Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients.
BACKGROUND
Although known to be an independent predictor of poor outcomes in medical intensive care unit (ICU) patients, limited data exist regarding the prevalence of and risk factors for delirium among surgical (SICU) and trauma ICU (TICU) patients. The purpose of this study was to analyze the prevalence of and risk factors for delirium in surgical and trauma ICU patients.


METHODS
SICU and TICU patients requiring mechanical ventilation (MV) >24 hours were prospectively evaluated for delirium using the Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU). Those with baseline dementia, intracranial injury, or ischemic/hemorrhagic strokes that would confound the evaluation of delirium were excluded. Markov models were used to analyze predictors for daily transition to delirium.


RESULTS
One hundred patients (46 SICU and 54 TICU) were enrolled. Prevalence of delirium was 73% in the SICU and 67% in the TICU. Multivariable analyses identified midazolam [OR 2.75 (CI 1.43-5.26, p = 0.002)] exposure as the strongest independent risk factor for transitioning to delirium. Opiate exposure showed an inconsistent message such that fentanyl was a risk factor for delirium in the SICU (p = 0.007) but not in the TICU (p = 0.936), whereas morphine exposure was associated with a lower risk of delirium (SICU, p = 0.069; TICU p = 0.024).


CONCLUSIONS
Approximately 7 of 10 SICU and TICU patients experience delirium. In keeping with other recent data on benzodiazepines, exposure to midazolam is an independent and potentially modifiable risk factor for the transitioning to delirium.
Pandharipande
Pratik
P
Department of Anesthesia/Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Cotton
Bryan A
BA
Shintani
Ayumi
A
Thompson
Jennifer
J
Pun
Brenda Truman
BT
Morris
John A
JA
Dittus
Robert
R
Ely
E Wesley
EW
D000328:Adult; D000368:Aged; D002492:Central Nervous System Depressants / Q000627:therapeutic use; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D015995:Prevalence; D012121:Respiration, Artificial; D012307:Risk Factors
D002492:Central Nervous System Depressants