Lorazepam Is an Independent Risk Factor for Transitioning to Delirium in Intensive Care Unit Patients

Pandharipande, Pratik P.; Shintani, Ayumi; Peterson, Josh F.; Pun, Brenda T.; Wilkinson, Grant R.; Dittus, Robert S.; Bernard, Gordon R.; Ely, E. Wesley

doi:10.1097/00000542-200601000-00005

Cited by 1,050 publications

(688 citation statements)

References 31 publications

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“…Among assessable patients at 14 days, those who were ever delirious had a higher (worse) median NIHSS (11 [6][7][8][9][10][11][12][13][14][15][16][17][18][19] vs. 3 [1][2][3][4][5][6][7][8][9][10][11][12][13][14]; P ¼ 0.002) and a higher (worse) median mRS (5 [4][5] vs. 4 [2][3][4][5]; P ¼ 0.003). In multivariate models, being ever delirious was associated with increased odds of poor outcome (mRS >3 vs. mRS <2) at 28 days (odds ratio [OR], 8.7; 95% CI, 1.4-52.5; P ¼ 0.018) after correction for admission NIHSS (1.5 per point; 95% CI, 1.1-1.9; P ¼ 0.003) and age (OR, 1.06 per year; 95% CI, 1.006-1.1; P ¼ 0.03).…”

Section: Functional Outcomes Among Assessable Patientsmentioning

confidence: 99%

“…Risk factors for delirium symptoms are typically global (infection [3] and intravenous sedation, particularly benzodiazepines [BZDs]) (4,5) as opposed to focal lesions (e.g., hematoma). Most mechanically ventilated patients are delirious during hospitalization (1), potentially because of the sedation regimen (e.g., BZD infusion), but sedation is typically minimized in neurologically injured patients to permit repeated neurologic assessment that may lead to an acute intervention (6).…”

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confidence: 99%

See 1 more Smart Citation

Intracerebral Hemorrhage and Delirium Symptoms. Length of Stay, Function, and Quality of Life in a 114-Patient Cohort

Naidech

Beaumont²,

Rosenberg³

et al. 2013

Am J Respir Crit Care Med

105

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Rationale: The prognostic significance of delirium symptoms in intensive care unit (ICU) patients with focal neurologic injury is unclear. Objectives: To determine the relationship between delirium symptoms and subsequent functional outcomes and quality of life (QOL) after intracerebral hemorrhage. Methods: We prospectively enrolled 114 patients. Delirium symptoms were routinely assessed twice daily using the Confusion Assessment Method for the ICU by trained nurses. Functional outcomes were recorded with modified Rankin Scale (scored from 0 [no symptoms] to 6 [dead]), and QOL outcomes with Neuro-QOL at 28 days, 3 months, and 12 months. Measurements and Main Results: Thirty-one (27%) patients had delirium symptoms ("ever delirious"), 67 (59%) were never delirious, and the remainder (14%) had persistent coma. Delirium symptoms were nearly always hypoactive, were detected mean 6 days after intracerebral hemorrhage presentation, and were associated with longer ICU length of stay (mean 3.5 d longer in ever vs. never delirious patients; 95% confidence interval, 1.5-8.3; P ¼ 0.004) after correction for age, admit National Institutes of Health (NIH) Stroke Scale, and any benzodiazepine exposure. Delirium symptoms were associated with increased odds of poor outcome at 28 days (odds ratio, 8.7; 95% confidence interval, 1.4-52.5; P ¼ 0.018) after correction for admission NIH Stroke Scale and age, and with worse QOL in the domains of applied cognition-executive function and fatigue after correcting for the NIH Stroke Scale, age, benzodiazepine exposure, and time of follow-up. Conclusions: After focal neurologic injury, delirium symptoms were common despite low rates of infection and sedation exposure, and were predictive of subsequent worse functional outcomes and lower QOL. Keywords: delirium; outcomes; quality of lifeThe symptoms of delirium, a potential consequence of multiple clinical disease states and physiologic aberrations, include a shift in baseline mental status, inattention, and disorganized thinking or altered level of consciousness. Although nonspecific, this syndrome is an independent predictor of higher mortality (1), longer length of stay (LOS), higher cost of care, and worse long-term cognitive outcomes in medical, surgical, burn, and trauma intensive care unit (ICU) patients (2). There are few such data, however, in ICU patients with focal neurologic injury without systemic illness.Risk factors for delirium symptoms are typically global (infection [3] and intravenous sedation, particularly benzodiazepines [BZDs]) (4, 5) as opposed to focal lesions (e.g., hematoma). Most mechanically ventilated patients are delirious during hospitalization (1), potentially because of the sedation regimen (e.g., BZD infusion), but sedation is typically minimized in neurologically injured patients to permit repeated neurologic assessment that may lead to an acute intervention (6).Screening tests for delirium have been recently validated in neurologically ill patients (7-9), including ischemic stroke (7, 10) and intracerebra...

