Incidence, risk factors and consequences of ICU delirium

Ouimet, Sébastien; Kavanagh, Brian P.; Gottfried, S. B.; Skrobik, Yoanna

doi:10.1007/s00134-006-0399-8

Cited by 850 publications

(714 citation statements)

References 37 publications

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“…However, our results could be subject to confounding by nonenvironmental factors or any other environmental change. The use of specific medication or physical restraints, undertreated pain and the duration of mechanical ventilation are possible risk factors for the development of delirium [7,13,34,35]. In our study population, the duration of mechanical ventilation and the use of psychoactive medication, opioids and physical restraints were not different between the two settings.…”

Section: Discussionmentioning

confidence: 59%

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Intensive care unit environment may affect the course of delirium

et al. 2012

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Purpose: Delirium is a common disorder in intensive care unit (ICU) patients. It is unclear whether ICU environment affects delirium. We investigated the influence of ICU environment on the number of days with delirium during ICU admission. Methods: In this prospective before-after study, ICU delirium was compared between a conventional ICU with wards and a single-room ICU with, among others, improved daylight exposure. We included patients admitted for more than 24 h between March and June 2009 (ICU with wards) or between June and September 2010 (single-room ICU). Patients who remained unresponsive throughout ICU admission were excluded. The presence of delirium in the preceding 24 h was assessed daily with the confusion assessment method for the ICU (CAM-ICU) by research physicians combined with evaluation of medical and nursing charts. The number of days with delirium was investigated with Poisson regression analysis. Results: We included 55 patients (449 observation days) in the ICU with wards and 75 patients (468 observation days) in the single-room ICU. After adjusting for confounding, the number of days with delirium decreased by 0.4 days (95 % confidence interval 0.1-0.7) in the singleroom ICU (p = 0.005). The incidence of delirium during ICU stay was similar in the ICU with wards (51 %) and in the single-room ICU (45 %, p = 0.53). Conclusions: This study is the first to show that ICU environment may influence the course of delirium in ICU patients.

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Section: Discussionmentioning

confidence: 59%

“…Delirium in the ICU is associated with complications and adverse outcomes including prolonged hospital stay [4,5] and increased morbidity and mortality [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Intensive care unit environment may affect the course of delirium

et al. 2012

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“…22 In a study of 764 critically ill patients, an increase in the severity of illness by a single point, as assessed by the APACHE II score, resulted in a 4.9% relative increase in the odds of delirium. 23 When compared with non-delirious controls, higher levels of inflammatory cytokines, such as interleukins 6 and 8, were noted among delirious patients following hip fracture repair. 24 That emergency or complicated surgery predispose to delirium would come as little surprise to the perioperative physician; however, there are a number of patient-specific risk factors that may predict risk.…”

Section: Predictorsmentioning

confidence: 96%

“…22 Dans une étude sur 764 patients dans un état critique, une augmentation d'un seul point de la gravité de la maladie (score APACHE II) a abouti à une augmentation relative de 4,9 % du risque de delirium. 23 Quand on les a comparés à des patients non atteints de delirium, des taux plus élevés de cytokines inflammatoires (interleukine 6 et interleukine 8, par exemple) ont été constatés chez les patients avec delirium après réparation d'une fracture de hanche. 24 Le fait qu'une chirurgie urgente ou compliquée prédispose au delirium ne constitue pas réellement une surprise pour le spécialiste en médecine périopératoire; il y a toutefois un certain nombre de facteurs de risque propres au patient qui peuvent prédire le risque.…”

Section: é Léments Prédictifsunclassified

Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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Purpose Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following noncardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended. Principal findings Delirium is characterized by an acute onset and a fluctuating course, inattention, disorganized thinking and an altered level of consciousness, and occurs in up to 40% of patients in the perioperative period. The pathophysiology of delirium is multifactorial, but it is believed to be related to inflammation, altered neurotransmission, and stress in the patient who has had surgery. Acetylcholine and dopamine appear to play a significant role. There is an increased risk of a poor outcome in patients who develop delirium, including a longer hospital stay and death. Surgical and patient factors play a significant role in predicting who will subsequently develop delirium. Prevention is much more effective than treatment in the management of delirium. The most effective prevention strategies include proactive geriatric assessment and care of the patient on a geriatrics surgical ward as well as prophylactic low-dose antipsychotic agents. From an anesthetic perspective, evidence in some surgical populations would support the use of regional techniques and minimal sedation. If delirium develops, treatment with lowdose oral antipsychotics appears to be most effective.Conclusions Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Define delirium in the context of other cognitive changes following non-cardiac surgery. 2. Understand the incidence and adverse outcomes associated with delirium. 3. List predisposing and precipitating factors of postoperative delirium and identify the patient at risk. 4. Explain the underlying pathophysiologic mechanisms believed to be implicated in causing delirium. 5. Formulate an anesthetic plan that minimizes the risk of developing postoperative delirium. 6. Devise a management plan to treat postoperative delirium most effectively while minimizing the adverse effects of treatment.Like other Western nations, Canada's population is aging rapidly. Over the past 50 years, the proportion of Canadians over the age of 65 has risen from 7.7% to 13.7%. A Statistics Canada estimates that the proportion of seniors will double 123Can J Anesth/J Can Anesth (2012) 59:304-320 DOI 10.1007 yet again by 2036 and will represent 23-25% of Canada's population. B This rapid demographic shift will impact anesthesiologists and hospitals ...

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“…Delirium, the acute onset of confusion and consciousness disturbances with a fluctuating course [1], occurs frequently in critically ill patients [2][3][4]. Delirium is associated with a prolonged stay in the intensive care unit (ICU) and hospital, increased morbidity and mortality rate, higher costs [2,3,5] and adverse long-term outcome [6,7].…”

Section: Introductionmentioning

confidence: 99%

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

et al. 2014

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Methods: A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The 10 predictors (age, APACHE-II, urgent and admission category, infection, coma, sedation, morphine use, urea level, metabolic acidosis) were collected within 24 hours after ICU admission. The confusion assessment method for the Intensive Care Unit (CAM-ICU) was used to identify ICU delirium. CAM-ICU screening compliance and inter-rater reliability measurements were used to secure the quality of the data. Permanent repository linkResults: 2,852 adult ICU patients were screened of which 1,824 (64%) were eligible for the study. Main reasons for exclusion were length of stay <1day (19.1%) and sustained coma (4.1%). CAM-ICU compliance was mean (SD) 82±16% and inter-rater reliability 0.87±0.17. The median delirium incidence was 22.5% (IQR 12.8%-36.6%). Although the incidence of all ten predictors differed significantly between centers, the area under the receiver operating characteristic (AUROC) curve of the 8 participating centers remained good: 0.77 (95%CI:0.74-0.79). The linear predictor and intercept of the prediction rule were adjusted and resulted in improved recalibration of the PRE-DELIRIC model. Conclusions:In this multinational study we recalibrated the PRE-DELIRIC-model. Despite differences in the incidence of predictors between the centers in the different countries the performance of the PRE-DELIRICmodel remained good. Following validation of the PRE-DELIRIC model it may facilitate implementation of strategies to prevent delirium and aid improvements in delirium management of ICU patients.4

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Incidence, risk factors and consequences of ICU delirium

Abstract: Delirium is associated with a history of hypertension and alcoholism, higher APACHE II score, and with clinical effects of sedative and analgesic drugs.

Cited by 850 publications

References 37 publications

Intensive care unit environment may affect the course of delirium

Intensive care unit environment may affect the course of delirium

Postoperative delirium: risk factors and management: Continuing Professional Development

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

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