Incidence and risk factors for delirium development in ICU patients - a prospective observational study

Abstract

a Background and Aims. Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. Methods. A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period. We evaluated the incidence of delirium and its predisposing and precipitating risk factors. All patients were assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU). Results and Conclusions. Of the total of 332 patients with a median APACHE II (the Acute Physiology and Chronic Health Evaluation) score of 12, who were evaluated for delirium, 48 could not be assessed using CAM-ICU (47 due to prolonged coma, 1 due to language barriers). The incidence of delirium was 26.1%, with trauma and medical patients being more likely to develop delirium than surgical patients. Risk of delirium was significantly associated with age ≥ 65 years, and alcohol abuse in their anamnesis, with APACHE II score on admission, and with the use of sedatives and/or vasopressors. Delirious patients who remained in the ICU for a prolonged period showed a greater need for ventilator support and had a greater ICU-mortality.

Suvorexant for the prevention of delirium

“…[ 1 ] Delirium is a frequently encountered complication in patients undergoing various surgical procedures, needing for acute care and hospitalized in intensive care unit (ICU), with the incidence ranging from 5% to 39%. [ 2 – 5 ] Delirium is associated with poorer functional outcomes, hospital re-admissions, prolonged ICU, hospital length of stay, reduced quality of life, and increased mortality, [ 5 – 9 ] which may impose a considerable financial burden to the family and society. [ 5 , 10 ] Therefore, exploring the drugs that prevent the development of delirium is of clinical significance.…”

Prevalence and risk factors related to haloperidol use for delirium in adult intensive care patients: the multinational AID-ICU inception cohort study

“…The observed prevalence of delirium in adult ICU patients ranges from 26 to 80% [4,5]; mixed and hypoactive subtypes of delirium are more common than the hyperactive subtype [6]. The most valid and recommended monitoring tools for routine assessment of delirium in ICU are the Confusion Assessment Method (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) [7].…”

Predictors of Delirium Incidence, Time to Onset, and Recurrence in a Mixed Medical-surgical ICU Population: A Secondary Analysis Using Cox and CHIAD Decision Tree Modeling

“…Delirium is a common and serious clinical syndrome characterized by uctuating cognitive dysfunction that affects 20-80% of ICU patients [57,58]. The risk of delirium relies on the interaction between predisposing and precipitating risk factors [23,29]. It is associated with increased short-and long-term morbidity and mortality [1-5, 7-9, 11-17].…”

“…The American Psychiatric Association's Diagnostic and Statistical Manual, 5th edition (DSM-V) de nes delirium by: disturbances of (1) attention, (2) cognition, (3) that develops over a short period, (4) differs from baseline, (5) uctuates, (5) is not otherwise explained by another neurocognitive disorder, and (6) with evidence suggesting a potential cause in the history, physical examination, or laboratory ndings [22]. Risk factors are multifactorial and may be divided into patient-related and hospital-related [23]. Patient-related factors include: age, gender, underlying disease, baseline cognitive impairment, illness severity (measured as Acute Physiology and Chronic Health Evaluation (APACHE) IV score), and presence of deliriumatadmission.…”