Incidence of Delirium in Critically Ill Cancer Patients.

Luis A Sánchez-Hurtado,Ángel Herrera-Gómez,Humberto Guevara-García,Francisco J García-Guillén,Nancy Hernández-Sánchez,Silvio A Ñamendys-Silva,Mario Del Moral-Armengol

doi:10.1155/2018/4193275

Abstract

Objective The aim of this study was to estimate the incidence of delirium and its risk factors among critically ill cancer patients in an intensive care unit (ICU). Materials and Methods This is a prospective cohort study. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was measured daily at morning to diagnose delirium by a physician. Delirium was diagnosed when the daily was positive during a patient's ICU stay. All patients were followed until they were discharged from the ICU. Using logistic regression, we estimated potential risk factors for developing delirium. The primary outcome was the development of ICU delirium. Results There were 109 patients included in the study. Patients had a mean age of 48.6 ± 18.07 years, and the main reason for admission to the ICU was septic shock (40.4%). The incidence of delirium was 22.9%. The mortality among all subjects was 15.6%; the mortality rate in patients who developed delirium was 12%. The only variable that had an association with the development of delirium in the ICU was the days of use of mechanical ventilation (OR: 1.06; CI 95%: 0.99–1.13;p=0.07). Conclusion Delirium is a frequent condition in critically ill cancer patients admitted to the ICU. The duration in days of mechanical ventilation is potential risk factors for developing delirium during an ICU stay. Delirium was not associated with a higher rate of mortality in this group of patients.

Highlights

Delirium is an acute brain dysfunction, characterized by an acute change or fluctuation in mental status, inattention, disorganized thinking, or an alteration in level of consciousness [1,2,3,4]
After reviewing the potential risk factors and clinical characteristics under investigation in the current study, we found several significant differences between patients with delirium and those without delirium; patients with delirium were found to be on mechanical ventilation for a greater number of day, were older in age, and their cancer had metastasized (Tables 1 and 2). ese characteristics, as well as other characteristic deemed clinically relevant, were included in univariate and multivariate logistic regression models; results of the analyses indicate that mechanical ventilation for a greater number of day is associated with the development of delirium in the intensive care unit (ICU) (Table 3)
Delirium is a frequent complication in patients hospitalized or admitted to the ICU. is study found that in patients admitted to a mixed oncology ICU, the incidence of delirium was 22.9%. e time in days of use of mechanical ventilation was the only characteristic associated with the development of delirium at the ICU when adjusted for another variable

Summary

Introduction

Delirium is an acute brain dysfunction, characterized by an acute change or fluctuation in mental status, inattention, disorganized thinking, or an alteration in level of consciousness [1,2,3,4]. Delirium has long-term consequences, such as prolonged cognitive impairment, impaired activities of daily living, and decreased quality of life in survivors of a critical illness [8, 9]. Multiple risk factors for delirium, classified as predisposing and precipitating risk factors, include age, presence of a previous illness, high severity of acute illness, and therapeutic options such as mechanical ventilation, sedation, emergency surgery, and metabolic disorders, among others [5, 10]. E prevalence of delirium in the ICU setting has been reported to range from 20 to 40%; when mechanical ventilation is used, this rate increases to 60–80%. Pain Research and Management range can be explained by a number of characteristics including illness severity and the instrument used. Older critically ill patients may have a rate of more than 80% [9]

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Conclusion