2016
Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care Providers
Kamdar BB, Knauert MP, Jones SF, Parsons EC, Parthasarathy S, Pisani MA. Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care Providers. Annals Of The American Thoracic Society 2016, 13: 1370-7. PMID: 27104770, PMCID: PMC5021080, DOI: 10.1513/annalsats.201601-087oc.Peer-Reviewed Original ResearchConceptsPoor sleepICU outcomesProviders' perceptionsIntensive care unit outcomesAvailable evidence-based guidelinesDevelopment of deliriumIntensive care unitEvidence-based guidelinesCritical care providersBetter sleep qualityMinority of providersICU surveyICU patientsIll patientsCare unitMechanical ventilationICU providersPatient outcomesRecent guidelinesPhysical therapyMost cliniciansPromotion protocolSleep qualityCare providersICUQuantifying the Severity of a Delirium Episode Throughout Hospitalization: the Combined Importance of Intensity and Duration
Vasunilashorn SM, Marcantonio ER, Gou Y, Pisani MA, Travison TG, Schmitt EM, Jones RN, Inouye SK. Quantifying the Severity of a Delirium Episode Throughout Hospitalization: the Combined Importance of Intensity and Duration. Journal Of General Internal Medicine 2016, 31: 1164-1171. PMID: 27259291, PMCID: PMC5023588, DOI: 10.1007/s11606-016-3671-9.Peer-Reviewed Original ResearchConceptsPost-hospital outcomesDelirium intensitySeverity measuresEpisode of deliriumPoor clinical outcomeDelirium durationDelirium episodesEntire hospitalizationAdult patientsClinical outcomesDelirium severityRelative riskIndependent cohortDeliriumStrong associationOutcomesHospitalizationCognitive changesDurationSeverityPredictive validityEpisodesAssociationCombined importancePatients
2015
The authors reply
Murphy TE, Araujo KL, Pisani MA. The authors reply. Critical Care Medicine 2015, 43: e589-e590. PMID: 26575672, PMCID: PMC4686334, DOI: 10.1097/ccm.0000000000001342.Peer-Reviewed Original ResearchAwake or Sedated: Trends in the Evaluation and Management of Agitation in the Intensive Care Unit
DeBiasi EM, Akgün KM, Pisani M. Awake or Sedated: Trends in the Evaluation and Management of Agitation in the Intensive Care Unit. Seminars In Respiratory And Critical Care Medicine 2015, 36: 899-913. PMID: 26595050, DOI: 10.1055/s-0035-1564875.BooksConceptsICU patientsSedation practicesIll intensive care unit (ICU) patientsIntensive care unit patientsSedation assessment scaleMechanical ventilation durationCare unit patientsManagement of agitationMost ICU patientsIntensive care unitImproved clinical outcomesMultidisciplinary treatment modelLife-saving interventionsHospital lengthMinimal sedationSedative medicationsUnit patientsCare unitClinical outcomesMechanical ventilationVentilation durationPatient distressFunctional impairmentPractice guidelinesPatient discomfortSedation in Critically Ill Patients
Oldham M, Pisani MA. Sedation in Critically Ill Patients. Critical Care Clinics 2015, 31: 563-587. PMID: 26118921, DOI: 10.1016/j.ccc.2015.03.010.Peer-Reviewed Original ResearchSleep Loss and Circadian Rhythm Disruption in the Intensive Care Unit
Knauert MP, Haspel JA, Pisani MA. Sleep Loss and Circadian Rhythm Disruption in the Intensive Care Unit. Clinics In Chest Medicine 2015, 36: 419-429. PMID: 26304279, DOI: 10.1016/j.ccm.2015.05.008.BooksMeSH KeywordsCircadian RhythmCritical IllnessDeliriumHumansIntensive Care UnitsSleepSleep DeprivationConceptsCritical illnessSleep disruptionAppropriate administrative supportIntensive care unit environmentIntensive care unitCircadian rhythm disruptionDelirium reductionIll patientsCare unitPharmacologic interventionsSleep disturbancesRhythm disruptionCare deliveryMultidisciplinary strategyUnit environmentSleep lossIllnessDisruptionPatientsEffective strategySleepEnvironmental factorsAssociation of Cumulative Dose of Haloperidol With Next-Day Delirium in Older Medical ICU Patients*
Pisani MA, Araujo KL, Murphy TE. Association of Cumulative Dose of Haloperidol With Next-Day Delirium in Older Medical ICU Patients*. Critical Care Medicine 2015, 43: 996-1002. PMID: 25746748, PMCID: PMC4400211, DOI: 10.1097/ccm.0000000000000863.Peer-Reviewed Original ResearchConceptsMedical ICU patientsNext-day deliriumTime-dependent confoundingICU patientsCumulative doseMedical ICUNonintubated patientsOdds ratioConfusion Assessment MethodTreatment of deliriumDose of haloperidolAge 60 yearsEfficacy of haloperidolRoute of administrationAcademic medical centerImportant clinical covariatesICU stayIntubated patientsClinical covariatesObservational studyHigher oddsMedical CenterDeliriumPatientsHaloperidol
2013
Patterns of Opiate, Benzodiazepine, and Antipsychotic Drug Dosing in Older Patients in a Medical Intensive Care Unit
