Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population*

Abstract

Objective There is a high prevalence of delirium in older medical intensive care unit (ICU) patients and delirium is associated with adverse outcomes. We need to identify modifiable risk factors for delirium in the ICU, such as medication use. The objective of this study was to examine the impact of benzodiazepine or opioid use on the duration of ICU delirium in an older medical population. Design Prospective cohort study. Setting Fourteen-bed medical intensive care unit in an urban university teaching hospital. Patients 304 consecutive admissions age 60 and older. Interventions None Main Outcome Measurements The main outcome measure was duration of ICU delirium, specifically the first episode of ICU delirium. Patients were assessed daily for delirium with the Confusion Assessment Method for the ICU (CAM-ICU) and a validated chart review method. Our main predictor was the receipt of benzodiazepines or opioids during ICU stay. A multivariable model was developed using Poisson rate regression. Results Delirium occurred in 239 of 304 patients (79%). The median duration of ICU delirium was 3 days with a range of 1-33 days. In a multivariable regression model receipt of a benzodiazepine or opioid (RR, 1.64, 95% CI, 1.27-2.10) was associated with increased delirium duration. Other variables associated with delirium duration in this analysis include preexisting dementia (RR, 1.19, 95% CI 1.07-1.33), receipt of haloperidol (RR, 1.35, 95% CI, 1.21-1.50), and severity of illness (RR, 1.01, 95% CI, 1.00-1.02). Conclusions The use of benzodiazepines or opioids in the ICU is associated with longer duration of a first episode of delirium. Receipt of these medications may represent modifiable risk factors for delirium. Clinicians caring for ICU patients should carefully evaluate the need for benzodiazepines, opioids and haloperidol.

Influence of Sedation Strategies on Unplanned Extubation in a Mixed Intensive Care Unit

“…19 This association may also reflect the deliriogenic effect of benzodiazepines as sedative agents. [20][21][22][23] In addition, some patients who inappropriately receive benzodiazepines for the management of pain may be predisposed to delirium with paradoxical excitation. Tung et al 19 compared patients who self-extubated with a matched group of control patients and found that the patients with unplanned extubation were twice as likely to be agitated (54% vs 22%; P < .05).…”

Prolonged stay at the paediatric intensive care unit associated with paediatric delirium

“…Therefore, effect sizes may also be smaller than reported. For example, the use of psychotropic medications, such as benzodiazepines and opioids, notorious for their increased risk of ICU delirium [7,8] was not examined directly. However, effects of benzodiazepines and opioids arguably were controlled for indirectly, given the fact that their use is predominantly associated with mechanical ventilationin our PICU, this would typically be the case-and this was included in the analyses.…”

‘Cooperative Sedation’: Optimizing Comfort while Maximizing Systemic and Neurological Function

“…In general, benzodiazepines are thought to be the most closely associated with delirium, as supported by the SEDCOM trial [36], although other data have linked benzodiazepines and opioids to the onset and increased duration of delirium [37]. Although propofol is not associated with delirium, it does aff ect cognition as shown in the ANIST study [15].…”