Delirium in the Cardiovascular ICU

McPherson, John; Wagner, Chad E.; Boehm, Leanne M.; Hall, J. D.; Johnson, Daniel; Miller, Lance; Burns, Kathleen; Thompson, Jennifer L.; Shintani, Ayumi; Ely, E. Wesley; Pandharipande, Pratik

doi:10.1097/ccm.0b013e31826ab49b

Cited by 231 publications

(129 citation statements)

References 70 publications

(64 reference statements)

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“…Our result is, however, supported by other studies identifying use of physical restraints as an important risk factor for the development of delirium [31]. Catheters and drainages preclude mobilization and have been associated with delirium in cardiac surgery patients [32]. Use of restraint was identified as a risk factor for delirium in mechanically ventilated patients [33] and in a multicenter study of ICU patients, which, however, could not assess its independent predictive value [34].…”

Section: Discussionsupporting

confidence: 86%

Risk factors for new-onset delirium in patients with bloodstream infections: independent and quantitative effect of catheters and drainages—a four-year cohort study

Dittrich

Tschudin‐Sutter

Widmer

et al. 2016

Ann. Intensive Care

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BackgroundBloodstream infections (BSI) and delirium are frequent in critically ill patients. During systemic inflammatory response to BSI, cytokines may interact with neurotransmitters and neuronal receptors driving acute brain dysfunction. However, prospectively collected data on incidence, prediction and impact of delirium in association with BSI are lacking. This study aimed to determine the incidence and predictors of new-onset delirium and its impact on outcome in critically ill adult patients with BSI.MethodsFrom 2011 to 2014, all consecutive adult patients with BSI treated in the intensive care units of an academic medical care center were identified. Pertinent clinical and microbiological data including the Intensive Care Delirium Screening Checklist (ICDSC) were assessed. Multivariable analysis was performed to identify variables independently associated with ICDSC ≥4.ResultsAmong 240 patients, 145 (60%) had an ICDSC ≥4 (i.e., delirium). In-hospital mortality was 34%. Delirious patients had a higher mortality (40 vs. 23%; p = 0.005), a lower proportion with return to functional baseline (30 vs. 46%; p = 0.012), and a higher proportion with unfavorable outcome in survivors (74 vs. 54%; p = 0.010). Multivariable analyses revealed age (OR 1.04, 95% CI 1.02–1.06), male gender (OR 2.26, 95% CI 1.17–4.36), and the number of catheters and drainages before diagnosis of BSI (OR for every additional catheter = 1.14, 95% CI 1.04–1.25) as independent predictors for delirium (adjusted for SAPS [simplified acute physiology score] II, Riker Sedation-Agitation Scale [SAS], Sequential Organ Failure Assessment [SOFA] score, dementia and/or leukoencephalopathy, and albumin levels).ConclusionsThe incidence of delirium in patients with BSI is high and associated with adverse outcome. The number of catheters and drainages may constitute a useful and readily available predictor of delirium in patients with BSI allowing to identify patients at high risk. Ultimately, reliable identification of patients at increased risk for delirium is key for allocation of specific prevention strategies.

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Section: Discussionsupporting

confidence: 86%

Risk factors for new-onset delirium in patients with bloodstream infections: independent and quantitative effect of catheters and drainages—a four-year cohort study

Dittrich

Tschudin‐Sutter

Widmer

et al. 2016

Ann. Intensive Care

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“…Reported prevalences vary from 25% in our mixed-population CVICU [25] to 80% in medical-intensive care units [9]. Previous reports have stated that survivors of cardiac arrest who experienced a myocardial infarction have a higher prevalence of delirium [27].…”

Section: Discussionmentioning

confidence: 99%

Delirium in Survivors of Cardiac Arrest Treated With Mild Therapeutic Hypothermia

