Delirium In Intensive Care Patients Research Articles

Dynamic delirium – Nursing intervention to reduce delirium in patients critically Ill, a randomized control trial

ObjectiveTo determine the effectiveness of a nursing intervention based on the Dynamic Symptom Model (DSM) and scientific evidence versus daily care in reducing the incidence and duration of delirium in intensive care patients. MethodWe designed the intervention named “DyDel” (By Dynamic Delirium) based on the theoretical approach of the DSM and from scientific evidence. A double-masked clinical trial of parallel groups was developed to test DyDel, with 213 patients older than 18 admitted to the intensive care unit (ICU) randomized to the study groups. The intervention group received DyDel each shift from day 0 until discharged from the ICU, while the control group received daily care in the ICU. At the same time, all participants were followed to measure primary (incidence and duration of delirium) and secondary outcomes (level of sedation and pain, days of mechanical ventilation, stay in ICU, and physical restriction). ResultsOverall, the study population were older than 60 years (60.3 ± 15.2 years), the male gender (59.6 %), and the diagnosis of acute myocardial infarction (73.7 %) were predominant. Comparing groups of study, the incidence of delirium was lower in the intervention group (5.6 %) than in the control group (14.8 %) (p = 0.037). The intervention group had lower days with delirium (0.07 ± 0.308) than the control group (0.34 ± 1.28) (p = 0.016), lower pain intensity (p = 0.002) and lower days of physical restraints (p = 0.06). ConclusionNon-pharmacological care, like the DyDel intervention, includes the family and focuses on the different patient's needs, which can help to reduce the incidence and duration of delirium in patients admitted to adult ICUs. Implications for Clinical PracticeDyDel was non-pharmacological and included the family. The DyDel's activities were focused on physiological, psychological, spiritual, and social needs and the experience and trajectory of delirium. The nurse can give humanized care in the ICU by applying DyDel.

The effect of nonpharmacological interventions applied by nurses to intensive care patients on the duration of delirium: a meta-analysis study.

It was aimed to determine the effect level of nonpharmacological methods applied by nurses to patients hospitalized in the intensive care unit on the duration of delirium. For this study, relevant studies were accessed by searching in July-October 2022. After the necessary exclusions were made, 14 studies were included in the study. The total sample size of the studies was 1123. According to the results, nonpharmacological interventions applied by nurses to intensive care patients were found to reduce the duration of delirium (SMD: - 0.625, 95% CI: - 1.1040-0.210; Z = - 2.950, p = 0.003, I2 = 93.119%). The country of the study (SMD: - 0.047, p = 0.001) and the types of nonpharmacological interventions used (SMD: - 0.062, p = 0.000) influenced the effect size of modulators on the duration of delirium in ICU patients. Nonpharmacological interventions applied by nurses, who have significant responsibilities in the protection and promotion of health, were found to reduce the duration of delirium in intensive care patients. This study shows that nurses, one of the main components of the multidisciplinary team in intensive care, are successful when they apply nonpharmacological interventions well.

Monitoring delirium in the intensive care unit: Diagnostic accuracy of the CAM-ICU tool when performed by certified nursing assistants – A prospective multicenter study

BackgroundMonitoring delirium in critically ill patients is recognized as a major challenge. Although involving certified nursing assistants could be a valuable help in this field, such strategy has never been formally investigated. ObjectivesFollowing theoretical training, we conducted a prospective multicenter study assessing the diagnostic accuracy of a CAM-ICU delirium screening strategy performed by CNAs in clinical settings, compared to parallel blinded evaluations conducted by nurses and physicians. MethodsFrom October 2020 to June 2022, adult intensive care patients admitted in three French University teaching hospitals with Richmond Agitation Sedation Scale ≥−2 were independently assessed for delirium by the three members of the care team (clinical nursing assistant, nurse and physician) using CAM-ICU in a random order. Physician’s assessment served as the reference standard for comparisons. ResultsWe analyzed results from 268 triplets of CAM-ICU assessments performed sequentially on 203 patients. Prevalence of delirium was 22%. Compared to physician's assessments, clinical nursing assistants demonstrated a sensitivity (Se) of 88% CI95% [80–96] and a specificity (Sp) of 95% [92–98] in detecting delirium. There was no significant difference in the performance of clinical nursing assistants and nurses (Se = 90 % [82–97] p = 0.77, Sp = 98 % [95–100] p = 0.19). We observed high agreement between results obtained by physicians and clinical nursing assistants (ĸ = 0.82) and clinical nursing assistants performance remained consistent in the subgroups at higher risk of delirium. ConclusionEvaluation of the CAM-ICU by clinical nursing assistants is feasible and should be seen as an opportunity to increase routine monitoring of delirium in intensive care patients. Implication for Clinical PracticeDelirium is a severe and underestimated complication of intensive care unit stay. This study results demonstrate the great performance of trained clinical nursing assistants in detecting delirium using the CAM-ICU. Further research is needed to define the most effective role for clinical nursing assistants in the routine management of delirium in intensive care patients.

Prevention of Delirium in Intensive Care Patients After Open Heart Surgery

Prevention of Delirium in Intensive Care Patients After Open Heart Surgery

Effect of earplug/eye mask on sleep and delirium in intensive care patients.

