Methods of Identifying Neurological Delirium (MIND) Grant uri icon

abstract

  • Purpose: The aim of this study is to determine if Bispectral Index (BIS) monitoring, a relatively inexpensive and rapid continuous assessment tool, performs as well as the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) for diagnosing the presence of delirium in aging ICU patients. Significance: Early detection and intervention to decrease delirium is important as delirium leads to increased length of stay with an additional 17.5 million inpatient days, incurs more than $5 billion in Medicare charges annually, and affects up to 80% of ICU patients. We know specific electroencephalogram (EEG) changes occur with delirium, regardless of age or etiology; however, continuous full EEG monitoring is not feasible in an ICU environment. As a modified EEG providing continuous monitoring, the BIS monitor may be a feasible method for continuous detection, allowing for earlier intervention, decreased LOS, and improved patient outcomes. Method: This pilot study uses a correlational design to determine if the BIS monitor is equivalent (non-inferior) to the CAM-ICU. Setting/Sample: The study site is a large, Magnet(R) academic medical center. An observational sample of 20 mechanically ventilated participants who are =50 years old and within 24 hours of Medical-Surgical ICU admission. Procedures: All participants will have the BIS monitor applied using a standardized protocol. CAM-ICU assessment and BIS monitor data will be collected at standardized times for each participant four consecutive ICU days. Demographic and pharmacological data will be collected from the EHR. Instruments: CAM-ICU is a validated tool for intermittent delirium detection. The BIS monitor is a noninvasive instrument providing continuous fronto-temporal cerebral cortex EEG. Analysis plan: Matthew's correlation coefficient (MCC) and a 95% confidence interval will be used to determine how well BIS compares with CAM-ICU for diagnosing delirium. The index will be computed alone and as a weighted composite measure with the theta/alpha ratio. Nursing Implications: This study will provide preliminary data to address the feasibility and fidelity of BIS monitoring for detecting delirium. Furthermore, the results will convey supporting information to appropriately design and power a larger and more definitive validation study.
  • submission does not request or require and abstract

date/time interval

  • July 2018 - January 2022