Factors Affecting Delirium in ICU Patients

Jeong, In-Seok; Cho, Mi-Kyoung

doi:10.3390/ijerph20105889

Cited by 5 publications

(2 citation statements)

References 36 publications

(45 reference statements)

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“…Advanced age and illness severity are recognized as significant risk factors for delirium (44)(45)(46). To mitigate the confounding influences of these variables in our analysis, we utilized the propensity score matching technique.…”

Section: Discussionmentioning

confidence: 99%

Former smoking, but not active smoking, is associated with delirium in postoperative ICU patients: a matched case-control study

Komninou,

Egli,

Rossi

et al. 2024

Front. Psychiatry

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ObjectiveTo examine the relationship between current and former smoking and the occurrence of delirium in surgical Intensive Care Unit (ICU) patients.MethodsWe conducted a single center, case-control study involving 244 delirious and 251 non-delirious patients that were admitted to our ICU between 2018 and 2022. Using propensity score analysis, we obtained 115 pairs of delirious and non-delirious patients matched for age and Simplified Acute Physiology Score II (SAPS II). Both groups of patients were further stratified into non-smokers, active smokers and former smokers, and logistic regression was performed to further investigate potential confounders.ResultsOur study revealed a significant association between former smoking and the incidence of delirium in ICU patients, both in unmatched (adjusted odds ratio (OR): 1.82, 95% confidence interval (CI): 1.17-2.83) and matched cohorts (OR: 3.0, CI: 1.53-5.89). Active smoking did not demonstrate a significant difference in delirium incidence compared to non-smokers (unmatched OR = 0.98, CI: 0.62-1.53, matched OR = 1.05, CI: 0.55-2.0). Logistic regression analysis of the matched group confirmed former smoking as an independent risk factor for delirium, irrespective of other variables like surgical history (p = 0.010). Notably, also respiratory and vascular surgeries were associated with increased odds of delirium (respiratory: OR: 4.13, CI: 1.73-9.83; vascular: OR: 2.18, CI: 1.03-4.59). Medication analysis showed that while Ketamine and Midazolam usage did not significantly correlate with delirium, Morphine use was linked to a decreased likelihood (OR: 0.27, 95% CI: 0.13-0.55).DiscussionNicotine’s complex neuropharmacological impact on the brain is still not fully understood, especially its short-term and long-term implications for critically ill patients. Although our retrospective study cannot establish causality, our findings suggest that smoking may induce structural changes in the brain, potentially heightening the risk of postoperative delirium. Intriguingly, this effect seems to be obscured in active smokers, potentially due to the recognized neuroprotective properties of nicotine. Our results motivate future prospective studies, the results of which hold the potential to substantially impact risk assessment procedures for surgeries.

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Section: Discussionmentioning

confidence: 99%

Former smoking, but not active smoking, is associated with delirium in postoperative ICU patients: a matched case-control study

Komninou,

Egli,

Rossi

et al. 2024

Front. Psychiatry

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“…The prevention and early recognition of delirium in the setting of EDs is the most effective strategy to reduce complications in older patients [ 33 , 39 , 40 ]. Delirium can lead to a decline in the general health of older patients, aspiration pneumonia, decreased mobility, pressure ulcers, weakness, falls, malnutrition, injuries and fractures, electrolyte abnormalities, long-term cognitive impairment, and increased overall mortality [ 41 , 42 ]. Delirium can manifest in two major psychomotor forms: hypoactive delirium and hyperactive [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Current Trends for Delirium Screening within the Emergency Department

Saviano,

Zanza,

Longhitano

et al. 2023

Medicina

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Delirium is an acute neurological disorder that involves attention and cognition. It is associated with a high risk of morbidity and mortality among older people (>65 years old). In the context of the Emergency Department (ED), it is frequently experienced by patients but often not recognized. Literature studies have identified some screening instruments for an initial evaluation of delirium. Most of these tools have not been validated yet in the context of emergencies, but, in other settings, they were very useful for assessing and maximizing the recognition of this condition among older patients. We conducted a review of the literature, including randomized control trials, clinical and observational studies, and research studies published in recent years, confirming that most of the screening tools for delirium used in the intensive care unit (ICU) or the geriatric department have not been tested in the ED, and the ideal timing and form of the delirium assessment process for older adults have not been defined yet. The aim of our review is to summarize the updated evidence about the screening tools for delirium in the context of the ED, due to the fact that overcrowding of the ED and the stressful condition of emergency situations (that contribute to the onset of delirium) could expose older patients to a high risk of complications and mortality if delirium is not promptly recognized. In conclusion, we support the evidence that delirium is a current and real condition that emergency physicians have to face daily, and we are aware that more research is needed to explore this field in order to improve the overall outcomes of older patients admitted to the ED.

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Adherence to optimal delirium management practices in intensive care units in Brazil: a nationwide survey

Bispo,

Souza

2024

JBI Evidence Implementation

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Background: Effective delirium management is crucial, considering its association with adverse outcomes. Adherence to best practices has the potential to reduce the incidence and prevalence of delirium and improve health outcomes. Objectives: The objectives of this project were to describe self-assessed adherence to best practices in delirium management by health care professionals in intensive care units (ICUs) in Brazil, assess the health care professionals’ perception of the importance of adequate delirium prevention and treatment in ICUs, and compare the compliance rates with best practices between public and private ICUs. Method: A cross-sectional study was conducted in Brazil using an online questionnaire consisting of three parts, namely, data about the health care professionals and the ICU in which they worked; statements about the 17 best practices; and questions related to perceptions of delirium prevention and management by ICU physicians and nurses. The survey was sent to email addresses registered with the Brazilian Association of Intensive Care Medicine. Results: The compliance rate exceeded 50% for only eight best practices. These included the identification and management of pressure sores and falls in delirium patients, with compliance rates of 77.8% and 74.1%, respectively. Conclusion: Among ICU professionals in Brazil, adherence to best practices in delirium management is low, particularly for practices involving patient education and involvement of their relatives in their care. These results emphasize the importance of enhancing delirium management in Brazilian health care institutions, regardless of hospital classification. Spanish abstract: http://links.lww.com/IJEBH/A274

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Factors Affecting Delirium in ICU Patients

Cited by 5 publications

References 36 publications

Former smoking, but not active smoking, is associated with delirium in postoperative ICU patients: a matched case-control study

Former smoking, but not active smoking, is associated with delirium in postoperative ICU patients: a matched case-control study

Current Trends for Delirium Screening within the Emergency Department

Adherence to optimal delirium management practices in intensive care units in Brazil: a nationwide survey

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