Retrospective evaluation of a delirium order set utilizing nonpharmacologic and pharmacologic interventions for the treatment of delirium in medical intensive care unit patients

Abstract Purpose To describe the use of a medical intensive care unit (MICU) delirium order set pilot and its associated impact on utilization of nonpharmacologic and pharmacologic interventions, pharmacologic continuation at transitions of care, and resolution of ICU delirium. Methods This was a retrospective cohort analysis of MICU patients who received delirium management using an order set pilot compared to standard care. Patients 18 years of age or older admitted to the MICU between May 2019 and January 2020 who received an antipsychotic or valproic acid for the treatment of delirium were included. Results Pharmacologic treatment continuation past ICU discharge occurred in 30% of patients in the pilot cohort (n = 50) compared to 54% of patients receiving standard care (n = 50; P = 0.027). On treatment days 1 through 7, utilization of deliriogenic medications was significantly lower in the pilot cohort (78% vs 96%, P = 0.007). No differences were observed between the groups in delirium resolution, delirium recurrence, hospital and ICU length of stay, or mortality. Conclusion A MICU order set prioritizing nonpharmacologic management and limiting the duration of pharmacologic agents for delirium may aid providers in the management of ICU delirium and reduce exposure to pharmacologic interventions. </jats:sec

Design Guidance for Freeway Main-Line Ramp Terminals

This paper presents the results of a study to develop improved design guidance for freeway main-line ramp terminals on the basis of modern driver behavior and vehicle performance capabilities. The primary steps included a crash analysis, an observational field study, and a driver behavioral study. This research reached several key conclusions, as follows. Vehicle merging speeds tend to be closer to freeway speeds at tapered acceleration lanes than at parallel acceleration lanes. The recommended minimum lengths for acceleration lanes presented in the 2004 edition of AASHTO's A Policy on Geometric Design of Highways and Streets (Green Book) are conservative and, under certain conditions, could be reduced by 15%. In a situation in which a significant volume of trucks uses an entrance ramp, an acceleration lane length that will better accommodate trucks can be derived by using speed–distance curves developed for a range of weight-to-power ratios. The recommended minimum lengths for deceleration lanes presented in the 2004 Green Book are conservative and do not account for deceleration in the freeway. Providing deceleration lanes longer than the minimum values given in the Green Book may promote casual deceleration by exiting drivers. Several potential changes for consideration in the next edition of the Green Book are recommended on the basis of the findings and conclusions of this research. </jats:p