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 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Intensive Care
Published in: Annals of Intensive Care 1/2012

Open Access 01-12-2012 | Research

Delirium in postoperative nonventilated intensive care patients: risk factors and outcomes

Authors: Rodrigo Bernardo Serafim, Maximiliano F Dutra, Felipe Saddy, Bernardo Tura, Jose Eduardo Couto de Castro, Luciana C Villarinho, Maria da Gloria Santos, Fernando Augusto Bozza, José Rodolfo Rocco

Published in: Annals of Intensive Care | Issue 1/2012

Login to get access

Abstract

Background

Delirium features can vary greatly depending on the postoperative population studied; however, most studies focus only on high-risk patients. Describing the impact of delirium and risk factors in mixed populations can help in the development of preventive actions.

Methods

The occurrence of delirium was evaluated prospectively in 465 consecutive nonventilated postoperative patients admitted to a surgical intensive care unit (SICU) using the confusion assessment method (CAM). Patients with and without delirium were compared. A multiple logistic regression was performed to identify the main risk factors for delirium in the first 24 h of admission to the SICU and the main predictors of outcomes.

Results

Delirium was diagnosed in 43 (9.2%) individuals and was more frequent on the second and third days of admission. The presence of delirium resulted in longer lengths of SICU and hospital stays [6 days (3–13) vs. 2 days (1–3), p < 0.001 and 26 days (12–39) vs. 6 days (3–13), p <0.001, respectively], as well as higher hospital and SICU mortality rates [16.3% vs. 4.0%, p = 0.004 and 6.5% vs. 1.7%, p = 0.042, respectively]. The risk factors for delirium were age (odds ratio (OR), 1.04 [1.02-1.07]), Acute Physiologic Score (APS; OR, 1.11 [1.04-1.2]), emergency surgery (OR, 8.05 [3.58-18.06]), the use of benzodiazepines (OR, 2.28 [1.04-5.00]), and trauma (OR, 6.16 [4.1-6.5]).

