Incidence and Prevalence of Delirium Subtypes in an Adult ICU: A Systematic Review and Meta-Analysis*

Abstract

Objectives: Use systematic review and meta-analytic methodology to estimate the pooled incidence, prevalence, and proportion of delirium cases for each delirium subtype (hypoactive, hyperactive, and mixed) in an adult ICU population. Data Sources: We conducted a search of the MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, and PsycINFO databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards from database inception until October 22, 2017, with no restrictions. Study Selection: We included original research conducted in adults admitted to any medical, surgical, or speciality ICU that reported incidence or prevalence estimates of delirium according to delirium subtype. Data Extraction: Data were extracted on sample size, population demographics, condition information, and reported delirium estimates. Data Synthesis: Forty-eight studies (27,342 patients; 4,550 with delirium) with an overall pooled prevalence of 31% (95% CI, 24–41; I 2 = 99%) met inclusion criteria. The pooled incidence (n = 18 studies) of delirium subtypes were hyperactive (4% [95% CI, 2–6]; I 2 = 92%]), hypoactive (11% [95% CI, 8–17; I 2 = 97%]), and mixed (7% [95% CI, 4–11; I 2 = 97%]). The pooled prevalence (n = 31 studies) of delirium subtypes were hyperactive (4% [95% CI, 3–6; I 2 = 94%]), hypoactive (17% [95% CI, 13–22; I 2 = 97%]), and mixed (10% [95% CI, 6–16; I 2 = 99%]). The pooled prevalence of hypoactive delirium in study populations with a similarly high severity of illness or mechanically ventilated was higher (severity of illness: 29% [95% CI, 18–46%; I 2 = 95%], 100% mechanically ventilated: 35% [95% CI, 23–55%; I 2 = 93%]) compared with the pooled prevalence of hypoactive delirium. Conclusions: Despite significant heterogeneity between studies, these data show the majority of delirious ICU patients to have hypoactive delirium, a finding with potential monitoring, management, and prognostic implications. The prevalence of hypoactive delirium varies between-study populations and is higher in patients with greater severity of illness.

Identifying determinants for the application of physical or chemical restraint in the management of psychomotor agitation on the critical care unit

“…“Stereotypical” delirious behaviour was cited in one study (Palacios‐Cena et al, ). This shows a concerning lack of knowledge amongst staff regarding delirium types and manifestations, as hyperactive delirium is the least common presenting state (Krewulak et al, ). Subjective diagnosis of delirium is associated with significant under‐detection (van Eijk, ) and delays the appropriate treatment of underlying causes.…”

“…This shows a concerning lack of knowledge amongst staff regarding delirium types and manifestations, as hyperactive delirium is the least common presenting state (Krewulak et al, 2018) However, physical and chemical restraint has been associated with the development or exacerbation of delirium Pan et al, 2018) and therefore does not reflect evidence-based practice. Further research is indicated to explore how unit customs and nurses' perceptions of delirium and agitation impact on restraint use.…”

“…Delirium is a rapid onset, reversible, fluctuating condition characterised by inattention, changes in cognition, disordered sleep-wake cycle and increased or decreased psychomotor activity (American Psychiatric Association, 2013). It affects approximately 20%-50% of mechanically ventilated patients (Krewulak, Stelfox, Leigh, Ely, & Fiest, 2018). Of the three delirium subtypes (hyper and hypo-active, mixed), hyperactive delirium, although the least common, is the most obvious and clinically disruptive (Krewulak et al, 2018).…”

“…It affects approximately 20%-50% of mechanically ventilated patients (Krewulak, Stelfox, Leigh, Ely, & Fiest, 2018). Of the three delirium subtypes (hyper and hypo-active, mixed), hyperactive delirium, although the least common, is the most obvious and clinically disruptive (Krewulak et al, 2018). Hyperactive delirium manifests as psychomotor agitation, hypervigilance, a disordered sleep-wake cycle and the presence of hallucinations and delusions (Cavallazzi, Saad, & Marik, 2012).…”

Hipertensos internados em uma unidade de terapia intensiva geral: características clínicas, gravidade e desfecho

“…Os principais motivos de causa de internação No grupo de hipertensos estudados, 44,8%fizeram uso de medicamento antihipertensivo na unidade de terapia intensiva geral, sendo mais da metade correspondente à classe dos diuréticos (64,6%). Achado, que pode estar relacionado ao elevado uso de diurético na unidade de terapia intensiva100 , associado ao balanço hídrico positivo, a presença de edema agudo de pulmão e lesão pulmonar aguda em maior porcentagem, seguida da lesão renal aguda e pressão venosa central elevada101 , entre outras causas. ,29 dias.…”