Incidence and risk factors of delirium in surgical intensive care unit

Ali, Muhammad Asghar; Ahmed, Waqas; Raza, Syed Amir; Khan, Muhammad Faisal; Salim, Bushra

doi:10.1136/tsaco-2020-000564

Cited by 20 publications

(18 citation statements)

References 22 publications

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“…Delirium is defined as a deterioration in the level of consciousness, attention and cognitive function, which can occur over a short period of time and fluctuates over the hospital stay (Selim & Wesley Ely, 2017). Up to 64% of intensive care unit (ICU) patients were reported to experience delirium worldwide (Ali et al, 2021;Pun et al, 2021;Tsuruta et al, 2014), whereas the pooled incidence and prevalence of delirium in meta-analyses were 31.8% and 33%, respectively (Krewulak et al, 2018;Salluh et al, 2015). Delirium can happen in three forms: hyperactive, hypoactive and mixed delirium (Ali & Cascella, 2022).…”

Section: Introductionmentioning

confidence: 99%

Delirium incidence, predictors and outcomes in the intensive care unit: A prospective cohort study

Alzoubi

Shaheen

Yousef

2023

Int J of Nursing Practice

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AimThe aim of this study was to investigate the incidence, predictors, and outcomes of delirium in intensive care units.BackgroundDelirium is a common complication in intensive care units. In developing countries, it can be misdiagnosed or unrecognised.DesignProspective cohort study reported according to the strengthening the reporting of observational studies in epidemiology criteria.MethodsWe included patients who were conscious, >18 years old, and admitted to the intensive care units for at least 8 h between December 2019 and February 2020. Patients with a Richmond score of −4 or −5, mental disability, receptive aphasia and/or visual or auditory impairment were excluded from the study. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM‐ICU), whereas the functional outcome was assessed by the Katz Activity of Daily Living Index.ResultsThis study included 111 patients with a delirium incidence of 31.5%. The severity of illness was the only significant predictor of delirium. Patients with delirium had longer intensive care unit and in‐hospital stays in contrast to those without delirium. Delirium was associated with in‐hospital and 4‐month mortality but not the activities of daily living.ConclusionsDelirium is associated with increased length of stay and mortality. Further investigation to determine whether delirium management can improve outcomes is warranted.

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Section: Introductionmentioning

confidence: 99%

Delirium incidence, predictors and outcomes in the intensive care unit: A prospective cohort study

Alzoubi

Shaheen

Yousef

2023

Int J of Nursing Practice

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“…Hypernatremia has been reported as an independent risk factor in delirium in previous studies ( 14 – 16 ). This study lends further support to this finding in a relatively larger, contemporary cohort of patients receiving cardiac surgery.…”

Section: Discussionmentioning

confidence: 85%

“…In addition, factors such as intraoperative fluid management and cardiopulmonary bypass can cause hypernatremia as well (30)(31)(32). Hypernatremia has been reported as an independent risk factor in delirium in previous studies (14)(15)(16). This study lends further support to this finding in a relatively larger, contemporary cohort of patients receiving cardiac surgery.…”

Section: Discussionmentioning

confidence: 95%

“…However, the impact of hypernatremia on delirium has not been fully explored yet. Rare studies focused on the relevant field (14)(15)(16)(17), typically involving small sample sizes and drawing controversial conclusions. Accordingly, this nested case-control study was conducted to evaluate the association between exposure to hypernatremia and the risk of delirium after cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Hypernatremia and Delirium After Cardiac Surgery: A Nested Case-Control Study

