Incidence and factors related to delirium in an intensive care unit.

Satomi Mori,Fernanda Souza Angotti Carrara,Cibelli Rizzo Cohrs,Juliana Rumy Tsuchihashi Takeda,Suely Sueko Viski Zanei,Iveth Yamaguchi Whitaker

doi:10.1590/s0080-623420160000500007

Abstract

To identify the incidence of delirium, compare the demographic and clinical characteristics of patients with and without delirium, and verify factors related to delirium in critical care patients. Prospective cohort with a sample made up of patients hospitalized in the Intensive Care Unit (ICU) of a university hospital. Demographic, clinical variables and evaluation with the Confusion Assessment Method for Intensive Care Unit to identify delirium were processed to the univariate analysis and logistic regression to identify factors related to the occurrence of delirium. Of the total 149 patients in the sample, 69 (46.3%) presented delirium during ICU stay, whose mean age, severity of illness and length of ICU stay were statistically higher. The factors related to delirium were: age, midazolam, morphine and propofol. Results showed high incidence of ICU delirium associated with older age, use of sedatives and analgesics, emphasizing the need for relevant nursing care to prevent and identify early, patients presenting these characteristics. Identificar a incidência de delirium, comparar as características demográficas e clínicas dos pacientes com e sem delirium e verificar os fatores relacionados ao delirium em pacientes internados em Unidade de Terapia Intensiva (UTI). Coorte prospectiva, cuja amostra foi constituída de pacientes internados em UTI de um hospital universitário. Variáveis demográficas, clínicas e da avaliação com o Confusion Assessment Method for Intensive Care Unit para identificação de delirium foram processadas para análise univariada, e regressão logística para identificar fatores relacionados à ocorrência do delirium. Do total de 149 pacientes da amostra, 69 (46,3%) apresentaram delirium durante a internação na UTI, observando-se que a média da idade, o índice de gravidade e o tempo de permanência nas UTI foram estatisticamente maiores. Os fatores relacionados ao delirium foram: idade, midazolam, morfina e propofol. Os resultados mostraram elevada incidência de delirium na UTI e sua ocorrência associada às idades mais avançadas e o uso de sedativos e analgésicos, ressaltando-se a importância da atuação do enfermeiro na prevenção e identificação precoce do quadro nos pacientes com essas características.

Highlights

Delirium is an acute neurological disorder that is frequently observed in Intensive Care Unit (ICU) patients
Considering the negative aspects of delirium on patients’ prognosis, the evaluation and recognition of this clinical condition by health professionals is important in the context of intensive care.These aspects were observed by 1,384 ICU professionals from 41 North American hospitals who completed a questionnaire about beliefs and practices related to delirium
86% have recognized that delirium was underdiagnosed, 90% agreed that delirium damaged weaning from mechanical pulmonary ventilation (MPV) and 95% agreed that the occurrence of delirium increased length of hospital stay

Summary

Introduction

Delirium is an acute neurological disorder that is frequently observed in Intensive Care Unit (ICU) patients. It is characterized by transitory changes of consciousness and cognition, generally for a short period of time[1]. Patients that developed this disorder performed worst in the clinical outcomes, contributing to extended length of hospital stay, an increase in the possibility of adverse events such as respiratory and neurological complications and higher mortality rate[1,2,3]. Regarding the identification of delirium, 59% agreed to make evaluation to detect it[4]. These data reinforce the idea that preventive care and identification should be improved

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Conclusion