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Background

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Worldwide Background

In 2001, Ely et al. validated the detection tool for delirium diagnosis: CAM-ICU

In 2002, the Society of Critical Medicine suggests its monitoring and in 2004 it is described as an independent outcome predictor.


In 2009 the CAM ICU was translated, adapted and validated to the Spanish language byTobar et al. and Toro et al.

Delirium diagnosis is clinical and the most widely used tools in the ICU critical patient are CAM-UCI and ICDSC.

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Uruguayan Background

In 2006 the first pilot project of delirium in the ICU was done in the Clinicas Hospital (Medicine School, University of the Republic) and at the same moment, a survey at national level was carried out with the objective to evaluate the knowledge on delirium in Uruguay’s ICU health teams:

Incidence of Delirium in the Critically ill Patients and its related variables. Mesa P Echavarría E, Galusso F, Cancela (Critical Care Medicine Department). Otero M Suárez A, Schwartzmann L. (Medical Psychology Department) Medicine School University of the Republic (UDELAR) Montevideo, Uruguay.

Delirium in the critically ill patients: aspects of their knowledge in the health teams in Uruguay" Echavarría E, Mesa P, Galusso F, Cancela M (Critical Care Medicine Department). Otero M, Suárez A, Schwartzmann L. (Medical Psychology Department) Medicine School, University of the Republic (UDELAR) Montevideo, Uruguay.

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Pasteur Hospital Background

2013-2015

In 2013 at the Pasteur Hospital ICU, educational activities were implemented with the purpose of achieving an adequate monitoring of the acute brain dysfunction in the critically ill patient.

In October 2013 the recommendations for agitation and delirium in the Pasteur Hospital ICU  were written based on the guidelines suggested by the Critical Care Medicine Society.

In November 2013 a survey addressed to the health team was done in order to evaluate the knowledge on this subject. Although most proffessionals stated that agitated and delirious patients were frequent in the ICU, they considered those syndromes underdiagnosed and undertreated.

From January to March 2014 educational and training workshops were conducted so as to improve the diagnosis and monitoring of the brain dysfunction.

From April 2014 to April 2015,  data collection for Agitation and Delirium in the ICU project was done; a prospective project with the objective to measure the incidence of delirium and agitation in the ICU, their related risk factors and their morbimortality.

In November 2015 the Agitation and Delirium study was presented in the Uruguayan Congress of Intensive Care Medicine.

Out of 1104 patients admitted in this period, only the patients with mechanical ventilation (MV)

higher or equal 48 hours were included. After applying the exclusion criteria the final population was of 230 patients.

The incidence of delirium was 80%, and the incidence of agitation was 65%, which is related with international data from other ICUs.

The patients with delirium had more days of MV, and a prolonged length of Hospital and ICU stay and required more days of analgesia and sedation as well as they presented higher Hospital mortality.

The Agitation and Delirium in the ICU paper was presented in the XIV Uruguayan Congress of Intensive Care Medicine and was granted the First Award to the best scientific work.

2016

2016

In April 2016 going further with the approach to delirium not only at national level, but also at regional level the integration with the Fernandez Hospital ICU health team headed by Previgliano I. MD (Buenos Aires, Argentina) was carried out.

From September to December 2016 new educational educational workshops on the brain route with the slogan For an ICU without Delirium were implemented aimed at the incorporation of the ABCDEF Bundle in the daily practices based on the Pain, Agitation and Delirium (PAD) guidelines of the Critical Care Medicine Society.

2017

On March 15: the World Delirium Day was celebrated with an educational journey.

In June 2017 we presented two posters at the American Delirium Society 7th  Annual Conference 

June 4-6, 2017, Nashville, TN, USA:

Agitation in the ICU. Author: Patricia Mesa, MD Co-Authors: Ignacio Previgliano, MD; Sonia Altez, RN; Silvina Favretto, MD; Maria Orellano, MD; Cinthya Lecor, RN; E. Wesley Ely, MD, MPH; Ana Soca, MD 

Delirium in the ICU: A Prospective Cohort in Mechanical Ventilated Patients. Author: Patricia Mesa, MD, Ignacio Previgliano, MD; Sonia Altez, RN; Silvina Favretto, MD; Maria Orellano, MD; Cinthya Lecor, RN; E. Wesley Ely, MD, MPH; Ana Soca, MD

Grant of the BEST POSTER AWARD by the American Delirium Society  for the work Delirium in the ICU: A Prospective Cohort in Mechanical Ventilated Patients.

 

In October 2017 the publication of “Delirium in a Latin American Intensive Care Unit. A prospective cohort study of mechanically ventilated patients”  paper in the Revista Brasilera de Terapia Intensiva ( RBTI) was done:

Delirium in the ICU: A Prospective Cohort in Mechanical Ventilated Patient. Mesa P, Previgliano IJ, Altez S, Favretto S, Orellano M, Lecor C, Soca A, Ely EW. Rev Bras Ter Intensiva. 2017 Jul-Sep;29(3):337-345. 

