Lin SM, Huang CD, Liu CY, Lin HC, Wang CH, Huang PY, Fang YF, Shieh MH, Kuo HPRisk factors for the development of early-onset delirium and the subsequent clinical outcome in mechanically ventilated patients. J Crit Care 23:372-379

Article (PDF Available)inJournal of critical care 23(3):372-9 · October 2008with81 Reads
DOI: 10.1016/j.jcrc.2006.09.001 · Source: PubMed
The aim of the study was to investigate the risk factors of developing early-onset delirium in mechanically ventilated patients and determine the subsequent clinical outcomes. Confusion assessment method for the intensive care unit (ICU) was used to assess the enrolled mechanically ventilated patients for delirium. The risk factors of developing delirium and clinical outcomes were determined in these subjects. Delirium was present in 31 (21.7%) of 143 patients in the first 5 days. In multivariable analysis, hypoalbuminemia (odds ratio, 5.94; 95% confidence interval, 1.23-28.77) and sepsis (odds ratio, 3.65; 95% confidence interval, 1.03-12.9) increased the risk of developing delirium in mechanically ventilated patients. The patients with delirium had a higher in-hospital mortality (67.7% vs 33.9%, respectively; P = .001) and longer duration of mechanical ventilation (19.5 +/- 15.8 vs 9.3 +/- 8.8 days, respectively; P = .003) than patients without delirium. The incidence of nosocomial pneumonia was increased in delirious patients (64.5% vs 38.4%, P = .01) compared with nondelirious patients, whereas the lengths of ICU or hospital stay were similar between both groups. Mechanically ventilated patients with sepsis or hypoalbuminemia were more vulnerable to develop delirium in their early stay in the ICU. Early-onset delirium is associated with prolonged duration of mechanical ventilation and higher incidence of nosocomial pneumonia, leading to a higher mortality.


    • "It may also prolong the duration of hospital stay and increase the need for nursing care and mortality rate [14] [17] [18]. Long-lasting untreated delirium could be quite dangerous by leaving long-term cognitive impairment and major psychological sequels for the patients [1]. "
    [Show abstract] [Hide abstract] ABSTRACT: Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes. A total of 201 patients admitted to 2 mixed medical-surgical ICUs were randomly allocated to protocol and control groups. A multidisciplinary team approved the protocol. Pain was assessed by Numerical Rating Scale and Behavioural Pain Scale, agitation by Richmond Agitation Sedation Scale, and delirium by Confusion Assessment Method in ICU. The Persian version of the scales was prepared and tested for validity, reliability, and feasibility in a preliminary study. The patients in the protocol group were managed pharmacologically according to the protocol, whereas those in the control group were managed according to the ICU routine. The median (interquartile range) for the duration of mechanical ventilation in the protocol and control groups was 19 (9.3-67.8) and 40 (0-217) hours, respectively (P = .038). The median (interquartile range) length of ICU stay was 97 (54.5-189) hours in the protocol group vs 170 (80-408) hours in the control group (P < .001). The mortality rate in the protocol group was significantly reduced from 23.8% to 12.5% (P = .046). The current randomized trial provided evidence for a substantial reduction in the duration of need to ventilatory support, length of ICU stay, and mortality rates in ICU-admitted patients through protocol-directed management of PAD.
    Full-text · Article · Sep 2013
    • "SICU P. 114 14.5 59.6 75.4 29.8 Once daily during hospital stay Hospital stay CAM-ICU Discharge placement; functional ability Freeman CM 2009 [12] SICU R. 121 18 NR N60 35 NA Hospital stay CAM-ICU MV duration, LOS in ICU and hospital, discharge placement Dubois MJ 2001 [13] Mixed ICU P. 216 15.2 47 65.7 19 Three times daily × first 5 days ICU stay ICDSC + psychatric assessment Complications, mortality, LOS Ely EW 2004 [14] Medical and coronary ICUs P. 224 25.2 48 55 81.7 Daily Six months CAM-ICU Six-month mortality, LOS in hospital and post-ICU, ventilatorfree days, cognitive function Kishi Y 1995 [15] Mixed ICU P. 238 NR 64.7 50.4 16 Daily during ICU stay During ICU stay DSM-III-R LOS in ICU, ICU mortality Lin SM 2004 [16] Medical ICU P. 102 64.9 ‡ 52.9 73 22 Twice daily × first 5 days 60 days CAM-ICU 60-day mortality, Lin SM 2008 [17] Medical ICU P. 143 63.3 ‡ 60.1 76 21.7 Daily or twice during first 5 days Hospital stay CAM-ICU MV duration, hospital mortality, LOS in hospital and ICU, pneumonia Ouimet S 2007 [18] Mixed ICU P. 358 16.2 63 59.6 35.2 Daily during ICU stay Hospital stay ICDSC LOS in ICU and hospital, ICU mortality Salluh JI 2010 [1] Mixed ICU Cross sectional 497 4 ¶ 52.5 62 32.2 One day point assessment Hospital stay or 30 days CAM-ICU Hospital and ICU mortality, LOS in ICU and hospital, Shehabi Y 2010 [19] Mixed ICUs P. 354 18.7 62 50 64.4 "
    [Show abstract] [Hide abstract] ABSTRACT: 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.
    Full-text · Article · Dec 2012
    • "또한 억제대를 하고 있고, 통증이나 진 정 약물의 투여, 노인환자, 병의 상태가 심각한 경우에 더 많이 발생한다(Thomason et al., 2005). 중환자실 증후군은 폐렴을 비롯한 각종 합병증을 유발하고 입 원 기간을 연장 시킬 뿐만 아니라 높은 사망률과도 관련된다 (Arnold, 2005; Lin et al., 2008 "
    [Show abstract] [Hide abstract] ABSTRACT: This study was to investigate intensive care unit (ICU) nurse's knowledge and nursing performance on the intensive care unit syndrome.
    Article · Jan 2010
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