Background

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.

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.

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

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

Dec 2018 to February 2019

Participation in the organization of the First Latin American Delirium Symposium a be held in the City of San Pablo in March 2019.

Preparation of scientific papers for presentation at said symposium, participation in the first Latin American Delirium Symposium with two conferences Treatment no Pharmacology of delirium and Delirium in the ICU.

We attach a link to the symposium: www.ladig-ads.com

December 2018 to February 2019

Preparation of the presentation to the invitation in round table of the American Delirium Society 9th Annual Conference June 16-18, 2018 Boston, USES. https://americandeliriumsociety.org/2019-conference-information

Round table: 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.

March 2019

First Latin American Delirium Symposium in the City of San Pablo.

Preparation of scientific papers for presentation at said symposium, participation in the first Latin American Delirium Symposium with two conferences:

Non-pharmacological treatment of delirium
Delirium in ICU

We attach a link to the symposium: www.ladig-ads.com

June 2019

American Delirium Society 9th Annual Conference June 16-18, 2018 Boston, USES. https://americandeliriumsociety.org/2019-conference-information

July 2019 , the participation in the meeting of experts in delirium around the world takes place, after the invitation made by the Global Council Brain on Health (GCBH) and by the American Association Retired Persons (AARP), being the only representatives of America Latina, in Boston, Massachusetts, USA. The objective of the meeting was to make the recommendations Preserving Your Brain Health During Illness or Surgery: Recommendations to Prevent and Treat Delirium.

September 2019 , Dr. Patricia Mesa is interviewed by the channel of the State Health Services Administration (ASSE Comunica) to refer to the team of For an ICU without delirium of the Pasteur Hospital.

October 2019 , the Delirium exhibition is presented at the UCI. Neuroreanimation course in the postgraduate specialization in Intensive Medicine, Chair of Intensive Medicine, Faculty of Medicine, Hospital de Clínicas.

November 2019 , participates in the XVI Uruguayan Congress of Intensive Medicine, October 29 to November 1, 2019, Montevideo, Uruguay. The following interventions are carried out:

Round table coordination: Sedation and analgesia in the ICU (Dra. Estrella Echavarría and Dra. Patricia Mesa).

Conference presentation: Sedation and delirium in the critical patient.

Presentation of free oral works:

Analysis of the variables that influence delirium in two therapy units. Latin American intensive studies with different statistical tools.

Mesa P., Previgliano I., Nuñez, M. Ponteville Ch., Aversa I., Lecor C., Altez S., Favretto S., Orellano M., Leyes C., Banchero A., Da Luz J., Pereira L., Cugliari T., Peretti C., Soca A. Hospital JA Férnandez, Buenos Aires, Argentina; Pasteur Hospital, Montevideo, Uruguay.

Evaluation of the post-ICU syndrome, cognitive, psychological and physical aspects and its relationship with delirium in the ICU.

Mesa P., Previgliano I., Lecor C., Leyes C., Banchero A., Orellano M., Altez S., Favretto S., Da Luz J., Pereira L., Cugliari T., Peretti C., De Mattos S., Somma V., Soca A. Hospital JA Férnandez, Buenos Aires, Argentina; UCI Hospital Pasteur, Montevideo, Uruguay.

March 2020 , the document Preserving your Brain Health During Illness or Surgery: GCBH Recommendations to Prevent and Treat Delirium was published in the Global Council Brain on Health (GCBH) and American Association Retired Persons (AARP).

May 2020 , the invitation from the COVID-19 COS Core Outcome Score is received for participation in a project with an international initiative that seeks to establish outcomes for research trials in COVID-19. University of Sydney School of Public Health, Faculty of Medicine.

Invitation to participate in the committee of experts for discussion in the following workshops:

Respiratory Failure - Multiorganic failure, 13th May 2020

Shortness of breath, 14th May 2020

Recovery, 14th May 2020

May 2020 , participates in the UCI Conference Cycle of the Pasteur Hospital, through the conference Neurosychiatric and Neurological Complications in COVID-19.