November 2017

Presentation of the For an ICU without Delirium Poster in the 15th Intensive Medicine Uruguayan Congress (November 3 - 6, Montevideo, Uruguay).

Presentation in the XIII World Congress of Federation of Societies of Intensive and Critical Care Medicine Río de Janeiro, Brazil (November 8-11),of  the work “Delirium development associated factors in two Latin American Intensive Care Units” Previgliano I, Mesa P,

Aversa I, Altez S, Favretto S, Nuñez M, Orellano M, Lecor C, Soca A, Ely W, 

1: J. A. Fernández Hospital– Buenos Aires- Argentina.

2: Pasteur Hospital-Montevideo, Uruguay.

3: Mathematics and Statistics Department Pharmacy and Biochemistry School. University of Buenos Aires.

4: Vanderbilt University Medical Center NashvilleTN-USA ).

Multi centered work carried out  jointly between the two ICUs, the Pasteur Hospital ICU and the Fernandez Hospital ICU.(Buenos Aires, Argentina)

2018

March 2018 

On March 14 on the World Awareness Delirium Day, we were interviewed on TV for the public diffusion of the concept of Delirium and its importance.

See the link: “Sabemos más sobre Delirium http://www.canal10.com.uy/arriba-gente/2018/conocemos-mas-del-delirium.

In June 2018 we presented two posters at the American Delirium Society 8th  Annual Conference 

June 10-12, 2018, San Francisco CA, USA:  

 

For an ICU without delirium. Authors: Patricia Mesa, MD Co-Authors: Ignacio Previgliano MD, Maria Orellano MD, Sonia Altez RN, Cinthya Lecor RN;; Cecilia Leyes RN, Silvina Favretto, MD;  Da Luz J. NA, Pereira L NA, Pereira L NA, E. Wesley Ely, MD, MPH; Ana Soca, MD. 

Delirium development associated factors in two latin American Intensive Care Units : A Prospective Cohort in Mechanical Ventilated Patients. Authors: Ignacio Previgliano, MD, Patricia Mesa, Aversa I., Nuñez G. ,MD, Sonia Altez, RN; Silvina Favretto, MD; Maria Orellano, MD; Cinthya Lecor, RN; E. Wesley Ely, MD, MPH; Ana Soca, MD

At that moment the Latin American Delirium Special Interest Group ( LADSIG) was created as part of the American Delirium Society to educate and represent the delirium research in Latin America. 

September 2018 

Participation in the Sedation, Analgesia and Delirium Symposium in the 5th Updating Journeys of Intensive Care Medicine Department. Medicine School, Clinicas Hospital, Montevideo Uruguay (September 14-15) with two conferences:

- Delirium in the ICU: Experience in Uruguay (For an ICU without Delirium team)

- Nursing Care in the mechanical ventilated and arousal patients (For an ICU without  

  Delirium team).

 

October 2018

 

Participation in the16th Journeys of Intensive Care Medicine Inland. San José, Uruguay ; (October 24-25: Roundtable: Delirium in the ICU ( Cinthya Lecor RN ,Cecilia Leyes RN, For an ICU without Delirium team).

 

December 2018

In December 2018 For an ICU without Delirium study was presented at the IV National Nursing Congress of Psychiatry and Mental Health in Montevideo Uruguay and it was granted the Second Award to the Best scientific work.

2019

March 2019

On March 13, 2019 the First Latin American Symposium of Delirium was held in San Pablo, Brazil, on the Delirium Awareness World day.

This event was organized by the Geriatric Department of Clinicas Hospital of San Pablo University Medicine School and the Latin American Delirium Special Interest Group, where several researchers on the subject from Brazil and Latin American took part.

Participation in the organization and presentation of two conferences:

Delirium in the ICU and Non Pharmacological treatment of Delirium.

June 2019

Junio 2019 ADS 9th Annual Conference Boston MA,USA (June 16-18).

Participation in Roundtable: Delirium Recognition and Reduction: Practices Across The 

Americas: moderator: Rakesh Arora, speakers: MD Roberta Esteves Vieira de Castro, MD; Patricia Mesa, MD; Flavia Garcez, MD; Indalecio Carboni Bisso, MD; Jose Maldonado, MD.

 

 https://americandeliriumsociety.org/2019-conference-information

At this moment, we are working on the Evaluation of the Post Intensive Care Unit Syndrome in the patients studied in the Pasteur Hospital ICU and are intending to implement a training project at national level to improve the clinical intervention and treatment of delirium in Uruguay: Point of Care Delirum Education ( POCDE study).