Prevalence, Risk Factors, and Outcomes of Delirium in Mechanically Ventilated Adults*

Mehta, Sangeeta; Cook, Deborah J.; Devlin, John W.; Skrobik, Yoanna; Meade, Maureen O.; Fergusson, Dean; Herridge, Margaret S.; Steinberg, Marilyn; Granton, John; Ferguson, Niall D.; Tanios, Maged; Dodek, Peter; Fowler, Robert; Burns, Karen E. A.; Jacka, Michael J.; Olafson, Kendiss; Mallick, Ranjeeta; Reynolds, Steven; Keenan, Sean; Burry, Lisa

doi:10.1097/ccm.0000000000000727

Cited by 282 publications

(204 citation statements)

References 40 publications

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“…29 Subsyndromal delirium is common in ICU patients; one study reported a prevalence approaching 90% in patients who did not have full delirium. 5 It is unknown whether subsyndromal delirium is a transitive state that is predictive of the imminent development of full delirium. At the University of Pennsylvania Medical Center, we found the prevalence of subsyndromal delirium to be common in patients who did and did not go on to develop full delirium (47.2% of delirious patients vs 42.7% of nondelirious patients).…”

Section: Subsyndromal Deliriummentioning

confidence: 99%

“…5,6,14,26 The pain, agitation, and delirium guidelines state that benzodiazepine use may be a risk factor for delirium development. 10 It is prudent to avoid administering benzodiazepines as first-line sedatives or in excessively high doses to critically ill patients due to the potential delirious effects of these medications.…”

Section: Critical Carementioning

confidence: 99%

“…2,[4][5][6][7][8] Unfortunately, the pathophysiology of this syndrome is not well understood. Proposed mechanisms for pathogenesis include neuroinflammation and neurotransmitter imbalances.…”

mentioning

confidence: 99%

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Screening and Management of Delirium in Critically Ill Patients

2015

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Delirium is highly prevalent in the critically ill population and has been associated with numerous negative outcomes including increased mortality. The presentation of a delirious patient in the intensive care unit (ICU) is characterized by a fluctuating cognitive status and inattention that varies dramatically among patients. Delirium can present in 3 different motoric subtypes: hyperactive, hypoactive, and mixed. Two tools, the Intensive Care Delirium Screening Checklist and Confusion Assessment ICU, are validated and recommended for the detection of delirium in critically ill patients. The identification of delirium in a critically ill patient should be facilitated using one of these tools. An intermediate form of delirium known as subsyndromal delirium also exists, although the significance of this syndrome is largely unknown. Another phenomenon known as sedation-related delirium has been recently described, although more research is needed to understand its significance. Patients in the ICU are exposed to many risk factors for developing delirium; controlling these risk factors is essential for preventing delirium development in critically ill patients. Nonpharmacologic interventions have been shown to prevent patients from developing delirium. Prevention is crucial because once delirium develops pharmacologic therapy is limited.

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Section: Subsyndromal Deliriummentioning

confidence: 99%

Section: Critical Carementioning

confidence: 99%

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Screening and Management of Delirium in Critically Ill Patients

2015

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“…These patients are at high risk of prolonged duration of MV, length of stay, tracheostomy, and mortality 70,71 . The use of specific drugs (risperidone, dexmedetomidine, quetiapine) and non-pharmacological interventions (patient daily orientation, early mobilization, improvement of sleep quality) could control and decrease the incidence of delirium 72,73 .…”

Section: Deliriummentioning

confidence: 99%

The Process of Weaning from Mechanical Ventilation

Aguirre-Bermeo¹,

Mancebo²

2016

BRN

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Mechanical ventilation is a common process in intensive care units. The weaning period has to be initiated as soon as possible because a delay in recognition that weaning can begin may prolong the duration of mechanical ventilation unnecessarily. The inappropriate management of weaning could influence outcomes; therefore, patients on weaning require continuous attention and intervention. The main objective of this review is to provide a description of the entire scenario and update on outcomes and common recommendations for the correct management of this complex process. The role of modern ventilator modes and non-invasive mechanical ventilation are discussed. Finally, the description and outcomes of a group of patients who have poor outcomes (prolonged weaning group), the importance of their identification, and suggestions for their general management are also presented. (BRN Rev. 2016;2:185-97)

