Factors associated with persistent delirium after intensive care unit admission in an older medical patient population.
OBJECTIVE
This study was designed to identify factors associated with persistent delirium in an older medical intensive care unit (ICU) population.


METHODS
This is a prospective cohort study of 309 consecutive medical ICU patients 60 years or older. Persistent delirium was defined as delirium occurring in the ICU and continuing upon discharge to the ward. The Confusion Assessment Method was used to assess for delirium. Patient demographics, severity of illness, and medication data were collected. Univariate and multivariate analysis were used to assess factors associated with persistent delirium.


RESULTS
Of 309 consecutive admissions to the ICU, 173 patients had ICU delirium, survived the ICU stay, and provided ward data. One-hundred patients (58%) had persistent delirium. In a multivariable logistic regression model, factors significantly associated with persistent delirium included age more than 75 years (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.23-5.16), opioid (morphine equivalent) dose greater than 54 mg/d (OR, 2.90; 95% CI, 1.15-7.28), and haloperidol (OR, 2.88; 95% CI, 1.38-6.02); change in code status to "do not resuscitate" (OR, 2.62; 95% CI 0.95-7.35) and dementia (OR, 1.93; 95% CI 0.95-3.93) had less precise associations.


CONCLUSIONS
Age, use of opioids, and haloperidol were associated with persistent delirium. Further research is needed regarding the use of haloperidol and opioids on persistent delirium.
Pisani
Margaret A
MA
Department of Internal Medicine, Pulmonary and Critical Care Section, and the Program on Aging, Yale University School of Medicine, New Haven, CT 06520-8057, USA. margaret.pisani@yale.edu
Murphy
Terrence E
TE
Araujo
Katy L B
KL
Van Ness
Peter H
PH
D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000704:Analysis of Variance; D003422:Critical Care; D003693:Delirium / Q000139:chemically induced / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology; D006220:Haloperidol / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D010343:Patient Admission; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index
D000701:Analgesics, Opioid; D011619:Psychotropic Drugs; D006220:Haloperidol