Pisani MA, Bramley K, Vest MT, Akgün KM, Araujo KL, Murphy TE. Patterns of Opiate, Benzodiazepine, and Antipsychotic Drug Dosing in Older Patients in a Medical Intensive Care Unit. American Journal Of Critical Care 2013, 22: e62-e69. PMID: 23996429, PMCID: PMC4309662, DOI: 10.4037/ajcc2013835.Peer-Reviewed Original ResearchConceptsMedical intensive care unitIntensive care unitOlder patientsCare unitNursing shiftsHigh dosesEvening shiftsNight shiftsYale-New Haven HospitalEvening nursing shiftsPatients 60 yearsRoute of administrationImportant clinical covariatesMean ageClinical covariatesPsychoactive medicationsDrug dosingRandom effects Poisson modelDose levelsPatientsHaloperidolTotal dosesLorazepamSleep deprivationFentanyl
2012
Among patients admitted to ICU, delirium is most common in those with neurological diagnoses, and is associated with adverse health outcomes
Pisani MA, Ferrante L. Among patients admitted to ICU, delirium is most common in those with neurological diagnoses, and is associated with adverse health outcomes. Evidence-Based Nursing 2012, 16: 81. PMID: 23171569, DOI: 10.1136/eb-2012-101054.Commentaries, Editorials and LettersICU delirium
Jones SF, Pisani MA. ICU delirium. Current Opinion In Critical Care 2012, 18: 146-151. PMID: 22322260, DOI: 10.1097/mcc.0b013e32835132b9.Peer-Reviewed Original ResearchConceptsICU deliriumRisk factorsLong-term neurocognitive impairmentDelirium-related outcomesPreferred pharmacologic treatmentSignificant adverse outcomesUse of sedativesUse of protocolsPharmacologic treatmentAtypical antipsychoticsVentilator managementAdverse outcomesUnderdiagnosed problemDeliriumNeurocognitive impairmentSusceptible individualsAvailable evidenceRecent evidenceOutcomesLong-term impactTreatmentLimited studiesRobust evidenceNegative outcomesManagement
2010
Factors associated with persistent delirium after intensive care unit admission in an older medical patient population
Pisani MA, Murphy TE, Araujo KL, Van Ness PH. Factors associated with persistent delirium after intensive care unit admission in an older medical patient population. Journal Of Critical Care 2010, 25: 540.e1-540.e7. PMID: 20413252, PMCID: PMC2939229, DOI: 10.1016/j.jcrc.2010.02.009.Peer-Reviewed Original ResearchConceptsPersistent deliriumMedical intensive care unit populationIntensive care unit admissionIntensive care unit populationMultivariable logistic regression modelCare unit admissionConfusion Assessment MethodPatients 60 yearsProspective cohort studyUse of haloperidolUse of opioidsSeverity of illnessMedical patient populationLogistic regression modelsICU stayUnit admissionICU deliriumCohort studyPatient demographicsMedication dataPatient populationConsecutive admissionsCode statusDeliriumUnit population
2009
Days of Delirium Are Associated with 1-Year Mortality in an Older Intensive Care Unit Population
Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH. Days of Delirium Are Associated with 1-Year Mortality in an Older Intensive Care Unit Population. American Journal Of Respiratory And Critical Care Medicine 2009, 180: 1092-1097. PMID: 19745202, PMCID: PMC2784414, DOI: 10.1164/rccm.200904-0537oc.Peer-Reviewed Original ResearchConceptsICU deliriumPatient populationNumber of daysOlder intensive care unit patientsIntensive care unit populationAdverse long-term outcomesIntensive care unit patientsRelevant covariatesUrban acute care hospitalDuration of deliriumPost-ICU admissionConfusion Assessment MethodOlder patient populationProspective cohort studyCare unit patientsSeverity of illnessLong-term outcomesDays of deliriumPsychoactive medication useAcute care hospitalsChart review methodImportant health outcomesICU admissionCohort studyICU populationBenzodiazepine and opioid use and the duration of intensive care unit delirium in an older population*
Pisani MA, Murphy TE, Araujo KL, Slattum P, Van Ness PH, Inouye SK. Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population*. Critical Care Medicine 2009, 37: 177-183. PMID: 19050611, PMCID: PMC2700732, DOI: 10.1097/ccm.0b013e318192fcf9.Peer-Reviewed Original ResearchConceptsModifiable risk factorsICU deliriumDelirium durationOpioid useRisk factorsFirst episodeMedical intensive care unit patientsIntensive care unit deliriumMedical intensive care unitIntensive care unit patientsUrban university teaching hospitalConfusion Assessment MethodProspective cohort studyCare unit patientsSeverity of illnessIntensive care unitUniversity Teaching HospitalMain outcome measuresUse of benzodiazepinesChart review methodMultivariable regression modelsImpact of benzodiazepinesCohort studyMedian durationUnit patients
2008
Analytic Reviews: Considerations in Caring for the Critically Ill Older Patient
