Sedative use and delirium during noninvasive positive pressure ventilation: A prospective observational study

Abstract

Outcome of delirium during intensive care unit stay in Japan Akira Mikami, Ui Yamada, Ryosuke Miyamichi, Toshiaki Mochizuki, Norio Otani, Shinichi Ishimatsu St Luke's International Hospital, Japan Background/Purpose: Delirium has been recognized as associated with impaired outcome, but in Japan, it is still an underdiagnosed form of acute brain dysfunction. The aim of this study was to investigate the association between delirium in the intensive care unit (ICU), outcome, and other factors. Methods: A prospective cohort study was conducted on ICU patients for 6 months at a general hospital in Tokyo, Japan. We included patients who assessed by nursing staff twice daily with the Confusion Assessment Method for the ICU (CAM-ICU) and the Richmond Agitation-Sedation Scale. Cox regression with timevarying covariates was used to determine the independent relationship between delirium and clinical outcomes. Results:Of 251patients, 138 (55%)weremale,mean agewas 65.3± 18.0 years old, length of ICU stay was 3.3 ± 3.7, and length of hospital stay was 28.6± 39.0. Among the patients, 46 (18%) developed delirium at some point during the ICU stay. Judging from DSM-IV, 39 (16%) were diagnosed by psychotherapic physician. A bivariate analysis showed several different factors (dementia, infection, postoperative, respiratory failure, cardiac decompensation, benzodiazepine, and steroid) were the associate with delirium. Patients who developed delirium had higher 6-monthmortality rates (39% vs 9%) and length of ICU and hospital stay (6.0 vs 2.7 days, 49.8 vs 24.7 days). Conclusions: Delirium occurred in 18% of this cohort. Delirium was an independent predictor of higher 6-month mortality and longer hospital stay.