Current status of delirium assessment tools in the intensive care unit: a prospective multicenter observational survey

Delirium is a critical challenge in the intensive care unit (ICU) or high care unit (HCU) setting and is associated with poor outcomes. There is not much literature on how many patients in this setting are assessed for delirium and what tools are used. This study investigated the status of delirium assessment tools of patients in the ICU/HCU. We conducted a multicenter prospective observational study among 20 institutions. Data for patients who were admitted to and discharged from the ICU/HCU during a 1-month study period were collected from each institution using a survey sheet. The primary outcome was the usage rate of delirium assessment tools on an institution- and patient-basis. Secondary outcomes were the delirium prevalence assessed by each institution's assessment tool, comparison of delirium prevalence between delirium assessment tools, delirium prevalence at the end of ICH/HCU stay, and the relationship between potential factors related to delirium and the development of delirium. Result showed that 95% of institutions used the Intensive Care Delirium Screening Checklist (ICDSC) or the Confusion Assessment Method for the ICU (CAM-ICU) to assess delirium in their ICU/HCU, and the remaining one used another assessment scale. The usage rate (at least once during the ICU/HCU stay) of the ICDSC and the CAM-ICU among individual patients were 64.5% and 25.1%, and only 8.2% of enrolled patients were not assessed by any delirium assessment tool. The prevalence of delirium during ICU/HCU stay was 17.9%, and the prevalence of delirium at the end of the ICU/HCU stay was 5.9%. In conclusion, all institutions used delirium assessment tools in the ICU/HCU, and most patients received delirium assessment. The prevalence of delirium was 17.9%, and two-thirds of patients had recovered at discharge from ICU/HCU

Assessment of urine partial oxygen pressure to predict postoperative acute kidney injury in major surgical patients

　Urine partial oxygen pressure (PuO2) was monitored in postoperative intensive care unit (ICU) patients to verify if an earlier diagnosis of acute kidney injury (AKI) is possible. Fifty-nine patients who were admitted to the ICU after surgery for at least 48 hours at Kawasaki Medical Center between January 2019 and June 2020 were assessed for AKI using the Kidney Disease: Improving Global Outcome (KDIGO) criteria. The AKI group had 15 patients while the non-AKI group had 44 cases. The PuO2 of each group showed no significant difference. Arterial partial oxygen pressure (PaO2) was measured concurrently with PuO2. When the ratio of PuO2 to PaO2 (PuO2 / PaO2) from each group was compared, the AKI group had a significantly higher ratio just 2 hours after admission to the ICU. Reduced oxygen consumption in the renal medulla may be a possible cause of AKI in those patients. Thus, measuring the PuO2 / PaO2 ratio in postoperative patients 2 hours after ICU admission could be useful to predict AKI earlier than is currently done