Delirium Bibliography

Reference Information

Title

Incidence, risk factors and outcomes of delirium in intensive care unit of universiti kebangsaan malaysia medical centre

Authors

Vyveganathan, L., Izaham, A., Mohamad Yusof, A., Wan Mat, W. R., Abdul Rahman, R., Abdul Manap, N.

Year

2016

Journal

Anesthesia and Analgesia

Abstract

Background & Objectives: Delirium is often seen among patients managed in intensive care units (ICUs) and this may cause added morbidity and mortality. The present study determined the incidence, risk factors and outcomes of delirium in the ICU of Universiti Kebangsaan Malaysia Medical Centre. Materials & Methods: This prospective cross sectional observational study was conducted over three months duration. Patients 18 years and above admitted for more than 24 hours in general ICU were recruited. Confusion Assessment Method (CAM-ICU) was done daily to assess delirium, if the patient had sedation score of above Richmond Agitation and Sedation Scale (RASS) -3. They were followed up till discharged. Environmental, predisposing and precipitating factors to delirium were collected. The outcomes of delirium measured were length of mechanical ventilation and ICU stay. Results: The overall incidence of delirium was 42%. Among patients who had delirium, 68% were hypoactive, 25% mixed and 7% were hyperactive in type. The significant predisposing risk factors for developing delirium were increasing with older age, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, visual or hearing impairment, smoking, renal impairment, diabetes and hypertension. The factors precipitating delirium were sepsis, use of vasopressors, renal replacement therapies and Acute Respiratory Distress Syndrome (ARDS). The presence of catheters, higher Sequential Organ Failure Assessment (SOFA) scores, and abnormal urea and bilirubin levels further significantly increased risk of delirium. Environmental conditions increasing the risk of delirium were absence of daylight exposure, no visible clocks and use of physical restraints. Length of mechanical ventilation and ICU stay were significantly prolonged in patients with delirium. Conclusion: Recognising predisposing factors and optimising the modifiable risk factors of delirium is important as it significantly prolongs mechanical ventilation and ICU stay.

PMID

Keywords

bilirubin
urea
adult respiratory distress syndrome
agitation
APACHE
artificial ventilation
catheter
clinical study
delirium
diabetes mellitus
exposure
hearing impairment
human
hypertension
intensive care unit
kidney disease
Malaysia
observational study
renal replacement therapy
risk factor
sedation
sepsis
Sequential Organ Failure Assessment Score
smoking
sunlight
visual impairment

Page(s)

157

Volume

123

Issue

3