Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

Kwizera, Arthur; Nakibuuka, Jane; Ssemogerere, Lameck; Sendikadiwa, Charles; Obua, Daniel; Kizito, Samuel; Tumukunde, Janat; Wabule, Agnes; Nakasujja, Noeline

doi:10.1155/2015/491780

Cited by 15 publications

(21 citation statements)

References 33 publications

(47 reference statements)

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“…The predisposing and precipitating factors identified in our study are in accordance with previous reports. ( 11 , 13 , 22 , 23 ) In fact, an association between age and delirium has often been described, thereby establishing delirium as a frequent complication in older ICU patients. ( 2 , 11 , 13 , 24 - 26 ) An independent association between delirium and long-term mortality has been detected in critically ill patients and in those with severe pneumonia, ( 25 , 27 - 29 ) but a counterfactual analysis showed that delirium prolongs the ICU stay but does not cause death in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

Sosa¹,

Roberti²,

Franco³

et al. 2018

Revista Brasileira De Terapia Intensiva

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ObjectiveTo describe the incidence of and risk factors for delirium in the intensive care unit of a tertiary care teaching hospital in Argentina and to conduct the first non-European study exploring the performance of the PREdiction of DELIRium in ICu patients (PRE-DELIRIC) model.MethodsProspective observational study in a 20-bed intensive care unit of a tertiary care teaching hospital in Buenos Aires, Argentina. The PRE-DELIRIC model was applied to 178 consecutive patients within 24 hours of admission to the intensive care unit; delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).ResultsThe mean age was 64.3 ± 17.9 years. The median time of stay in the intensive care unit was 6 (range, 2 - 56) days. Of the total number of patients, 49/178 (27.5%) developed delirium, defined as a positive CAM-ICU assessment, during their stay in the intensive care unit. Patients in the delirium group were significantly older and had a significantly higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The mortality rate in the intensive care unit was 14.6%; no significant difference was observed between the two groups. Predictive factors for the development of delirium were increased age, prolonged intensive care unit stay, and opioid use. The area under the curve for the PRE-DELIRIC model was 0.83 (95%CI; 0.77 - 0.90).ConclusionsThe observed incidence of delirium highlights the importance of this problem in the intensive care unit setting. In this first study conducted outside Europe, PRE-DELIRIC accurately predicted the development of delirium.

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Section: Discussionmentioning

confidence: 99%

Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

Sosa¹,

Roberti²,

Franco³

et al. 2018

Revista Brasileira De Terapia Intensiva

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“…Prior studies have generally not used validated criteria for delirium assessment, have focused on psychiatric settings, and have not rigorously examined the relationship of delirium to outcomes [15]. One prospective study [16] of 160 mechanically ventilated patients in four intensive care units (ICUs) in Kampala, Uganda found a 51% prevalence of delirium; it was not powered to detect an association of delirium with mortality and only included in-hospital outcomes.…”

Section: Introductionmentioning

confidence: 99%

Delirium as a predictor of mortality and disability among hospitalized patients in Zambia

et al. 2021

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Objective To study the epidemiology and outcomes of delirium among hospitalized patients in Zambia. Methods We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. The primary exposure was delirium duration over the initial 3 days of hospitalization, assessed daily using the Brief Confusion Assessment Method. The primary outcome was 6-month mortality. Secondary outcomes included 6-month disability, evaluated using the World Health Organization Disability Assessment Schedule 2.0. Findings 711 adults were included (median age, 39 years; 461 men; 459 medical, 252 surgical; 323 with HIV). Delirium prevalence was 48.5% (95% CI, 44.8%-52.3%). 6-month mortality was higher for delirious participants (44.6% [39.3%-50.1%]) versus non-delirious participants (20.0% [15.4%-25.2%]; P < .001). After adjusting for covariates, delirium duration independently predicted 6-month mortality and disability with a significant dose-response association between number of days with delirium and odds of worse clinical outcome. Compared to no delirium, presence of 1, 2 or 3 days of delirium resulted in odds ratios for 6-month mortality of 1.43 (95% CI, 0.73–2.80), 2.20 (1.07–4.51), and 3.92 (2.24–6.87), respectively (P < .001). Odds of 6-month disability were 1.20 (0.70–2.05), 1.73 (0.95–3.17), and 2.80 (1.78–4.43), respectively (P < .001). Conclusion Among hospitalized medical and surgical patients in Zambia, delirium prevalence was high and delirium duration independently predicted mortality and disability at 6 months. This work lays the foundation for prevention, detection, and management of delirium in low-income countries. Long-term follow up of outcomes of critical illness in resource-limited settings appears feasible using the WHO Disability Assessment Schedule.

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“…Studies of delirium conducted in sub-Saharan Africa have had generally not used validated instruments for delirium assessment and have not rigorously examined potential risk factors for delirium in hospitalized patients [ 9 ]. One recent prospective study of 160 mechanically ventilated patients in four ICUs in Kampala, Uganda identified several demographic, admission, clinical, and treatment-related risk factors for delirium using a validated tool for delirium assessment [ 10 ]. However, the study did not include medical and surgical patients from non-ICU settings, where many critically ill patients are cared for in LMICs with limited ICU capacities [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for delirium among hospitalized patients in Zambia

et al. 2021

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Objective To identify risk factors for delirium among hospitalized patients in Zambia. Methods We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. We report associations of exposures including sociodemographic and clinical factors with delirium over the first three days of hospital admission, assessed using a modified Brief Confusion Assessment Method (bCAM). Findings 749 patients were included for analysis (mean age, 42.9 years; 64.8% men; 47.3% with HIV). In individual regression analyses of potential delirium risk factors adjusted for age, sex and education, factors significantly associated with delirium included being divorced/widowed (OR 1.64, 95% CI 1.09–2.47), lowest tercile income (OR 1.58, 95% CI 1.04–2.40), informal employment (OR 1.97, 95% CI 1.25–3.15), untreated HIV infection (OR 2.18, 95% CI 1.21–4.06), unknown HIV status (OR 2.90, 95% CI 1.47–6.16), history of stroke (OR 2.70, 95% CI 1.15–7.19), depression/anxiety (OR 1.52, 95% CI 1.08–2.14), alcohol overuse (OR 1.96, 95% CI 1.39–2.79), sedatives ordered on admission (OR 3.77, 95% CI 1.70–9.54), severity of illness (OR 2.00, 95% CI 1.82–2.22), neurological (OR 7.66, 95% CI 4.90–12.24) and pulmonary-system admission diagnoses (OR 1.91, 95% CI 1.29–2.85), and sepsis (OR 2.44, 95% CI 1.51–4.08). After combining significant risk factors into a multivariable regression analysis, severity of illness, history of stroke, and being divorced/widowed remained predictive of delirium (p<0.05). Conclusion Among hospitalized adults at a national referral hospital in Zambia, severity of illness, history of stroke, and being divorced/widowed were independently predictive of delirium. Extension of this work will inform future efforts to prevent, detect, and manage delirium in low- and middle-income countries.

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Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

Cited by 15 publications

References 33 publications

Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

Delirium as a predictor of mortality and disability among hospitalized patients in Zambia

Risk factors for delirium among hospitalized patients in Zambia

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