Delirium in cancer patients admitted to the intensive care unit: a retrospective
            study

Gouveia, Bárbara Rocha; Jomar, Rafael Tavares; Valente, Tânia Cristina de Oliveira

doi:10.5935/0103-507x.20190064

Cited by 7 publications

(8 citation statements)

References 19 publications

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“…This frequency is similar to previous reports on critically ill, but not terminally ill, patients with cancer requiring ICU care, which ranges from 22.9% to 39.3%. [22][23][24] It is also comparable with rates of delirium in ICU patients without cancer, which range from 20% to 80%. 9,28 In addition, we also found that patients with delirium had significantly higher ICU and hospital mortality compared with patients without delirium.…”

Section: Discussionmentioning

confidence: 68%

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Delirium as a Risk Factor for Mortality in Critically Ill Patients With Cancer

Tao

Seier

Marasigan-Stone

et al. 2023

JCO Oncology Practice

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PURPOSE Although delirium is known to negatively affect critically ill patients, little data exist on delirium in critically ill patients with cancer. METHODS We analyzed 915 critically ill patients with cancer between January and December 2018. Delirium screening was performed using the Confusion Assessment Method for the intensive care unit (ICU), performed twice daily. Confusion Assessment Method-ICU incorporates four features of delirium: acute fluctuations in mental status, inattention, disorganized thinking, and altered levels of consciousness. Multivariable analysis controlling for admitting service, pre-ICU hospital length of stay (LOS), metastatic disease, CNS involvement, Mortality Probability Model II score on ICU admission, mechanical ventilation, and others was performed to determine precipitating factors for delirium, ICU, and hospital mortality and LOS. RESULTS Delirium occurred in 40.5% (n = 317) of patients; 43.8% (n = 401) were female; the median age was 64.9 (interquartile range, 54.6-73.2) years; 70.8% (n = 647) were White, 9.3% (n = 85) were Black, and 8.9% (n = 81) were Asian. The most common cancer types were hematologic (25.7%, n = 244) and gastrointestinal (20.9%, n = 191). Delirium was independently associated with age (OR, 1.01; 95% CI, 1.00 to 1.02; P = .038), longer pre-ICU hospital LOS (OR, 1.04; 95% CI, 1.02 to 1.06; P < .001), not resuscitating on admission (OR, 2.18; 95% CI, 1.07 to 4.44; P = .032), CNS involvement (OR, 2.25; 95% CI, 1.20 to 4.20; P = .011), higher Mortality Probability Model II score (OR, 1.02; 95% CI, 1.01 to 1.02; P < .001), mechanical ventilation (OR, 2.67; 95% CI, 1.84 to 3.87; P < .001), and sepsis diagnosis (OR, 0.65; 95% CI, 0.43 to 0.99; P = .046). Delirium was also independently associated with higher ICU mortality (OR, 10.75; 95% CI, 5.91 to 19.55; P < .001), hospital mortality (OR, 5.84; 95% CI, 4.03 to 8.46; P < .001), and ICU LOS (estimate, 1.67; 95% CI, 1.54 to 1.81; P < .001). CONCLUSION Delirium significantly worsens outcome in critically ill patients with cancer. Delirium screening and management should be integrated into the care of this patient subgroup.

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Section: Discussionmentioning

confidence: 68%

“…20 To date, there have been only four studies conducted on delirium in ICU patients with cancer who are not at the end of life. [21][22][23][24] These analyses also suffer from small sample size, have widely varying results, and lack indepth outcomes analysis.…”

Section: Introductionmentioning

confidence: 99%

Delirium as a Risk Factor for Mortality in Critically Ill Patients With Cancer

Tao

Seier

Marasigan-Stone

et al. 2023

JCO Oncology Practice

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“…This frequency of delirium in this special population of critically but not terminally ill oncological ICU patients lies between those reported for general wards and palliative care units [8]. Very limited and controversial data have been available in this particular patient population so far [9,10,25]. The much higher delirium frequency of 95% observed by Almeida et al (n = 170) might be explained by three reasons: 1) by the divergent population of severely ill, mechanically ventilated patients; 2) by preventive measures including delirium monitoring, daily awakening trials and early mobilization implemented at the study hospital; 3) by patients in persistent coma or sedation until death without delirium screening potentially in uencing the frequency observed in the present study [9].…”

Section: Frequencymentioning

confidence: 63%

“…Comparing oncological patients with and without delirium, sepsis occurred in 26/176 (15%) and 6/312 (1.9%) patients (p < 0.001), while shock was diagnosed in 30/176 (6.1%) and 6/312 (1.9%) patients, respectively (p < 0.001). The SAPS II in delirious and non-delirious patients with malignancy was 41 (27-68) and 24 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), respectively (p < 0.001).…”

Section: Descriptive Datamentioning

confidence: 97%

Delirium In ICU Patients With Malignancy: Patient Characteristics, Resource Utilization and Outcomes