Pollock¹,

Hollenbeck²,

Wang³

et al. 2016

American Journal of Critical Care

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Background Mild therapeutic hypothermia (TH) is a recommended treatment for comatose patients resuscitated from cardiac arrest. To our knowledge, the prevalence of delirium and its associated risk factors has not been assessed in survivors of cardiac arrest treated with TH. Objective To determine the prevalence and risk factors for delirium among survivors of cardiac arrest who were treated with TH. Methods We conducted a retrospective observational study of 251 patients following cardiac arrest treated with TH between 2007 and 2014. We obtained baseline demographic data and daily delirium assessments throughout the ICU stay. We assessed for the association between the duration of delirium and various risk factors. Results Of 251 patients, 107 (43%) awoke from coma. Of these 107 survivors, all of them had at least one day of delirium during their ICU stay. Median number of delirium days was 4.0 (IQR 2.0 to 7.5). A multivariable analysis revealed that age (OR 1.72, 95% CI 1.01 – 2.95, p=0.05), time from CPR to return of spontaneous circulation (ROSC) (OR 1.52, 95% CI 1.11–2.07 p =0.01), and total dose of pre-warming propofol (OR 0.02, 95% CI 0.00 – 0.48, p= 0.02) were associated with delirium duration. Conclusions Among patients treated with TH, delirium lasts a median of 4 days. Duration of delirium was best predicted by age and time from initiation of CPR to ROSC, while pre-warming exposure to total dose of propofol was associated with a shorter duration. These findings are limited to this unique cohort, and may not generalize to broader populations.

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“…It is an unspecific manifestation of acute illness occurring frequently in patients after cardiac surgery [2]. Delirium has been attributed to a longer intensive care unit (ICU) and hospital stay [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU

et al. 2016

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BackgroundRisk factors for delirium following cardiac surgery are incompletely understood. The aim of this study was to investigate whether intra-operative pathophysiological alterations and therapeutic interventions influence the risk of post-operative delirium.MethodsThis retrospective cohort study was performed in a 12-bed cardiosurgical intensive care unit (ICU) of a university hospital and included patients consecutively admitted after cardiac surgery during a 2-month period. The diagnosis of delirium was made clinically using validated scores. Comparisons between patients with and without delirium were performed with non-parametric tests. Logistic regression was applied to identify independent risk factors. Results are given as number (percent) or median (range).ResultsOf the 194 consecutive post-cardiac surgery patients, 50 (26 %) developed delirium during their ICU stay. Univariate analysis revealed that significant differences between patients with and without delirium occurred in the following intra-operative variables: duration of cardiopulmonary bypass (184 [72–299] vs 113 (37–717) minutes, p < 0.001), lowest mean arterial pressure (50 [30–70] vs 55 [30–75] mmHg, p = 0.004), lowest haemoglobin level (85 [56–133] vs 98 [53–150] g/L, p = 0.005), lowest body temperature (34.5 [24.4–37.2] vs 35.1 [23.9–37.2] °C, p = 0.035), highest noradrenaline support (0.11 [0.00–0.69] vs 0.07 [0.00–0.42] μg/kg/minute, p = 0.001), and frequency of red blood cell transfusions (18 [36 %] vs 26 [18 %], p = 0.018) and platelet transfusions (23 [46 %] vs 24 [17 %], p < 0.001). Only platelet transfusions remained an independent risk factor in the multivariate analysis (p < 0.001).ConclusionsIn patients undergoing cardiac surgery, various intra-operative events, such as transfusion of platelets, were risk factors for the development of a post-operative delirium in the ICU. Further research is needed to unravel the underlying mechanisms.

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Delirium in the Cardiovascular ICU

Cited by 231 publications

References 70 publications

Risk factors for new-onset delirium in patients with bloodstream infections: independent and quantitative effect of catheters and drainages—a four-year cohort study

Risk factors for new-onset delirium in patients with bloodstream infections: independent and quantitative effect of catheters and drainages—a four-year cohort study

Delirium in Survivors of Cardiac Arrest Treated With Mild Therapeutic Hypothermia

Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU

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