Incidence, prevalence and risk factors of delirium in ICU patients: A systematic review and meta‐analysis

Abstract

BackgroundDelirium is one of the most common problems in intensive care units (ICU), and it has a detrimental influence on the patients' health. Estimating the prevalence of delirium in ICU patients and understanding the risk factors for delirium are crucial tasks.ObjectiveTo offer empirical support for early detection of the risk of delirium in ICU patients, we conducted a systematic review and meta‐analysis to analyse the incidence， prevalence and risk factors of delirium in ICU patients.MethodsFrom inception to 19th December 2021, PubMed, Embase, Cochrane Library, Web of Science, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM) and Weipu Database (VIP) were searched for inclusion to the study. The quality of the included studies was assessed by two investigators independently. The outcomes of the meta‐analysis, which was conducted using the Stata 12.0 software, were reported using odds ratios (OR) and 95 percent confidence intervals (CI). Heterogeneity was determined using the I2 statistic.ResultsIn this meta‐analysis, 51 studies with a total of 39 076 patients were evaluated. The incidence and prevalence of delirium in ICU patients were 31 per 1000 and 33%, respectively. A total of 28 risk factors were identified. Of these 28 risk factors, the top five modifiable risk factors were pain (OR = 19.74, 95% CI [8.86–30.61]), use of physical restraints (OR = 15.46, 95% CI [3.68–27.25]), respiratory diseases (OR = 14.3, 95% CaI [8.42–20.19]), sleep deprivation (OR = 9.4, 95% CI [6.8–12.1]) and surgery (OR = 8.98, 95% CI [7–15.27]). Non‐modifiable risk factors included age (OR = 1.06, 95% CI[1.04, 1.07]) and gender (OR = 1.45, 95% CI[1.13, 1.77]). Of these 51 studies included in this analysis, 30 studies were shown with a low risk of bias while 21 studies were shown with a moderate risk of bias. Our results also demonstrated that 21 studies and 30 studies with intermediate methodological quality and low methodological quality respectively.ConclusionDelirium was shown to be prevalent among ICU patients. There are 28 risk factors for delirium that we discovered. These risk factors can assist physicians, nurses and other health care professionals prevent delirium in ICU patients.Relevance to practiceDelirium in ICU patients can potentially be prevented through appropriate prevention strategies by intensive care staff.

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“…In addition to sedative drugs, patients still need other treatments to protect themselves and ICU staff, namely by using safety devices such as bed railings, hands tied with soft straps, or bodies tied with soft straps to the bed. Besides that, in delirium or critical patients, CPOT can be used as a tool to detect pain [6,7]. This CPOT was developed by Gelinas et al in France and, not long after, translated and validated in various countries for use.…”

Quantitative electroencephalography predicts postoperative delirium in cardiac surgical patients after cardiopulmonary bypass: a prospective observational study

“…Specific qEEG features of each POD phenotype still need to be studied in the future. Notably, hypoactive delirium is the most common ([95% CI, 8–17%]), with an incidence of 11%, in patients admitted to the ICU ( 26 ). However, almost all delirious patients (10 of 11) in our study had hyperactive delirium.…”

Exploring Antipsychotic Use for Delirium Management in Adults in Hospital, Sub-Acute Rehabilitation and Aged Care Settings: A Systematic Literature Review

“…Delirium is a serious neurocognitive disorder that is common in patients with acute medical illnesses, chronic medical conditions and cognitive impairment. Incidence rates vary across clinical settings, and have been reported as between 33% [ 1 ] and 80% [ 2 ] in intensive care units (ICUs), between 26% and 62% during hospitalisation in inpatient palliative care units [ 3 ], 26% in acute stroke settings [ 4 ] and 3–29% in medical in-patients [ 5 ]. Additionally, an Australian study identified approximately 15% [ 6 ] of residents living in aged care homes presented to hospital with symptoms of delirium.…”