1. Eric Mauri Michael Marquis Matthew Kasztejna Advised by: Dr. Wes Ely
Delirium Detection
Eric Mauri
Michael Marquis
Matthew Kasztejna
Advised by: Dr. Wes Ely

2. Delirium Overview Brain’s form of organ dysfunction
Defined as a disturbance of consciousness characterized by an acute onset and fluctuating course of impaired cognitive functioning.
Develops in over 80% of ICU patients
Direct consequence of medical conditions, medication, toxin exposure, or a combination of all of these.

3. Delirium Demographics
Occurs in 15-60% of general patients and most frequent complication of hospitalization in older patients
Complicates 2-3 million people yearly.
Involves over 17.5 million inpatient days.
Over $4 billion in Medicare expenditures.
Development of delirium selected as one of the top three most important areas for quality of care improvement in older adults.

4. How is it detected? Arousal and Attention Assessment Problems
Confusion Assessment Method (CAM)
Acute onset of mental changes
Inattention
Disorganized thinking
Alertness
Problems
Subjective
No Standardization
Time Intensive

5. Project Objectives
Develop system that can continuously measure delirium in ICU patients
Device must be small, cost-effective, comfortable, and practical
Real-Time measurements, data storage, and analysis of information (software)

6. Proposed Solution Quantitative EEG Benefits Acquire digital signal
Transform it into the frequency domain
Focus on certain frequency bands that have been clinically shown to be important to sleep.
Benefits
Inexpensive
Noninvasive
Software reduces man hours
Most importantly several studies have shown that EEG can be effectively used to monitor sleep

7. Possible Systems Gold Standard EEG – Sleep Labs
Bispectral Index (BIS) – Aspect Medical
Sleep I/T
Vitaport - Temec

8. Ruled out systems Gold standard EEG BIS Most complex
The 26 lead system is too complicated for use in the ICU.
BIS
Simplest
Derived from measurements of frequency, amplitude and coherence of EEG.
3 lead system which produces a single number to describe changes in EEG that relate to levels of sedation and consciousness.

9. BIS Problems
Studies have shown that BIS is only effective for the first 3 stages of sleep.
During sleep the BIS number decreases as sleep progress from the first to third stage, however the number increases during REM sleep due to increased glucose metabolism in the brain.
Modified system would be too experimental for Dr. Ely’s work.

10. Remaining Possible Systems
Sleep I/T and Vitaport
Both systems are full clinical Polysomnographs (EEG, EOG, EMG, EKG, respiratory effort, oxygen saturation)
While currently too complex for ICU, the potential for simplification exists.
Dr. Ely prefers focus on Vitaport because it is seems to be best combination of (1) a validated sleep monitoring system and (2) a viable and practical method for use in ICU patients

11. Current Work
Educating ourselves about the Vitaport system and its features.
Currently in contact with Temec about obtaining a Vitaport system for experimentation.
Determining design changes to Vitaport as dictated by ICU environment.
Discussing possible modifications and requirements with Dr. Ely

12. Future Work
Continue working with Dr. Weinhouse and engineers at Temec.
After acquiring Vitaport system make necessary modifications.
Using the modified system collect actual data on ourselves and determine accuracy.