Zhang Z, Pan L, Ni H. Impact of delirium on clinical outcome in critically ill patients: A meta-analysis

Department of Critical Care Medicine, Jinhua Municipal Central Hospital, 351#, Mingyue Road, Jinhua, Zhejiang Province, 321000, P.R. China. Electronic address: .
General hospital psychiatry (Impact Factor: 2.61). 12/2012; 35(2). DOI: 10.1016/j.genhosppsych.2012.11.003
Source: PubMed


CONTEXT: Delirium is prevalent in the intensive care unit (ICU) and has been associated with negative clinical outcomes. However, a quantitative and systematic assessment of published studies has not been conducted. OBJECTIVE: Meta-analysis of clinical observational studies was performed to investigate the association between delirium and clinical outcomes. DATA SOURCES AND STUDY SELECTION: Relevant studies were identified by investigators from databases including Medline, Embase, OVID and EBSCO from inception to May 2012. Studies that reported the association of delirium with clinical outcomes in critical care setting were included. DATA EXTRACTION: Data were extracted independently by reviewers and summary effects were obtained using random effects model. DATA SYNTHESIS: Of the 16 studies included, 14 studies involving 5891 patients reported data on mortality, and delirious patients had higher mortality rate than non-delirious patients (odds ratio [OR]: 3.22; 95% confidence interval [CI]: 2.30-4.52). Delirious patients had higher rate of complications (OR: 6.5; 95% CI: 2.7-15.6), and were more likely to be discharged to skilled placement (OR: 2.59; 95% CI: 1.59-4.21). Furthermore, patients with delirium had longer length of stay in both ICU (weighted mean difference [WMD]: 7.32 days; 95% CI: 4.63-10.01) and hospital (WMD: 6.53 days; 95% CI: 3.03-10.03), and they spent more time on mechanical ventilation (WMD: 7.22 days; 95% CI: 5.15-9.29). CONCLUSION: Delirium in critically ill patients is associated with higher mortality rate, more complications, longer duration of mechanical ventilation, and longer length of stay in ICU and hospital.

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    • "The profound impact of psychotic disturbances on postoperative outcomes was noted in numerous studies. Postoperative delirium has been shown to be associated with prolonged and more costly hospital stay, impaired postoperative cognition, and higher possibility of early postoperative death [7]. Increased incidence of cognitive decline reported after intensive care unit delirium has a major impact on postoperative rehabilitation, social dependency of the patient and overall quality of postoperative life [8]. "
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    ABSTRACT: Introduction: The aim of our study was to identify the incidence and risk factors of delirium after cardiac surgery implementing Intensive Care Delirium Screening Checklist (ICDSC). Material and methods: 87 patients, undergoing cardiac surgery at Vilnius University hospital, were prospectively monitored for postoperative delirium development, during intensive care unit stay. Results: The incidence of postoperative delirium was 13.30%. No statistically relevant preoperative predictors of delirium were found. The duration of surgery was significantly longer in delirium group (4.51 ± 1.15 versus 3.76 ± 0.97 hours, P = 0.017). Patients in delirium group more often had blood product transfusions (1.50 (± 1.57) versus 0.49 (± 0.91) P = 0.003) and had a higher incidence of low cardiac output syndrome (33.30% versus 3.00%, P = 0.004); they were significantly longer mechanically ventilated (24.31 ± 28.35 versus 8.78 ± 4.77 (P < 0.001)) hours (OR = 1.15 (1.02-1.28)) and had twice longer ICU stay (5.00 ± 2.22 versus 2.60 ± 1.10 (P < 0.001)) days (OR = 1.91 (1.22-3.00)). Conclusions: The incidence of delirium after cardiac surgery was 13.3%. Independent predictors of delirium were duration of postoperative mechanical ventilation and intensive care unit stay.
    09/2013; 2013(4):323491. DOI:10.1155/2013/323491
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    ABSTRACT: Delirium occurs in up to 80% of patients admitted to intensive care units. Although under-diagnosed, delirium is associated with a significant increase in morbidity and mortality in critical patients. Here, we review the main risk factors, clinical manifestations and preventative and therapeutic approaches (pharmacological and non-pharmacological) for this illness.
    06/2013; 25(2):137-147. DOI:10.5935/0103-507X.20130025
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    ABSTRACT: Delirium is frequently diagnosed in critically ill patients and is associated with poor clinical outcomes. Haloperidol is the most commonly used drug for delirium despite little evidence of its effectiveness. The aim of this study was to establish whether early treatment with haloperidol would decrease the time that survivors of critical illness spent in delirium or coma. We did this double-blind, placebo-controlled randomised trial in a general adult intensive care unit (ICU). Critically ill patients (≥18 years) needing mechanical ventilation within 72 h of admission were enrolled. Patients were randomised (by an independent nurse, in 1:1 ratio, with permuted block size of four and six, using a centralised, secure web-based randomisation service) to receive haloperidol 2·5 mg or 0·9% saline placebo intravenously every 8 h, irrespective of coma or delirium status. Study drug was discontinued on ICU discharge, once delirium-free and coma-free for 2 consecutive days, or after a maximum of 14 days of treatment, whichever came first. Delirium was assessed using the confusion assessment method for the ICU (CAM-ICU). The primary outcome was delirium-free and coma-free days, defined as the number of days in the first 14 days after randomisation during which the patient was alive without delirium and not in coma from any cause. Patients who died within the 14 day study period were recorded as having 0 days free of delirium and coma. ICU clinical and research staff and patients were masked to treatment throughout the study. Analyses were by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Registry, number ISRCTN83567338. 142 patients were randomised, 141 were included in the final analysis (71 haloperidol, 70 placebo). Patients in the haloperidol group spent about the same number of days alive, without delirium, and without coma as did patients in the placebo group (median 5 days [IQR 0-10] vs 6 days [0-11] days; p=0·53). The most common adverse events were oversedation (11 patients in the haloperidol group vs six in the placebo group) and QTc prolongation (seven patients in the haloperidol group vs six in the placebo group). No patient had a serious adverse event related to the study drug. These results do not support the hypothesis that haloperidol modifies duration of delirium in critically ill patients. Although haloperidol can be used safely in this population of patients, pending the results of trials in progress, the use of intravenous haloperidol should be reserved for short-term management of acute agitation. National Institute for Health Research.
    The Lancet Respiratory Medicine 09/2013; 1(7):515-23. DOI:10.1016/S2213-2600(13)70166-8 · 9.63 Impact Factor
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