Pisani MA. Analytic Reviews: Considerations in Caring for the Critically Ill Older Patient. Journal Of Intensive Care Medicine 2008, 24: 83-95. PMID: 19114416, DOI: 10.1177/0885066608329942.Peer-Reviewed Original ResearchConceptsOlder patientsPhysiologic changesOlder intensive care unit patientsIntensive care unit admissionIntensive care unit patientsIll Older PatientsImportant physiologic changesOlder ICU patientsCare unit admissionCare unit patientsDevelopment of sepsisSeverity of illnessUnit admissionCritical illnessUnit patientsICU patientsPoor outcomeAdverse outcomesRisk factorsCritical careOutcome studiesChronologic agePatientsAge 65SepsisDelirium assessment in the intensive care unit: patient population matters
Pisani MA. Delirium assessment in the intensive care unit: patient population matters. Critical Care 2008, 12: 131. PMID: 18423059, PMCID: PMC2447584, DOI: 10.1186/cc6847.Peer-Reviewed Original Research
2007
Characteristics Associated With Delirium in Older Patients in a Medical Intensive Care Unit
Pisani MA, Murphy TE, Van Ness PH, Araujo KL, Inouye SK. Characteristics Associated With Delirium in Older Patients in a Medical Intensive Care Unit. JAMA Internal Medicine 2007, 167: 1629-1634. PMID: 17698685, DOI: 10.1001/archinte.167.15.1629.Peer-Reviewed Original ResearchConceptsAdmission risk factorsMedical record reviewIntensive care unitICU admissionRisk factorsOlder patientsRecord reviewCare unitMedical intensive care unitUrban university teaching hospitalOlder ICU patientsReceipt of benzodiazepinesConfusion Assessment MethodPatients 60 yearsProspective cohort studyLower arterial pHUniversity Teaching HospitalMain outcome measuresMultivariate logistic regressionDelirium durationICU deliriumCohort studyCreatinine levelsICU patientsArterial pHThe use of missingness screens in clinical epidemiologic research has implications for regression modeling
Van Ness PH, Murphy TE, Araujo KL, Pisani MA, Allore HG. The use of missingness screens in clinical epidemiologic research has implications for regression modeling. Journal Of Clinical Epidemiology 2007, 60: 1239-1245. PMID: 17998078, PMCID: PMC2443713, DOI: 10.1016/j.jclinepi.2007.03.006.Peer-Reviewed Original Research
2006
A research algorithm to improve detection of delirium in the intensive care unit
Pisani MA, Araujo K, Van Ness PH, Zhang Y, Ely E, Inouye SK. A research algorithm to improve detection of delirium in the intensive care unit. Critical Care 2006, 10: r121. PMID: 16919169, PMCID: PMC1750978, DOI: 10.1186/cc5027.Peer-Reviewed Original ResearchConceptsIntensive care unitDetection of deliriumCAM-ICUChart review methodCohort studyCare unitClinical careMedical intensive care unitDelirium instrumentCAM-ICU ratingsChart-based reviewIll ICU patientsPrevalence of deliriumConfusion Assessment MethodProspective cohort studyResearch settingsDelirium statusChart reviewICU patientsDeliriumDelirium researchPatientsChart-based methodPatient safetyDiagnostic accuracy
2005
Detection of Delirium in the Intensive Care Unit: Comparison of Confusion Assessment Method for the Intensive Care Unit with Confusion Assessment Method Ratings
McNicoll L, Pisani MA, Ely EW, Gifford D, Inouye SK. Detection of Delirium in the Intensive Care Unit: Comparison of Confusion Assessment Method for the Intensive Care Unit with Confusion Assessment Method Ratings. Journal Of The American Geriatrics Society 2005, 53: 495-500. PMID: 15743296, DOI: 10.1111/j.1532-5415.2005.53171.x.Peer-Reviewed Original ResearchConceptsConfusion Assessment MethodIntensive care unitCAM-ICUICU patientsCare unitMini-Mental State ExaminationCAM-ICU methodFalse-negative ratingsOlder ICU patientsRate of deliriumDetection of deliriumUniversity Teaching HospitalCAM methodsDetailed cognitive testingLevel of consciousnessMedical ICUTeaching hospitalInterrater reliability testingState ExaminationPatientsDeliriumCAM criteriaMore deficitsCognitive testingICU
2003
Cognitive impairment in the intensive care unit
Pisani MA, McNicoll L, Inouye SK. Cognitive impairment in the intensive care unit. Clinics In Chest Medicine 2003, 24: 727-737. PMID: 14710700, DOI: 10.1016/s0272-5231(03)00092-3.Peer-Reviewed Original ResearchMeSH KeywordsCognition DisordersCritical IllnessDeliriumDementiaHumansIntensive Care UnitsRisk FactorsConceptsPre-existing cognitive impairmentCognitive impairmentICU stayICU settingRisk factorsPost-ICU stayRate of deliriumDevelopment of deliriumIntensive care unitPsychoactive medication usePersistence of deliriumDelirium preventionDelirium ratesMedical ICUOlder patientsFrequent complicationMedication useCare unitHigh prevalenceDeliriumICUOlder personsStayImpairmentPatients