Incidence, Risk Factors and Consequences of ICU Delirium
Sébastien Ouimet, Brian P. Kavanagh, StewartB. Gottfried, Yoanna Skrobik
Intensive Care Med (2007) 33:66–73
Objective: delirium in the critically ill is reported in 11–80% of patients. We estimated the incidence of delirium using a validated scale in a large cohort of ICU patients and determined the associated risk factors and outcomes. Design and setting: Prospective study in a 16-bed medical-surgical intensive care unit (ICU).
Patients: 820 consecutive patients admitted to ICU for more than 24 h.
Interventions: tools used: the Intensive Care Delirium Screening Checklist for delirium, Richmond Agitation and Sedation Scale for sedation and Numerical Rating Scale for pain. Risk factors were evaluated with univariate and multivariate analysis. Factors influencing mortality were determined using Cox regression.
Results: delirium occurred in 31.8% of 764 patients. Risk of delirium was independently associated with a history of hypertension (OR 1.88, 95% CI 1.3–2.6), alcoholism (2.03, 1.2–3.2), and severity of illness (1.25, 1.03–1.07 per 5-point increment in APACHE II score) but not with age or corticosteroid use. Sedatives and analgesics increased the risk of delirium when used to induce coma (OR 3.2, 95% CI 1.5–6.8), and not otherwise. Delirium was linked to longer ICU stay (11.5 + 11.5 vs. 4.4 + 3.9 days), longer hospital stay (18.2 + 15.7 vs. 13.2 + 19.4 days), higher ICU mortality (19.7% vs. 10.3%), and higher hospital mortality (26.7% vs. 21.4%).
Conclusion: delirium is associated with a history of hypertension and alcoholism, higher APACHE II score and clinical effects of sedative and analgesic drugs.
Un reparto di Terapia Intensiva è un unico organismo… Non si può curare gli ammalati senza prendersi cura anche degli operatori.
Link veloci
Gestire il dolore
Flowchart doloreVNR
BPS
Gestire la sedazione
Flowchart sedaz/agitazRASS
Gestire il delirium
Flowchart DeliriumManuale CAM-ICU
Scheda di lavoro CAM-ICU
ICDSC
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