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Letter to the Editor • einstein (São Paulo) 22 • 2024 • https://doi.org/10.31744/einstein_journal/2024CE1332 linkcopy

Open-access Enhancing delirium awareness in South America: current insights and future perspectives for research and practice

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

    Dear Editor,

    With this letter, we aim to supplement the data published by Colleti Junior et al.(1) Evaluating the global prevalence of validated delirium assessment tools and implementing delirium management protocols is essential.(2) Delirium often complicates the care of elderly patients in hospitals, rehabilitation centers, and long-term care facilities, necessitating effective strategies to mitigate its effect on patient outcomes and recovery.(3)

    The World Delirium Awareness Day (WDAD) study assessed delirium prevalence on March 15, 2023 in 44 countries, 1664 wards, and 36 048 patients. South America contributed to 6.8% of the participation, 1.3% of the wards/units, and data from 0.4% of delirium-assessable patients (Tables 1S to 6S, Supplementary Material).(2,4) Notably, South America demonstrated a high utilization rate of validated delirium assessments at 95.4% (21/22), surpassing the global rate of 61% (15 458/25 268). This trend can be largely attributed to the widespread adoption of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) as the most frequently employed assessment tool. The prevalence of delirium in South America was 25.5% (38/149 patients), compared with the global rate of 18% (2788/15 458 patients). Notably, delirium management protocols were implemented in 59.1% (13/22) of wards/units. The top three nonpharmacological interventions for managing delirium cases were mobilization and pain management in 95.5%, and use of bed rails in 90.9%. The most common pharmacological interventions were dexmedetomidine (81.8%), quetiapine (68.2%), and haloperidol (63.6%). Barriers to effective delirium management were reported by 95.5% of respondents and included lack of time to educate staff (59.1%), communication gaps between different professionals (54.5%), and insufficient knowledge about delirium (50%) (Tables 1S to 6S, Supplementary Material).

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    Table 1S
    Assessments of delirium cases
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    Table 2S
    Hospital data
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    Table 3S
    Delirium assessment and management
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    Table 4S
    Nonpharmacological management
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    Table 5S
    Pharmacological management
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    Table 6S
    Barriers

    Latin American and Caribbean countries have made strides in research ethics governance; however, they still require support for enforcing a more comprehensive approach. The Pan American Health Organization (PAHO) strategies emphasize resource allocation and capacity building for ethics committees.(5) The WDAD study highlighted the low participation of South American countries in delirium research, prompting questions about the means by which delirium awareness can be enhanced in the region. Implementing additional protocols, increasing knowledge on the disorder, and providing better tools for practice are urgently needed.(2)

    A recent systematic review showed that only in 19.4% (14/72) of studies, nonpharmacological delirium prevention bundles were actively implemented, with most efforts being part of ICU sedation and analgesia protocols.(6) The reported implementation of protocols (59.1%) and use of validated tools (87.5%) may have been overestimated, indicating the need for increasing delirium awareness.(2)

    Given the preliminary findings on global delirium assessments, future efforts should prioritize raising awareness and implementing standardized protocols. Increasing delirium awareness is essential for enhancing clinical outcomes worldwide. The education and training of healthcare professionals, alongside the promotion of effective assessment tools, can improve the mechanism by which healthcare systems address delirium. Additionally, adapting interventions to regional contexts, such as effectuating culturally sensitive approaches in South America, can further boost the identification, prevention, and management of delirium, ultimately leading to improved patient outcomes.

    Supplementary material with further data on WDAD in South America, including acknowledgment of participants are provided below.

    • Ethics approval and consent to participate
      The study was approved by local ethics committees, e.g., Mannheim, Germany 2022-617; owing to anonymous data collection, patient consent was not required.

    Acknowledgement of participating clinicians

    We thank Mariana Ojeda, Ana Maria Mazzola, Ana Paula Cirese, Maria Eugenia Teran, Evangelina Pereyra Zamora, Giuliano Gaudenzi, Daniela Olmos, Sanchez Natalia Elizabeth, Mariela Mogadouro, Matias Cattoni, Maria Belen Frate, Monica Quinteros, Miguel Ángel Salas, and Carlos Nahuel Brito.

    REFERENCES

    • 1 Colleti Junior J, Araujo OR, Andrade AB, Carvalho WB. Practices related to assessment of sedation, analgesia and delirium among critical care pediatricians in Brazil. einstein (São Paulo). 2020;18:eAO5168.
    • 2 Nydahl P, Liu K, Bellelli G, Benbenishty J, van den Boogaard M, Caplan G, Chung CR, Elhadi M, Gurjar M, Heras-La Calle G, Hoffmann M, Jeitziner MM, Krewulak K, Mailhot T, Morandi A, Nawa RK, Oh ES, Collet MO, Paulino MC, Lindroth H, von Haken R; WDAD Study Group. A world-wide study on delirium assessments and presence of protocols. Age Ageing. 2024;53(7):afae129. Erratum in: Age Ageing. 2024;53(8):afae197.
    • 3 Lindroth H, Khan BA, Carpenter JS, Gao S, Perkins AJ, Khan SH, et al. Delirium Severity Trajectories and Outcomes in ICU Patients. Defining a Dynamic Symptom Phenotype. Ann Am Thorac Soc. 2020;17(9):1094-103.
    • 4 Lindroth H, Byrnes T, Fuchita M, Hetland B, Liu K, Maya K, McAndrew NS, Mulkey MA, Nydahl P, Palakshappa J, von Haken R, Psoter KJ, Oh ES; U.S. WDAD Study Team. Delirium in the United States: Results From the 2023 Cross-Sectional World Delirium Awareness Day Prevalence Study. J Acad Consult Liaison Psychiatry. 2024:S2667-2960(24)00067-3.
    • 5 Aguilera B, Carracedo S, Saenz C. Research ethics systems in Latin America and the Caribbean: a systemic assessment using indicators. Lancet Glob Health. 2022;10(8):e1204-8. Erratum in: Lancet Glob Health. 2022;10(11):e1565. Review.
    • 6 Bravo M, Bustos S, Acuña E, Cisternas I, Gutierrez P, Vega DP, et al. Epidemiology of delirium in hospitalized patients in Latin America: a systematic review. Acta Psychiatr Scand. 2023;147(5):420-9. Review.

    SUPPLEMENTARY MATERIAL Enhancing delirium awareness in South America: current insights and future perspectives for research and practice

    Ricardo Kenji Nawa, Thiago Junqueira Avelino-Silva, Roberta Esteves Vieira de Castro, María Adela Goldberg, Luis Daniel Umezawa Makikado, Fernando Tirapegui Sanhueza, Gabriel Heras-La-Calle, Heidi L. Lindroth, Keibun Liu, Rebecca von Haken, Peter Nydahl

    DOI: 10.31744/einstein_journal/2024CE1332

    Publication Dates

    • Publication in this collection
      09 Dec 2024
    • Date of issue
      2024

    History

    • Received
      13 Aug 2024
    • Accepted
      23 Aug 2024
    Creative Common - by 4.0
    This content is licensed under a Creative Commons Attribution 4.0 International License.
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