Speakers: Lic. Cynthia Lecor, Dra. Patricia Mesa.

June 2020 , participates in the annual congress of the American Delirium Society ADS

ADS 2020 Virtual Meeting, June 15, 2020.

June 2020 , participates in the meeting of the European Delirium Society EDA,

Delirium and COVID-19. June 30, 2020.

August 2020 , participates in the 26th World Congress on Neurology and Neurodisorders (Neurodisorders Congress 2020) August 26-27, 2020.

Asia Conference Series, oral presentation of the work Title: “ For an ICU without delirium ":

Evaluation of the impact of an educational intervention ”.

October 2020 , the team for AN ICU WITHOUT DELIRIUM, sends a delirium education project to the NIDUS BOOT CAMP (Network investigation Delirium US)

The Delirium Boot Camp was founded in 2013 through a NIA Leadership Award to Dr. Sharon K. Inouye to establish the Center of Excellence for Delirium in Aging: Research, Training and Educational Improvement (CEDARTREE) under the leadership from DM Fick, PhD, MSN and E. Wes Ely, MD, MPH.

The Boot Camp includes didactic sessions on a variety of delirium-specific investigations ranging from transnational to clinical research, as well as mock grant reviews, CAM training, grants, methods training, responding to grant / manuscript reviews, cognitive assessment virtual, networking sessions and more.

The annual Delirium Boot Camp began in 2013 through a K07 grant from the NIH to fund the Center of Excellence for Delirium in Aging: Research, Training and Educational Enhancement (CEDARTREE), with the goal of promoting research and training in the delirium.

Calendar of activities and participation in the NIDUS 8th DELIRIUM BOOT CAMP

October 28-29, 2020:

Proposed project submission.
Project acceptance
Obtaining participation as a BOOT CAMP 2021 student

In March 2021, the guidelines of the UCI of Hospital Pasteur are carried out on the following topics:

Delirium in ICU: Dra. Patricia Mesa - Lic. Cinthya Lecor.

Agitation in the ICU: Dr. Patricia Mesa - Lic. Cinthya Lecor- Dr. Ignacio Gutierrez

Dra. Laura Olivera

Mysthenic Crisis: Dr. Patricia Mesa- Dr. Sofia Martigani

April 2021 is published in Critical Care Medicine

"Core outcome measures for trials in people with COVID-19: respiratory failure, multiorgan failure, shortness of breath and recovery" Co-Author CTI Hospital Pasteur ".

June 2021 , the official invitation to be part of the Scientific Committee of the XVII Uruguayan Congress of Intensive Medicine and XIII Uruguayan Congress of Intensive Care Nursing is received via email, which will take place from December 7 to 10, 2021.

Montevideo, Uruguay.

June 2021 participates in the 2021 Virtual American Delirium Society Annual Conference. The meeting was held Sunday, June 13, 2021.

Project presented:

"Evaluation of the Post Intensive Care Syndrome Cognitive, Psychological and Physical Aspects and its Relation with Delirium in the Intensive Care Unit"

Tuesday, June 15, 2021 with authors: Previgliano I., Lecor C., Leyes C., Banchero A., Orellano M., ALtez S., Favretto S., Da Luz J., Pereira L., Cugliari T., Peretti C., De Mattos S., SommaV., Olivera L., Soca A., Pontet J.

July 2021 the acceptance of the abstract sent to the 10th Annual Johns Hopkins is received

Critical Care Rehabilitation Virtual Conference Live Virtual Conference to be held Nov. 4-6, 2021 called:

Delirium incidence in the Intensive Care Unit and its associated variables in two age ranges.

Table P1. Previgliano I2, Lecor C1., Favretto S1., Laws C1., Banchero A1., Orellano M1., ALtez S1., Da Luz 1J., Pereira L.1, Cugliari T.1, Peretti C.1, Olivera L1. , Soca A.1, Pontet J.1

1. Pasteur Hospital, Montevideo, Uruguay. 2.JA Fernandez Hospital, Buenos Aires, Argentina.