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“…In a recent study of 420 critically ill mechanically ventilated adult patients, 54% experienced delirium for at least 1 day (median delirium duration 2 days, interquartile range 1-4 days) [4]. The hippocampus and frontal cortex, both areas that are extremely vulnerable to metabolic and hypoxic-ischemic insults, appear to be predominantly involved.…”

mentioning

confidence: 99%

Critical illness: the brain is always in the line of fire

Smith

Meyfroidt

2017

Intensive Care Med

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Life-threatening systemic insults or diseases often affect the brain. In critically ill patients, acute brain dysfunction manifests in several ways including reduced consciousness, coma, or delirium. The pathophysiology is complex, incompletely understood, and may relate to critical illness-related inflammatory changes, neurotransmitter imbalances, or failure of adequate energy substrate delivery [1], as well as to the applied treatments, pharmacological neurotoxicity, or the hostile ICU environment (Fig. 1) [2].Delirium warrants some emphasis because it is the most common manifestation of critical illness-related brain dysfunction [3]. In a recent study of 420 critically ill mechanically ventilated adult patients, 54% experienced delirium for at least 1 day (median delirium duration 2 days, interquartile range 1-4 days) [4]. The hippocampus and frontal cortex, both areas that are extremely vulnerable to metabolic and hypoxic-ischemic insults, appear to be predominantly involved. Triggers of ICU delirium include predisposing factors (older age, previous cognitive impairment, arterial hypertension), precipitating factors (mainly related to the severity of critical illness), and factors that can potentially be treated or avoided including medications (benzodiazepines, opioids, and anticholinergics), pain, sepsis, fever, metabolic disturbances (dysglycemia, dysnatremia), and environmental factors (sleep deprivation, noisy environment).An acute encephalopathy is reported in up to 70% of patients with sepsis. Systemic insults, such as hemodynamic changes leading to impaired cerebral perfusion, severe hypoxemia, endocrine dysfunction, or fever, are aggravated by blood-brain barrier dysfunction, impairment of the cerebral microcirculation, microglial activation by pro-and anti-inflammatory cytokines and chemokines, and altered neurotransmission [5]. In some cases this can lead to cerebral edema, ischemia, or seizures.The electroencephalography (EEG) findings of sepsisrelated encephalopathy are characterized by a diffuse cortical dysfunction with generalized EEG slowing and the presence of theta and delta waves [3]. Seizures in sepsis are often non-convulsive in nature and require EEG monitoring for their identification. A recent single-center study identified a high incidence of non-convulsive seizures (11%) and periodic discharges (25%) in a cohort of patients with sepsis-related alterations in mental status, although this was not associated with a higher mortality or disability rates at 6 and 12 months after discharge [6]. However, loss of EEG reactivity to external stimulation, a sign of severe encephalopathy, was associated with increased mortality in this patient cohort. Large, prospective studies are required to determine the outcome effects of EEG abnormalities in the critically ill septic patient and whether their treatment modulates outcomes.Critical illness-related brain dysfunction is associated with worse short-term outcomes, such as longer duration of mechanical ventilation and increased ICU and hospital l...

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Prevalence, Risk Factors, and Outcomes of Delirium in Mechanically Ventilated Adults*

Abstract: In mechanically ventilated adults, delirium was common and associated with longer duration of ventilation and hospitalization. Physical restraint was most strongly associated with delirium.

Cited by 282 publications

References 40 publications

Screening and Management of Delirium in Critically Ill Patients

Screening and Management of Delirium in Critically Ill Patients

The Process of Weaning from Mechanical Ventilation

Critical illness: the brain is always in the line of fire

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