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Intensive Care Medicine
Published in: Intensive Care Medicine 12/2015

01-12-2015 | Original

Benzodiazepine-associated delirium in critically ill adults

Authors: Irene J. Zaal, John W. Devlin, Marijn Hazelbag, Peter M. C. Klein Klouwenberg, Arendina W. van der Kooi, David S. Y. Ong, Olaf L. Cremer, Rolf H. Groenwold, Arjen J. C. Slooter

Published in: Intensive Care Medicine | Issue 12/2015

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Abstract

Purpose

The association between benzodiazepine use and delirium risk in the ICU remains unclear. Prior investigations have failed to account for disease severity prior to delirium onset, competing events that may preclude delirium detection, other important delirium risk factors, and an adequate number of patients receiving continuous midazolam. The aim of this study was to address these limitations and evaluate the association between benzodiazepine exposure and ICU delirium occurrence.

Methods

In a cohort of consecutive critically ill adults, daily mental status was classified as either awake without delirium, delirium, or coma. In a first-order Markov model, multinomial logistic regression analysis was used, which considered five possible outcomes the next day (i.e., awake without delirium, delirium, coma, ICU discharge, and death) and 16 delirium-related covariables, to quantify the association between benzodiazepine use and delirium occurrence the following day.

Results

Among 1112 patients, 9867 daily transitions occurred. Benzodiazepine administration in an awake patient without delirium was associated with increased risk of delirium the next day [OR 1.04 (per 5 mg of midazolam equivalent administered) 95 % CI 1.02–1.05). When the method of benzodiazepine administration was incorporated in the model, the odds of transitioning to delirium was higher with benzodiazepines given continuously (OR 1.04, 95 % CI 1.03–1.06) compared to benzodiazepines given intermittently (OR 0.97, 95 % CI 0.88–1.05).

Conclusions

After addressing potential methodological limitations of prior studies, we confirm that benzodiazepine administration increases the risk for delirium in critically ill adults but this association seems to be limited to continuous infusion use only.
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Metadata
Title
Benzodiazepine-associated delirium in critically ill adults
Authors
Irene J. Zaal
John W. Devlin
Marijn Hazelbag
Peter M. C. Klein Klouwenberg
Arendina W. van der Kooi
David S. Y. Ong
Olaf L. Cremer
Rolf H. Groenwold
Arjen J. C. Slooter
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 12/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-015-4063-z

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