Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 3/2013

01-03-2013 | Original

Intensive care unit environment may affect the course of delirium

Authors: Irene J. Zaal, Carolina F. Spruyt, Linda M. Peelen, Maarten M. J. van Eijk, Rens Wientjes, Margriet M. E. Schneider, Jozef Kesecioglu, Arjen J. C. Slooter

Published in: Intensive Care Medicine | Issue 3/2013

Login to get access

Abstract

Purpose

Delirium is a common disorder in intensive care unit (ICU) patients. It is unclear whether ICU environment affects delirium. We investigated the influence of ICU environment on the number of days with delirium during ICU admission.

Methods

In this prospective before–after study, ICU delirium was compared between a conventional ICU with wards and a single-room ICU with, among others, improved daylight exposure. We included patients admitted for more than 24 h between March and June 2009 (ICU with wards) or between June and September 2010 (single-room ICU). Patients who remained unresponsive throughout ICU admission were excluded. The presence of delirium in the preceding 24 h was assessed daily with the confusion assessment method for the ICU (CAM-ICU) by research physicians combined with evaluation of medical and nursing charts. The number of days with delirium was investigated with Poisson regression analysis.

Results

We included 55 patients (449 observation days) in the ICU with wards and 75 patients (468 observation days) in the single-room ICU. After adjusting for confounding, the number of days with delirium decreased by 0.4 days (95 % confidence interval 0.1–0.7) in the single-room ICU (p = 0.005). The incidence of delirium during ICU stay was similar in the ICU with wards (51 %) and in the single-room ICU (45 %, p = 0.53).

