care, vol. 13, iss. 4, (2009), pp. R131)In critically ill patients, delirium is a serious and frequent disorder that is associated with a prolonged intensive care and hospital stay and an increased morbidity and mortality. Without the use of a delirium screening instrument, delirium is often missed by ICU nurses and physicians. The effects of implementation of a screening method on haloperidol use is not known. The purpose of this study was to evaluate the implementation of the confusion assessment method-ICU (CAM-ICU) and the effect of its use on frequency and duration of haloperidol use.
2009, Part of book or chapter of book (, pp. 279-283)Venticare geeft onder de naam Capita selecta ieder jaar een interessante verzameling artikelen uit op het gebied van de intensive care-geneeskunde. Alle artikelen zijn geschreven door deskundigen uit het vakgebied. De nadruk ligt op de praktische toepasbaarheid van de beschreven stof.