Risk factors for delirium in older trauma patients admitted to the surgical intensive care unit

Bryczkowski, Sarah; Lopreiato, Maeve C.; Yonclas, Peter; Sacca, James J.; Mosenthal, Anne C.

doi:10.1097/ta.0000000000000427

Cited by 54 publications

(35 citation statements)

References 17 publications

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“…A multiple linear regression analysis was performed to determine factors associated with days free from delirium or coma. Known risk factors for delirium, including ISS and propofol dose, were negatively associated with delirium‐coma‐free days in this analysis . Similarly, as expected, ventilator‐free days were positively associated with delirium‐coma‐free days .…”

Section: Discussionsupporting

confidence: 73%

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Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen

2019

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The appropriate level of sedation in patients with an open abdomen following damage control laparotomy (DCL) is debated. Chemical paralysis with neuromuscular blocking agents (NMBAs) has been used to decrease time to abdominal closure. We sought to evaluate the effect of NMBA use on sedation requirements in patients with an open abdomen and to determine the effect of sedation on patient outcomes. A retrospective cohort study was conducted at an American College of Surgeons’ verified level 1 trauma center. Adult trauma patients who underwent DCL between 2009 and 2015 were included. Patients with an intensive care unit length of stay of less than 48 hours and those who died before abdominal closure were excluded. The NMBA+ group received continuous NMBA within 24 hours of DCL; the NMBA− group did not. The primary outcome was cumulative sedation dose during the 7 days following DCL. Secondary outcomes included Richmond Agitation‐Sedation Scale (RASS) score, mechanical ventilation‐free days, and delirium‐coma‐free days. Delirium‐coma‐free days were analyzed with linear regression. A total of 222 patients were included (NMBA+ 125; NMBA− 97). Demographics were similar between groups including age, Injury Severity Score, and mechanism of injury. The median time to closure in the overall cohort was 2 days (interquartile range [IQR] 1–2 days). Propofol and fentanyl were the primary sedatives used. The NMBA+ group received higher cumulative doses of propofol (NMBA+ 5405 mg, IQR 3103–10,573 mg; NMBA− 3601 mg, IQR 1605–6887 mg; p=0.007), but not of fentanyl. Time to abdominal closure, but not NMBA use, was associated with a higher cumulative propofol dose on multivariate analysis. The NMBA+ group had significantly lower RASS scores on the first 3 days following DCL. Mechanical ventilation‐free days (NMBA+ 20 days vs NMBA− 18 days, p=0.960) and delirium‐coma‐free days (NMBA+ 18 days vs NMBA− 18 days, p=0.610) were similar between the groups. On linear regression, cumulative propofol dose was associated with fewer delirium‐coma‐free days (β‐coefficient −0.007, 95% confidence interval −0.015 to −0.003). In trauma patients managed with DCL, higher cumulative sedative doses were administered in patients who received adjunctive NMBA, although NMBA therapy was not associated with a higher cumulative propofol dose on multivariate analysis. Consideration must be given to the potential effect of sedation on delirium and awakening following DCL.

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Section: Discussionsupporting

confidence: 73%

“…Known risk factors for delirium, including ISS and propofol dose, were negatively associated with delirium-comafree days in this analysis. [27][28][29][30] Similarly, as expected, ventilator-free days were positively associated with delirium-coma-free days. 30 Benzodiazepines are a known risk factor for ICU delirium.…”

Section: Discussionsupporting

confidence: 71%

Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen

2019

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“…Unlike studies based on the National Trauma Databank 19 and a trauma registry, 18 positive blood alcohol on admission and history of alcohol use were not associated with or predictive of delirium in this study of trauma patients and in a large systematic review. 15 In addition, other previously reported risk factors such as positive results of drug toxicology screening on admission 19,21 and abnormal score on the Glasgow Coma Scale 21 were not related to delirium in our sample. Inpatient variables associated with delirium include mechanical ventilation and administration of sedatives and analgesics.…”

Section: Discussionmentioning

confidence: 60%

“…Studies of delirium in trauma patients have been retrospective in nature, 18,19 have included only patients undergoing mechanical ventilation, 5,17,20 or have had limited sample sizes. 5,17,20,21 The objective of this prospective, observational study was to determine the prevalence of delirium in trauma patients who reside in intermediate care units (IMCs) or in intensive care units (ICUs). Secondary aims were to explore and define characteristics and predictors of delirium in trauma patients.…”

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confidence: 99%

Delirium in Trauma Patients: Prevalence and Predictors

Rueden

Wallizer

Thurman

et al. 2017

Critical Care Nurse

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BACKGROUND Delirium is associated with increased mortality, morbidity, hospital costs, and postdischarge cognitive dysfunction. Most research focuses on nontrauma patients receiving mechanical ventilation in the intensive care unit. OBJECTIVES To determine the prevalence and predictors of delirium in trauma patients residing in intensive and intermediate care units of an academic medical center. METHODS Trauma patients were screened for delirium by using the Confusion Assessment Method for the Intensive Care Unit. Exclusion criteria included documented brain injury, history of psychosis or cognitive impairment, not speaking English, and hearing or vision loss. RESULTS Of the 215 study patients, 24% were positive for delirium; 36% of patients in the intensive care unit and 11% of patients in the intermediate care unit. Delirium-positive patients were older (mean age, 53.4 years) than patients who were not (mean age, 44 years; P = .004). Although mechanical ventilation (odds ratio, 4.73, P = .004) was the strongest independent risk factor for delirium, 12% of delirium-positive patients were not receiving mechanical ventilation. Other predictors of delirium were use of antipsychotic medications, higher scores on the Acute Physiology and Chronic Health Evaluation III, and lower scores on the Richmond Agitation-Sedation Scale. CONCLUSIONS Patients in both the intermediate and intensive care units, whether mechanical ventilation was used or not, were positive for delirium. Delirium prevention protocols may benefit trauma patients regardless of their inpatient location. (Critical Care Nurse. 2017;37[1]:40-48)

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“…19,30 sugiriéndose una periódica evaluación por equipos especializados para detección precoz, realizando procedimientos de valoración geriátrica integral 31,32 y prescripción segura de fármacos durante la hospitalización (según criterios de STOPP/START 33 y criterios de Beers 34 ).…”

Section: Medidas Generalesunclassified

Delirium: actualización en manejo no farmacológico

2014

Rev. chil. neuro-psiquiatr.

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Es llevado a un servicio de urgencia tras presentar caída a nivel mientras deambulaba, resultando con contusión de hemicuerpo izquierdo y dolor de parrilla costal ipsilateral, incrementado al esfuerzo físico e inspiración. Niega contusión craneana o pérdida de conciencia. En Urgencia se solicita TAC de tórax que muestra múltiples fracturas costales izquierdas (7º a 12º costilla) sin signos de contusión pulmonar. TAC de cerebro descarta complicación aguda. Exámenes de laboratorio sólo revelan leve anemia normocítica, normocrómica y glicemia 126 mg/dl. ECG con ritmo sinusal y alteraciones inespecíficas de la repolarización.

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Risk factors for delirium in older trauma patients admitted to the surgical intensive care unit

Abstract: Prognostic/epidemiologic study, level III.

Cited by 54 publications

References 17 publications

Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen

Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen

Delirium in Trauma Patients: Prevalence and Predictors

Delirium: actualización en manejo no farmacológico

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