Conclusions

This study is the first to show that ICU environment may influence the course of delirium in ICU patients.
Literature
1.
Ely EW, Girard TD, Shintani AK, Jackson JC, Gordon SM, Thomason JW, Pun BT, Canonico AE, Light RW, Pandharipande P, Laskowitz DT (2007) Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients. Crit Care Med 35:112–117PubMedCrossRef
2.
Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001) Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med 27:859–864PubMedCrossRef
3.
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. Revision, Washington DC, pp 135–147
4.
Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK (2001) The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 27:1892–1900PubMedCrossRef
5.
Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW (2005) Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 9:R375–R381PubMedCrossRef
6.
Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762PubMedCrossRef
7.
Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33:66–73PubMedCrossRef
8.
Lin SM, Liu CY, Wang CH, Lin HC, Huang CD, Huang PY, Fang YF, Shieh MH, Kuo HP (2004) The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 32:2254–2259PubMedCrossRef
9.
Marcantonio ER, Flacker JM, Wright RJ, Resnick NM (2001) Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 49:516–522PubMedCrossRef
10.
Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676PubMedCrossRef
11.
Lundstrom M, Edlund A, Karlsson S, Brannstrom B, Bucht G, Gustafson Y (2005) A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc 53:622–628PubMedCrossRef
12.
Hipp DM, Ely EW (2012) Pharmacological and nonpharmacological management of delirium in critically ill patients. Neurotherapeutics 9:158–175PubMedCrossRef
13.
Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L (2009) Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care 13:R77PubMedCrossRef
14.
van Eijk MM, Slooter AJ (2010) Delirium in intensive care unit patients. Semin Cardiothorac Vasc Anesth 14:141–147PubMedCrossRef
15.
Van Rompaey B, Elseviers MM, Van Drom W, Fromont V, Jorens PG (2012) The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care 16:R73PubMedCrossRef
16.
Ulrich RS, Zimring C, Barch XZ, Dubose J, Seo HB, Choi YS, Quan X, Joseph A (2008) A review of the research literature on evidence-based healthcare design. HERD 1:61–125PubMed
17.
Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR (2003) Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond agitation-sedation scale (RASS). JAMA 289:2983–2991PubMedCrossRef
18.
Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84PubMedCrossRef
19.
Kesecioglu J, Schneider MME (2012) The intensive care unit of tomorrow: a case study of patient-centred care. ICU Management 12:12–13
20.
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef
21.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRef
22.
Vincent JL, de MA, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 26:1793–1800PubMedCrossRef
23.
Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL (2001) Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 286:1754–1758PubMedCrossRef
24.
Vreeswijk R, Toornvliet A, Honing MLH, Bakker K, De Man T, Daas G, Spronk PE, de Jonghe JF, Kalisvaart KJ (2009) Validation of the Dutch version of the confusion assessment method (CAM-ICU) for delirium screening in the intensive care unit. Neth J Crit Care 13:73–78
25.
van Eijk MM, van den Boogaard M, van Marum RJ, Benner P, Eikelenboom P, Honing ML, van der Hoven B, Horn J, Izaks GJ, Kalf A, Karakus A, Klijn IA, Kuiper MA, de Leeuw FE, De Man T, van der Mast RC, Osse RJ, de Rooij SE, Spronk PE, van der Voort PH, van Gool WA, Slooter AJ (2011) Routine use of the confusion assessment method for the intensive care unit: a multicenter study. Am J Respir Crit Care Med 184:340–344PubMedCrossRef
26.
Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, Truman B, Bernard GR, Dittus RS, Ely EW (2004) Costs associated with delirium in mechanically ventilated patients. Crit Care Med 32:955–962PubMedCrossRef
27.
Zitman FG, Couvee JE (2001) Chronic benzodiazepine use in general practice patients with depression: an evaluation of controlled treatment and taper-off: report on behalf of the Dutch Chronic Benzodiazepine Working Group. Br J Psychiatry 178:317–324PubMedCrossRef
28.
Patanwala AE, Duby J, Waters D, Erstad BL (2007) Opioid conversions in acute care. Ann Pharmacother 41:255–266PubMedCrossRef
29.
30.
Groen G, Sluijter R, Stammes P, Ilderda R (2012) Implementation of the Hinssen-Knap algorithm for the calculation of sunshine duration. KNMI publication TR-319. Available via KNMI. http://​www.​knmi.​nl. Accessed 28 June 2012
31.
Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH (2009) Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 180:1092–1097PubMedCrossRef
32.
33.
Flaatten H (2005) Effects of a major structural change to the intensive care unit on the quality and outcome after intensive care. Qual Saf Health Care 14:270–272PubMedCrossRef
34.
Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y (2001) Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 27:1297–1304PubMedCrossRef
35.
Morrison RS, Magaziner J, Gilbert M, Koval KJ, McLaughlin MA, Orosz G, Strauss E, Siu AL (2003) Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 58:76–81PubMedCrossRef
36.
Shintani AK, Girard TD, Eden SK, Arbogast PG, Moons KG, Ely EW (2009) Immortal time bias in critical care research: application of time-varying Cox regression for observational cohort studies. Crit Care Med 37:2939–2945PubMedCrossRef
Metadata
Title
Intensive care unit environment may affect the course of delirium
Authors
Irene J. Zaal
Carolina F. Spruyt
Linda M. Peelen
Maarten M. J. van Eijk
Rens Wientjes
Margriet M. E. Schneider
Jozef Kesecioglu
Arjen J. C. Slooter
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 3/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-012-2726-6

Other articles of this Issue 3/2013

Intensive Care Medicine 3/2013 Go to the issue

Year in Review 2012

Year in review in Intensive Care Medicine 2012. II: Pneumonia and infection, sepsis, coagulation, hemodynamics, cardiovascular and microcirculation, critical care organization, imaging, ethics and legal issues

Original

Automated sedation outperforms manual administration of propofol and remifentanil in critically ill patients with deep sedation: a randomized phase II trial

Original

Research participants’ opinions of delayed consent for a randomised controlled trial of glucose control in intensive care

Correspondence

Voriconazole-induced bradycardia without QT interval prolongation: a possible non-concentration-dependent adverse effect

Editorial

The identity of Intensive Care Medicine

Original

Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study