Risk factors for delirium: are therapeutic interventions part of it?
Authors Xing J, Yuan Z, Jie Y, Liu Y, Wang M, Sun Y
Received 30 October 2018
Accepted for publication 8 April 2019
Published 17 May 2019 Volume 2019:15 Pages 1321—1327
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Dr Yu-Ping Ning
Jinyan Xing,1 Zhiyong Yuan,1 Yaqi Jie,2 Ying Liu,1 Mingxue Wang,1 Yunbo Sun1
1Department of Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, People’s Republic of China; 2School of Life Sciences, Qingdao University, Qingdao, 266071, People’s Republic of China
Background: Delirium is associated with increased morbidity and mortality in critically ill patients. Research on risk factors for delirium allows clinicians to identify high-risk patients, which is the basis for early prevention and diagnosis. Besides the risk factors for delirium that are commonly studied, here we more focused on the less-studied therapeutic interventions for critically ill patients which are potentially modifiable.
Materials and methods: A total of 320 non-comatose patients admitted to the ICU for more than 24 hrs during 9 months were eligible for the study. Delirium was screened once daily using the CAM-ICU. Demographics, admission clinical data, and daily interventions were collected.
Results: Ninety-two patients (28.75%) experienced delirium at least once. Delirious patients were more likely to have longer duration of mechanical ventilation, ICU stay, and hospital stay. Most of the less-studied therapeutic interventions were linked to delirium in the univariate analysis, including gastric tube, artificial airway, deep intravenous catheter, arterial line, urinary catheter, use of vasoactive drugs, and sedative medication. After adjusting with age and ICU length of stay, mechanical ventilation (OR: 5.123; 95% CI: 2.501–10.494), Acute Physiology and Chronic Health Evaluation (APACHE) II score≥20 at admission (OR: 1.897; 95% CI: 1.045–3.441), and gastric tube (OR: 1.935, 95% CI: 1.012–3.698) were associated with increased risk of delirium in multivariate analysis.
Conclusion: Delirium was associated with prolonged mechanical ventilation, ICU stay, and hospital stay. Multivariate risk factors were gastric tube, mechanical ventilation, and APACHE II score. Although being a preliminary study, this study suggests the necessity of earliest removal of tubes and catheters when no longer needed.
Keywords: delirium, critical care, intensive care unit, risk factors, prevention
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