Conclusions

Delirium negatively impacts postoperative nonventilated patients. Risk factors can be used to detect high-risk patients in a mixed population of SICU patients.
Appendix
Available only for authorised users
Literature
1.
Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS: Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004, 291: 1753–1762. 10.1001/jama.291.14.1753PubMedCrossRef
2.
Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, Gordon SM, Canonico AE, Dittus RS, Bernard GR, Ely EW: Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010, 38: 1513–1520. 10.1097/CCM.0b013e3181e47be1PubMedCentralPubMedCrossRef
3.
Salluh JI, Soares M, Teles JM, Ceraso D, Raimondi N, Nava VS, Blasquez P, Ugarte S, Ibanez-Guzman C, Centeno JV, et al.: Delirium epidemiology in Critical Care (DECCA): an international study. Crit Care 2010, 14: R210. 10.1186/cc9333PubMedCentralPubMedCrossRef
4.
Marcantonio E, Ta T, Duthie E, Resnick NM: Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. J Am Geriatr Soc 2002, 50: 850–857. 10.1046/j.1532-5415.2002.50210.xPubMedCrossRef
5.
Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, Truman B, Bernard GR, Dittus RS, Ely EW: Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004, 32: 955–962. 10.1097/01.CCM.0000119429.16055.92PubMedCrossRef
6.
Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW: Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 2005, 9: R375-R381. 10.1186/cc3729PubMedCentralPubMedCrossRef
7.
Salluh JI, Dal-Pizzol F, Mello PV, Friedman G, Silva E, Teles JM, Lobo SM, Bozza FA, Soares M: Delirium recognition and sedation practices in critically ill patients: a survey on the attitudes of 1015 Brazilian critical care physicians. J Crit Care 2009, 24: 556–562. 10.1016/j.jcrc.2009.04.004PubMedCrossRef
8.
Patel RP, Gambrell M, Speroff T, Scott TA, Pun BT, Okahashi J, Strength C, Pandharipande P, Girard TD, Burgess H, et al.: Delirium and sedation in the intensive care unit: survey of behaviors and attitudes of 1384 healthcare professionals. Crit Care Med 2009, 37: 825–832. 10.1097/CCM.0b013e31819b8608PubMedCentralPubMedCrossRef
9.
Young J, Murthy L, Westby M, Akunne A, O’Mahony R: Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ 2010, 341: c3704. 10.1136/bmj.c3704PubMedCrossRef
10.
Dyer CB, Ashton CM, Teasdale TA: Postoperative delirium. A review of 80 primary data-collection studies. Arch Intern Med 1995, 155: 461–465. 10.1001/archinte.1995.00430050035004PubMedCrossRef
11.
Dasgupta M, Dumbrell AC: Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc 2006, 54: 1578–1589. 10.1111/j.1532-5415.2006.00893.xPubMedCrossRef
12.
Aldemir M, Ozen S, Kara IH, Sir A, Bac B: Predisposing factors for delirium in the surgical intensive care unit. Crit Care 2001, 5: 265–270. 10.1186/cc1044PubMedCentralPubMedCrossRef
13.
Inouye SK: Delirium in hospitalized older patients. Clin Geriatr Med 1998, 14: 745–764.PubMed
14.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI: Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990, 113: 941–948.PubMedCrossRef
15.
Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, et al.: Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003, 289: 2983–2991. 10.1001/jama.289.22.2983PubMedCrossRef
16.
Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK: The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002, 166: 1338–1344. 10.1164/rccm.2107138PubMedCrossRef
17.
Fabbri RM, Moreira MA, Garrido R, Almeida OP: Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly. Arq Neuropsiquiatr 2001, 59: 175–179. 10.1590/S0004-282X2001000200004PubMedCrossRef
18.
McNicoll L, Pisani MA, Ely EW, Gifford D, Inouye SK: Detection of delirium in the intensive care unit: comparison of confusion assessment method for the intensive care unit with confusion assessment method ratings. J Am Geriatr Soc 2005, 53: 495–500. 10.1111/j.1532-5415.2005.53171.xPubMedCrossRef
19.
Bekker AY, Weeks EJ: Cognitive function after anaesthesia in the elderly. Best Pract Res Clin Anaesthesiol 2003, 17: 259–272. 10.1016/S1521-6896(03)00005-3PubMedCrossRef
20.
Ergina PL, Gold SL, Meakins JL: Perioperative care of the elderly patient. World J Surg 1993, 17: 192–198. 10.1007/BF01658926PubMedCrossRef
21.
Gabriel EA, Locali RF, Romano CC, Duarte AJ, Palma JH, Buffolo E: Analysis of the inflammatory response in endovascular treatment of aortic aneurysms. Eur J Cardiothorac Surg 2007, 31: 406–412. 10.1016/j.ejcts.2006.11.053PubMedCrossRef
22.
Rudolph JL, Jones RN, Levkoff SE, Rockett C, Inouye SK, Sellke FW, Khuri SF, Lipsitz LA, Ramlawi B, Levitsky S, Marcantonio ER: Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation 2009, 119: 229–236. 10.1161/CIRCULATIONAHA.108.795260PubMedCentralPubMedCrossRef
23.
Marcantonio ER, Goldman L, Orav EJ, Cook EF, Lee TH: The association of intraoperative factors with the development of postoperative delirium. Am J Med 1998, 105: 380–384. 10.1016/S0002-9343(98)00292-7PubMedCrossRef
24.
Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, Donaldson MC, Whittemore AD, Sugarbaker DJ, Poss R, et al.: A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 1994, 271: 134–139. 10.1001/jama.1994.03510260066030PubMedCrossRef
25.
Marcantonio ER, Flacker JM, Wright RJ, Resnick NM: Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001, 49: 516–522. 10.1046/j.1532-5415.2001.49108.xPubMedCrossRef
26.
Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr: A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999, 340: 669–676. 10.1056/NEJM199903043400901PubMedCrossRef
27.
Larsen KA, Kelly SE, Stern TA, Bode RH Jr, Price LL, Hunter DJ, Gulczynski D, Bierbaum BE, Sweeney GA, Hoikala KA, et al.: Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics 2010, 51: 409–418.PubMedCrossRef
28.
Mason SE, Noel-Storr A, Ritchie CW: The impact of general and regional anesthesia on the incidence of postoperative cognitive dysfunction and postoperative delirium: a systematic review with meta-analysis. J Alzheimers Dis 2010,22(Suppl 3):67–79.PubMed
Metadata
Title
Delirium in postoperative nonventilated intensive care patients: risk factors and outcomes
Authors
Rodrigo Bernardo Serafim
Maximiliano F Dutra
Felipe Saddy
Bernardo Tura
Jose Eduardo Couto de Castro
Luciana C Villarinho
Maria da Gloria Santos
Fernando Augusto Bozza
José Rodolfo Rocco
Publication date
01-12-2012
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2012
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/2110-5820-2-51

Other articles of this Issue 1/2012

Annals of Intensive Care 1/2012 Go to the issue

Research

Chronic alcohol exposure, infection, extended circulating white blood cells differentiated by flow cytometry and neutrophil CD64 expression: a prospective, descriptive study of critically ill medical patients

Research

Effect of tracheal suctioning on aspiration past the tracheal tube cuff in mechanically ventilated patients

Review

A fresh look at paralytics in the critically ill: real promise and real concern

Research

Short- and long-term outcomes of HIV-infected patients admitted to the intensive care unit: impact of antiretroviral therapy and immunovirological status

Review

Near infrared spectroscopy (NIRS) of the thenar eminence in anesthesia and intensive care

Review

Cardiac biomarkers in the intensive care unit