Hong

Shen

Shi

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe association between hypernatremia and delirium after cardiac surgery has rarely been investigated. This study aimed to determine whether hypernatremia increases the risk of delirium after exposure.Materials and MethodsFrom April 2016 to June 2021, 7,831 consecutive patients receiving cardiac surgery were screened for potential enrollment. The primary outcome was postoperative delirium (POD). For the respective case of delirium, 10 controls were matched according to the index date within the nested case-control design. Hypernatremia exposure was defined as serum sodium > 145 mmol/L within 7 days before the index date. A generalized estimation equation was performed to assess excess risks for POD associated with hypernatremia, adjusted for demographics and clinical variables.ResultsAbout 7,277 patients were included in the final analyses. About 669 (9.2%) patients with POD were assigned to the case group, and 6,690 controls were identified from the whole population. About 66.5% of the cases and 36.3% of the controls had hypernatremia exposure. After being adjusted to certain well-recognized confounding factors, hypernatremia showed a significant correlation with increased risk of delirium after cardiac surgery (adjusted OR, 1.73; 95% CI, 1.41~2.12). An e-value analysis suggested the robustness to unmeasured confounding.ConclusionsHypernatremia was associated with an increased risk of delirium after cardiac surgery. This finding could have implications for risk stratification, early detection, and management of delirium in patients receiving cardiac surgery.

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“…Intensive care unit (ICU)-acquired delirium impacts patient outcomes, i.e., higher mortality [1][2][3][4][5][6] and prolonged length hospital of stay (LOS) [1][2][3][6][7][8][9]. Delirium can be accurately identi ed by widely validated screening tools such as the intensive care delirium-screening checklist (ICDSC) and the confusion assessment method for the ICU (CAM-ICU) [10,11], but delirium in ICU settings is still poorly recognized [12].…”

Section: Introductionmentioning

confidence: 99%

Predicting Hospital Mortality and Length of Stay: The Delirium Screening Checklist versus Confusion Assessment Method for Intensive Care Units

Li¹,

Chen²,

Yeh³

et al. 2021

Preprint

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Background: Both the intensive care delirium screening checklist (ICDSC) and confusion assessment method for ICU (CAM-ICU) are valid tools for identification of delirium, however their relative predictive validity for important delirium outcomes, such as hospital mortality and LOS have not been well-established. We aim to compare the two tools for their predictive validity for outcomes related to delirium, hospital mortality and length of stay (LOS).Methods: The prospective cohort study conducted in six medical ICUs at a tertiary care hospital in Taiwan. The study enrolled consecutive adult patients (≥20 years) who were delirium free at ICU admission. Delirium was screened daily by trained research nurses using the ICDSC and CAM-ICU in random order. Arousal was assessed by the Richmond Agitation-Sedation Scale (RASS). Participants with any one positive result were classified as ICDSC- or CAM-ICU-delirium groups, respectively.Results: Delirium incidence evaluated by the ICDSC and CAM-ICU were 69.1% (67/97) and 50.5% (49/97), respectively. Although the ICDSC identified 18 more cases as delirious, substantial concordance (κ =0.63; p < 0.001) was found between tools. Independent of age, APACHE II score, and Charlson comorbidity index, both ICDSC- and CAM-ICU-rated delirium significantly predicted hospital mortality (adjusted odds ratio [aOR] 4.93; 95% confidence interval [CI]:1.56 to 15.63 vs. 2.79; 95% CI, 1.12 to 6.97, respectively), and only the ICDSC significantly predicted hospital LOS with a mean of 17.59 additional days compared to the no-delirium group. Irrespective of delirium status, a sensitivity analysis of normal-to-increased arousal (RASS≥0) test results did not alter the predictive ability of ICDSC- or CAM-ICU-delirium for hospital mortality (aOR 2.97; 95% CI, 1.06 to 8.37 vs. 3.82; 95% CI, 1.35 to 10.82, respectively). With reduced arousal (RASS<0), neither tool significantly predicted mortality or LOS.Conclusions: The ICDSC identified more delirium cases and may have higher predictive validity for mortality and LOS than the CAM-ICU. However, arousal substantially affected performance. Future studies may want to consider patients’ arousal when deciding which tool to use to maximize the effects of delirium identification on patient mortality.Trial registration: NCT 04206306

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Incidence and risk factors of delirium in surgical intensive care unit

Cited by 20 publications

References 22 publications

Delirium incidence, predictors and outcomes in the intensive care unit: A prospective cohort study

Delirium incidence, predictors and outcomes in the intensive care unit: A prospective cohort study

Association Between Hypernatremia and Delirium After Cardiac Surgery: A Nested Case-Control Study

Predicting Hospital Mortality and Length of Stay: The Delirium Screening Checklist versus Confusion Assessment Method for Intensive Care Units

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