Prevalence and Risk Factors for Development of Delirium in Surgical and Trauma Intensive Care Unit Patients

Abstract

Background Delirium or acute brain dysfunction is extremely prevalent in medical intensive care unit (ICU) patients, but limited data exist regarding its prevalence and risk factors among surgical (SICU) and trauma ICU (TICU) patients. The purpose of this study was to determine the prevalence and risk factors for delirium in surgical and trauma ICU patients. Methods SICU and TICU patients requiring mechanical ventilation (MV) >24 hours were prospectively evaluated for delirium using the Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU). Those with baseline dementia, intracranial injury, or ischemic/hemorrhagic strokes that would confound the evaluation of delirium were excluded. Markov models were used to determine predictors for daily transition to delirium. Results One-hundred patients (46 SICU and 54 TICU) were enrolled. Prevalence of delirium was 73% in the SICU and 67% in the TICU. Multivariable analyses identified midazolam [OR 2.75 (CI 1.43–5.26, p = 0.002)] exposure as the strongest independent risk factor for transitioning to delirium. Opiate exposure showed an inconsistent message such that fentanyl was a risk factor for delirium in the SICU (p = 0.007) but not in the TICU (p = 0.936), while morphine exposure was associated with a lower risk of delirium (SICU, p = 0.069; TICU p = 0.024). Conclusions Approximately 7 out of 10 SICU and TICU patients experience delirium. In keeping with other recent data on benzodiazepines, exposure to midazolam is an independent and potentially modifiable risk factor for the transitioning to delirium.

Incidence and risk factors for delirium development in ICU patients - a prospective observational study

“…The 26.1% incidence of delirium found in this study corresponds to a number of previous reports 16,21 . However, it is much lower than the incidence of up to 80% presented by other authors [1][2][3]39 . This discrepancy may be due to a variety of other factors:…”

“…There is a great variety of factors which put a patient at risk for the development of delirium 16,21,[39][40][41][42] . An awareness of these factors is crucial for prevention of delirium.…”

Mechanical Ventilation

“…This only confirms the notion that delirium and acute brain dysfunction are emerging areas of knowledge where much effort is needed to unify the present definitions [21] and increase the data on pathophysiology [22][23][24], epidemiology [9,17,18], and possible interventions [7,25].…”

“…Computers were also available for response during the Brazilian Congress of Intensive Care (May [8][9][10]2008 …”

Delirium in Critically ill Patients in a Tertiary Care Centre in Western Region of Nepal

“…2,3 Delirium has been reported to occur in 20-80% of patients in medical and surgical ICU setting. [4][5][6][7][8][9] It is associated with various adverse outcomes including self extubation, removal of catheter, 6 prolonged hospital stay, 10 increased mortality, 4,11,12 increased health care cost, 13 and long term cognitive impairment. 14,15 Despite high prevalence and enormous prognostic significance delirium often goes unrecognized.…”