title: Delirium is a Strong Predictor of Mortality in Patients Receiving Non-invasive Positive Pressure Ventilation.
abstract: Non-invasive positive pressure ventilation (NIPPV) has gained popularity over the years in the treatment of acute respiratory failure (ARF). Preliminary evidence suggests that delirium is an important factor contributing to NIPPV failure and death. This study was conducted to evaluate delirium and other associated factors of deaths in patients with ARF requiring the use of NIPPV.
  
  
  
  A prospective observational study was conducted in a specialised NIPPV unit. Consecutive patients admitted for ARF requiring NIPPV were assessed by a psychiatrist for presence of delirium using the Diagnostic and Statistical Manual Version IV (DSM-IV). APACHE II score, co-morbidities-, and lung function were also assessed. Patients were followed until their deaths for a minimum of 1 year. Univariate and multivariate Cox's regression analyses were performed to explore predictive factors for death.
  
  
  
  A total of 153 subjects were recruited, 49 (32.0 %) of whom had delirium. On univariate analysis, higher APACHE II score, lower BMI, presence of delirium, higher Charlson's co-morbidity index but not FEV1were associated with earlier death. On multivariate analysis, delirium (HR 4.4; 95 % CI 2.6-7.4; p < 0.001) and lower BMI (HR 0.92; 95 % CI 0.86-0.98; p = 0.013) were independently associated with earlier death within 1 year.
  
  
  
  There is a high prevalence of delirium in patients requiring NIPPV. The presence of delirium is a strong predictor of mortality. There is strong need to identify and manage these high-risk patients to improve their mortality. The collaboration between psychiatrists and physicians should be strengthened.
authors: Department of Psychiatry, United Christian Hospital, Kowloon, Hong Kong.
authors: Ka-Yee
authors: KY
authors: Chan
authors: Department of Medicine and Geriatrics, United Christian Hospital, 130 Hip Woo Street, Kowloon, Hong Kong.
authors: Linda S L
authors: LS
authors: Cheng
authors: Department of Psychiatry, United Christian Hospital, Kowloon, Hong Kong.
authors: Ivan W C
authors: IW
authors: Mak
authors: Department of Medicine and Geriatrics, United Christian Hospital, 130 Hip Woo Street, Kowloon, Hong Kong.
authors: Shu-Wah
authors: SW
authors: Ng
authors: Department of Psychiatry, United Christian Hospital, Kowloon, Hong Kong.
authors: Michael G C
authors: MG
authors: Yiu
authors: Department of Medicine and Geriatrics, United Christian Hospital, 130 Hip Woo Street, Kowloon, Hong Kong. chucm@ha.org.hk.
authors: Chung-Ming
authors: 0000-0001-7322-7749
authors: CM
authors: Chu
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D015995:Prevalence; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
keywords: Delirium; Noninvasive positive pressure ventilation; Respiratory failure