Abstract
IntroductionDelirium is an acute disturbance of consciousness and cognition. It is a common disorder in the intensive care unit (ICU) and associated with impaired long-term outcome. Despite its frequency and impact, delirium is poorly recognized by ICU-physicians and –nurses using delirium screening tools. A completely new approach to detect delirium is to use monitoring of physiological alterations. Temperature variability, a measure for temperature regulation, could be an interesting component to monitor delirium, but whether temperature regulation is different during ICU delirium has not yet been investigated. The aim of this study was to investigate whether ICU delirium is related to temperature variability. Furthermore, we investigated whether ICU delirium is related to absolute body temperature.MethodsWe included patients who experienced both delirium and delirium free days during ICU stay, based on the Confusion Assessment method for the ICU conducted by a research- physician or –nurse, in combination with inspection of medical records. We excluded patients with conditions affecting thermal regulation or therapies affecting body temperature. Daily temperature variability was determined by computing the mean absolute second derivative of the temperature signal. Temperature variability (primary outcome) and absolute body temperature (secondary outcome) were compared between delirium- and non-delirium days with a linear mixed model and adjusted for daily mean Richmond Agitation and Sedation Scale scores and daily maximum Sequential Organ Failure Assessment scores.ResultsTemperature variability was increased during delirium-days compared to days without delirium (βunadjusted=0.007, 95% confidence interval (CI)=0.004 to 0.011, p<0.001). Adjustment for confounders did not alter this result (βadjusted=0.005, 95% CI=0.002 to 0.008, p<0.001). Delirium was not associated with absolute body temperature (βunadjusted=-0.03, 95% CI=-0.17 to 0.10, p=0.61). This did not change after adjusting for confounders (βadjusted=-0.03, 95% CI=-0.17 to 0.10, p=0.63).ConclusionsOur study suggests that temperature variability is increased during ICU delirium.
Highlights
Delirium is an acute disturbance of consciousness and cognition
Temperature variability was increased during delirium-days compared to days without delirium (βunadjusted=0.007, 95% confidence interval (CI)=0.004 to 0.011, p
Delirium was not associated with absolute body temperature
Summary
Delirium is an acute disturbance of consciousness and cognition It is a common disorder in the intensive care unit (ICU) and associated with impaired long-term outcome. Delirium is an acute disturbance of attention, consciousness and cognition that usually fluctuates over time[1] It is a common disorder in the intensive care unit (ICU), with three different subtypes based on psychomotor behavior: hypoactive, hyperactive and mixed-type delirium[2]. In contrast to results from a research setting, the sensitivity of the CAM-ICU showed to be low in routine, daily practice (overall 47%)[11]. This hinders early detection of delirium, and the subsequent delay in treatment may worsen patient outcome[12]
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