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.
2012, Article / Letter to editor (Annals of Intensive Care, vol. 2, iss. 1, (2012))Rapid response systems (RRSs) are considered an important tool for improving patient safety. We studied the effect of an RRS on the incidence of cardiac arrests and unexpected deaths. Retrospective before- after study in a university medical centre. We included 1376 surgical patients before (period 1) and 2410 patients after introduction of the RRS (period 2). Outcome measures were corrected for the baseline covariates age, gender and ASA.
2012, Article / Letter to editor (Netherlands Journal of Critical Care, vol. 16, iss. 6, (2012), pp. 195-199)The implementation of rapid response systems (RRS) is based on the knowledge that deteriorating physiological processes are frequently present for hours or days before clear clinical deterioration is recognized [1,2]. It is assumed that this physiological deterioration is often treatable and that treatment will have greater effect when initiated early [3]. The RRS consists of an afferent limb, including “crisis detection” and “response triggering” and an efferent limb, the rapid response team (RRT) [4]. Even though robust evidence to support the effectiveness of the RRS is lacking [5-10] the system has been implemented worldwide. For example, Dutch hospitals are required to implement a patient safety programme including an RRS before 2013 [11]. This article explores the reasons why it is so difficult to prove the effectiveness of an RRS. We discuss the study designs that have been used and the various outcome measures in order to estimate the effects of an RRS. Finally, we make suggestions for future research.
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 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.
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 (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.