Sieber¹,

Rudiger²,

Schüpbach³

et al. 2021

Preprint

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Background: Whereas delirium in the general intensive care unit (ICU) population is common and well studied, knowledge on ICU delirium in patients with malignancy is scarce. The aim was to assess the frequency of delirium and its impact on resource utilizations and outcomes in ICU patients with malignancy.Methods: This retrospective, single-center longitudinal cohort study included all patients with malignancy admitted to ICUs of a University Hospital during one year. Delirium was diagnosed by an Intensive Care Delirium Screening Checklist (ICDSC) score ≥ 4. Groups were compared with Fisher’s exact and Mann-Whitney U tests. Multivariate analysis included binary logistic regression, Cox regression and multiple linear regression. Results are given as number (percentage; confidence interval (CI)) and median (interquartile range).Results: Of 488 ICU patients with malignancy, 176/488 (36%) developed delirium. Frequencies were high in patients with hepatic (13/21 [62%]; 95% CI 41-82%), lung (29/65 [45%]; 95% CI 33-56%) and colorectal malignancies (15/37 [41%]; 95% CI 24-56%). Delirious patients were older (66 [55-72] vs 61 [51-69] years, p = 0.001), had higher SAPS II (41 [27-68] vs 24 [17-32], p < 0.001) and more frequently sepsis (26/176 [15%] vs 6/312 [1.9%], p < 0.001) and / or shock (30/176 [6.1%] vs 6/312 [1.9%], p < 0.001). In multivariate analysis, delirium was independently associated with lower discharge home (OR [95% CI] 0.366 [0.236-0.567], p < 0.001), longer ICU (HR [95% CI] 0.295 [0.234-0.371], p < 0.001) and hospital length of stay (HR [95% CI] 0.619 [0.500-0.765], p < 0.001), longer mechanical ventilation (HR [95% CI] 0.401 [0.282-0.572], p < 0.001), higher ICU nursing workload (B [95% CI] 1.917 [1.665-2.206], p < 0.001) and ICU (B [95% CI] 2.077 [1.811-2.382], p < 0.001) and total costs (B [95% CI] 1.442 [1.301-1.597], p < 0.001). However, delirium was not independently associated with in-hospital mortality (OR [95% CI] 2.263 [0.925-5.537], p = 0.074).Conclusions: In ICU patients with malignancy, delirium was a frequent complication independently associated with high resource utilizations, however, it was not independently associated with in-hospital mortality.

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“…Medicamentos, como analgésicos e quimioterápicos, retirada da medicação, falta de oxigênio no sangue e outros distúrbios cerebrais podem ser algumas das causas (FUENTES et al, 2017;GOUVEIA;JOMAR;VALENTE, 2019). efeito adverso e sintomas extrapiramidais) e a quetiapina (possui hipotensão ortostática e sedação como efeitos adversos).…”

Section: Manejo Do Deliriumunclassified

Medicamentos na prática clínica de pacientes oncológicos em cuidados paliativos

Ferrari

Limberger

2021

DS-CS

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Introdução: Os cuidados paliativos melhoram a qualidade de vida dos pacientes e de seus familiares que enfrentam problemas associados a doenças potencialmente fatais, sejam elas físicas, psicológicas, sociais ou espirituais. Quando direcionado aos pacientes oncológicos é um tratamento essencial, pois propicia conforto e ainda visa priorizar a dignidade e valorizar os doentes de forma humanizada e holística. Objetivo: Buscou--se neste trabalho discutir e identificar as principais medicações descritas na literatura e utilizadas na prática clínica de pacientes oncológicos em cuidados paliativos, assim como suas indicações. Metodologia: Foi realizada uma pesquisa bibliográfica, na qual utilizou-se dissertações, manuais, Diretrizes do Ministério da Saúde e artigos científicos pesquisados em bases de dados como Pubmed, Science Direct e Google Scholar por meio dos descritores: cuidados de conforto, práticas complementares, cancerologia, dor oncológica, oncologia integrativa. Resultados: Neste artigo foram abordados os cuidados paliativos nos tratamentos dos sinais e sintomas de problemas respiratórios, náuseas e vômitos, constipação intestinal e diarreia, delirium, distúrbios hemorrágicos e a dor de pacientes oncológicos. Os resultados apontam a necessidade da correta identificação dos sintomas para a escolha adequada do tratamento farmacológico para estas condições, e a importância da equipe multidisciplinar para o seguimento farmacoterapêutico no manejo de complicações da doença e dos tratamentos. Conclusão: Conclui-se, então, a importância dos cuidados paliativos para os sinais e sintomas do câncer avançado, da necessidade de analisar e avaliar os sintomas de cada paciente a fim de realizar uma melhor prescrição e administração de cada medicamento.

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Delirium in cancer patients admitted to the intensive care unit: a retrospective study

Cited by 7 publications

References 19 publications

Delirium as a Risk Factor for Mortality in Critically Ill Patients With Cancer

Delirium as a Risk Factor for Mortality in Critically Ill Patients With Cancer

Delirium In ICU Patients With Malignancy: Patient Characteristics, Resource Utilization and Outcomes

Medicamentos na prática clínica de pacientes oncológicos em cuidados paliativos

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