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Section: Functional Outcomes Among Assessable Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

Intracerebral Hemorrhage and Delirium Symptoms. Length of Stay, Function, and Quality of Life in a 114-Patient Cohort

Naidech

Beaumont²,

Rosenberg³

et al. 2013

Am J Respir Crit Care Med

105

View full text Add to dashboard Cite

show abstract

“…Therefore, effect sizes may also be smaller than reported. For example, the use of psychotropic medications, such as benzodiazepines and opioids, notorious for their increased risk of ICU delirium [7,8] was not examined directly. However, effects of benzodiazepines and opioids arguably were controlled for indirectly, given the fact that their use is predominantly associated with mechanical ventilationin our PICU, this would typically be the case-and this was included in the analyses.…”

Section: Limitationsmentioning

confidence: 99%

Prolonged stay at the paediatric intensive care unit associated with paediatric delirium

Smeets

Tan

Vossen

et al. 2009

Eur Child Adolesc Psychiatry

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The objective of this study was to investigate, under circumstances of routine care, the impact of paediatric delirium (PD) on length of stay in the paediatric intensive care unit (PICU) as well as on direct financial costs. A five-year prospective observational study (2002)(2003)(2004)(2005)(2006)(2007) was carried out in a tertiary eight-bed PICU in the Netherlands. Critically ill children aged 1 to 18 years who were acutely, non-electively and consecutively admitted to the PICU and detected as having PD in routine care were compared to critically ill children aged 1 to 18 years without signs of PD. PD, population characteristics and severity of illness at admission were used as predictors for length of PICU stay. Differences in length of stay yielded short-term, direct medical costs associated with PD. Fortynine children with and 98 children without PD were included. PD prolonged length of PICU stay with 2.39 days, independent of severity of illness, age, gender, mechanical ventilation and medical indication for admission (B = 0.38, P \ 0.001). PD increased direct medical costs with 1.5%. The results suggest a negative prognostic influence of PD on duration of PICU stay in routine care, resulting in an increase of direct medical costs.

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“…La atropina en dosis mayores de 0.6 mg también puede establecer un delirio y, por supuesto, los benzodiazepínicos, que además de agravarlo, lo perpetúan (15) . El uso de anestesia regional sí disminuye la incidencia de manifestaciones psiquiátricas en estos pacientes (14) .…”

Section: Prevención Y Manejounclassified

TEMA 9-2014: Delirio postquirúrgico en fractura de cadera del paciente adulto mayor

Zamora

2014

RC_UCR-HSJD

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Lorazepam Is an Independent Risk Factor for Transitioning to Delirium in Intensive Care Unit Patients

Abstract: Lorazepam administration is an important and potentially modifiable risk factor for transitioning into delirium even after adjusting for relevant covariates.

Cited by 1,050 publications

References 31 publications

Intracerebral Hemorrhage and Delirium Symptoms. Length of Stay, Function, and Quality of Life in a 114-Patient Cohort

Intracerebral Hemorrhage and Delirium Symptoms. Length of Stay, Function, and Quality of Life in a 114-Patient Cohort

Prolonged stay at the paediatric intensive care unit associated with paediatric delirium

TEMA 9-2014: Delirio postquirúrgico en fractura de cadera del paciente adulto mayor

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