The impact of delirium on the survival of mechanically ventilated patients.
OBJECTIVE
To revalidate a means of assessing delirium in intensive care unit patients and to investigate the independent effect of delirium on the mortality of mechanically ventilated patients.


METHODS
A prospective cohort study.


METHODS
A 37-bed medical intensive care unit of a tertiary care hospital.


METHODS
Subjects were 102 of 131 consecutive mechanically ventilated patients.


METHODS
All the enrolled patients were assessed for delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Mortality rate were compared between patients with or without delirium, and the predictors of death were investigated.


RESULTS
The two CAM-ICU assessors' sensitivities in diagnosing delirium compared with reference standard were 91% and 95%, whereas their specificities were both 98%. They also demonstrated high interrater reliability with kappa statistics of 0.91. Delirium was present in 22 of 102 (22%) patients in the first 5 days. The delirious patients had higher intensive care unit mortality rate than nondelirious patients (63.6% vs. 32.5%, respectively), with a hazard ratio of 2.57 (95% confidence interval, 1.56-8.15). In multivariate analysis, delirium (odds ratio, 13.0; 95% confidence interval, 2.69-62.91), shock (odds ratio, 12.91; 95% confidence interval, 2.93-56.92), and illness severity (odds ratio, 9.61; 95% confidence interval, 2.24-41.18) were independent predictors of mortality.


CONCLUSIONS
This study confirms previous work showing that delirium is an independent predictor for increased mortality among mechanically ventilated patients.
Lin
Shu-Min
SM
Department of Thoracic Medicine II, Chang Gung Memorial Hospital, Taipei, Taiwan.
Liu
Chien-Ying
CY
Wang
Chun-Hua
CH
Lin
Horng-Chyuan
HC
Huang
Chien-Da
CD
Huang
Pei-Yao
PY
Fang
Yueh-Fu
YF
Shieh
Meng-Heng
MH
Kuo
Han-Pin
HP
D018806:APACHE; D000046:Academic Medical Centers; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D015897:Comorbidity; D003693:Delirium / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012121:Respiration, Artificial / Q000401:mortality*; D012131:Respiratory Insufficiency / Q000150:complications / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology