Risk factors for the development of early-onset delirium and the subsequent clinical outcome in mechanically ventilated patients.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Lin
Shu-Min
SM
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei 333, Taiwan.
Huang
Chien-Da
CD
Liu
Chien-Ying
CY
Lin
Horng-Chyuan
HC
Wang
Chun-Hua
CH
Huang
Pei-Yao
PY
Fang
Yueh-Fu
YF
Shieh
Meng-Heng
MH
Kuo
Han-Pin
HP
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003693:Delirium / Q000209:etiology*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome