Details

Autor(en) / Beteiligte

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

Titel

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

Ist Teil von

• Critical care medicine, 2015-03, Vol.43 (3), p.557-566

Ort / Verlag

United States: Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• OBJECTIVE:Delirium is common during critical illness and associated with adverse outcomes. We compared characteristics and outcomes of delirious and nondelirious patients enrolled in a multicenter trial comparing protocolized sedation with protocolized sedation plus daily sedation interruption. DESIGN:Randomized trial. SETTING:Sixteen North American medical and surgical ICUs. PATIENTS:Four hundred thirty critically ill, mechanically ventilated adults. INTERVENTIONS:All patients had hourly titration of opioid and benzodiazepine infusions using a validated sedation scale. For patients in the interruption group, infusions were resumed, if indicated, at half of previous doses. Delirium screening occurred daily; positive screening was defined as an Intensive Care Delirium Screening Checklist score of 4 or more at any time. MEASUREMENTS AND MAIN RESULTS:Delirium was diagnosed in 226 of 420 assessed patients (53.8%). Coma was identified in 32.7% of delirious compared with 22.7% of nondelirious patients (p = 0.03). The median time to onset of delirium was 3.5 days (interquartile range, 2–7), and the median duration of delirium was 2 days (interquartile range, 1–4). Delirious patients were more likely to be male (61.1% vs 46.6%; p = 0.005), have a surgical/trauma diagnosis (21.2% vs 11.0%; p = 0.030), and history of tobacco (31.5% vs 16.2%; p = 0.002) or alcohol use (34.6% vs 20.9%; p = 0.009). Patients with positive delirium screening had longer duration of ventilation (13 vs 7 d; p < 0.001), ICU stay (12 vs 8 d; p < 0.0001), and hospital stay (24 vs 15 d; p < 0.0001). Delirious patients were more likely to be physically restrained (86.3% vs 76.7%; p = 0.014) and undergo tracheostomy (34.6% vs 15.5%; p < 0.0001). Antecedent factors independently associated with delirium onset were restraint use (hazard ratio, 1.87; 95% CI, 1.33–2.63; p = 0.0003), antipsychotic administration (hazard ratio, 1.67; 95% CI, 1.005–2.767; p = 0.047), and midazolam dose (hazard ratio, 0.998; 95% CI, 0.997–1.0; p = 0.049). There was no difference in delirium prevalence or duration between the interruption and control groups. CONCLUSION:In mechanically ventilated adults, delirium was common and associated with longer duration of ventilation and hospitalization. Physical restraint was most strongly associated with delirium.