Environmental factors such as loud sounds and bright lights in intensive care units can cause sleep disorders and delirium. The present study aims to investigate the effects of the overnight use of earplugs and eye masks by intensive care patients on their sleep quality and the degree of delirium. This randomized controlled experimental study was conducted on the patients admitted to a coronary intensive care unit. The patients in the experimental group used earplugs and eye masks during the night, while those in the control group received only routine care. Data were collected using an information form, the Richards-Campbell sleep questionnaire (RCSQ), and the intensive care delirium screening checklist (ICDSC). The study included a total of 84 patients, 42 in the experimental group and 42 in the control group. The baseline average score of the patients in the experiment group on the RCSQ was 40.11 ± 16.55, with a Time 1 average score of 64.09 ± 14.07 and a Time 2 average score of 72.07 ± 11.75; their baseline average score on the ICDSC was 0.47 ± 0.50, with a Time 1 average score of 0.33 ± 065 and a Time 2 average score of 0.19 ± 039. The baseline average score of the patients in the control group on the RCSQ was 44.07 ± 7.30, with a Time 1 average score of 46.97 ± 9.22 and a Time 2 average score of 47.04 ± 11.53; the baseline average score of the control group on the ICDSC was 0.42 ± 0.50, with a Time 1 average score of 0.50 ± 0.70 and a Time 2 average score of 0.57 ± 0.66. A statistically significant difference was found between the Time 1 and Time 2 average scores of the experimental and control groups on the RCSQ and between the Time 2 average scores of the experimental and control groups on the ICDSC (U=198.00, P< .001; U=70.000, P< .001; U=614.000, P=·004 respectively). The earplugs and eye masks used by the intensive care patients overnight were associated with an increase in sleep quality and a decrease in the degree of delirium. The use of earplugs and eye masks is recommended for intensive care units in supporting sleep quality and preventing delirium.

Prevalência de delirium em terapia intensiva adulto

Objetivo: mensurar a prevalência de delirium em pacientes internados na terapia intensiva. Método: Trata-se de um estudo transversal com abordagem quantitativa, realizado em um hospital de alta complexidade de Caxias do Sul. A população investigada constituiu-se de 1271 pacientes, internados na terapia intensiva no ano de 2017. Para a coleta de dados foi utilizada uma planilha em formato eletrônico elaborada pelos pesquisadores. Os dados foram analisados mediante estatística descritiva. Resultados: evidenciaram que 8% (101) dos pacientes investigados foram diagnosticados com delirium; desses 50% tinham mais de 70 anos, 74% usaram benzodiazepínicos, 65% eram hipertensos, 71% possuíam alguma comorbidade e 76% sobreviveram. Conclusão: o delirium é uma patologia de início súbito, mas pode ser prevenida a partir de estratégias no plano de cuidados, sendo que é o enfermeiro que realiza a identificação dos pacientes com risco para desenvolver delirium, aplicando escalas específicas.

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Oversedation, delirium and immobilisation in the intensive care unit are associated with increased length of stay in the unit. Routines of systematic pain and sedation assessment and the use of valid tools are highly stressed in international guidelines. For improving the quality of pain treatment and sedation in a Norwegian intensive care unit, in 2009-2015, we compared supplementation with an analgosedation approach and the existing systematic approach, measured by the adherence to current international pain, sedation and delirium guidelines. In a longitudinal study following the Standards for Reporting Implementation Studies, pain, sedation, delirium and mobilisation data from patients' complete intensive care unit stays, encompassing three separate periods of 4-6months, were compared. The primary outcome was adherence to current protocol including assessment and documentation of patients' level of pain, sedation and prevalence of delirium at least every 8hr, early mobilisation and titration towards a light level of sedation. We included 205 patients, corresponding to 1,607 patient intensive care unit days. The patient sedation levels, measured by the Richmond Agitation and Sedation Scale, decreased significantly, from -2.2 in 2009--1.7 in 2015, so did the amount of administrated propofol. Mean pain scores measured by the numeric rating scale during activity were maximum 3.1 in 2014, decreasing to 2.2 in 2015. In patients not able to self-report, pain mean scores were 1.7 in 2014 and 1.6 in 2015, measured by the Critical Care Pain Observational Tool. The number of patients unable to assess for delirium decreased significantly. By discounting the group of patients unable to assess, the prevalence of delirium varied from 32%, 25% and 33%. The goal of having an awake patient able to cooperate, with acceptable levels of pain, was gradually achieved during a 6-year period. The results showed that pain treatment and sedation in the intensive care unit primarily succeeded in the setting of an established routine of systematic assessment and documentation. The results of the study draw attention to pain treatment, sedation and delirium in intensive care patients, as well as implementation strategies aimed at achieving healthcare personnel's adherence to international guidelines in clinical practice.

Prevalence of delirium in intensive care patients and association with sedoanalgesia, severity and mortality.

To establish the prevalence of delirium and its subsyndrome in intensive care and to associate it with the use of sedative and analgesia, severity and mortality. Carried out in two intensive care units of adult patients, this is a quantitative and transversal study, with 157 patients, using the Richmond Agitation-Sedation Scale to assess the level of sedation and the Intensive Care Delirium Screening Checklist for delirium. The T test and Chi-square test were applied for statistical analysis. The prevalence of delirium was 22.3%, and 49.7% of the subsyndrome. Associations of the use of midazolam with the presence of delirium (p=0.05) and subsyndromal delirium (p<0.01), use of clonidine with the appearance of delirium (p<0.01) and of fentanyl with subsyndromal delirium (p=0.09). There were no significant differences between the mortality of patients with delirium (p=0.40) and subsyndromal delirium (p=0.86), as well as association with the mortality score. The use of sedoanalgesia is associated with the presence of delirium and subsyndromal delirium. No significant statistical associations were found between the severity and mortality scores.

Identification of delirium and subsyndromal delirium in intensive care patients.

identify delirium and subsyndromal delirium in intensive care patients; age, hospitalization time, and mortality. a retrospective, quantitative study conducted in the Intensive Care Unit, using the Richmond Agitation-Sedation Scale to evaluate sedation and the Intensive Care Delirium Screening Checklist for the identification of delirium, with the participation of 157 patients. For statistical analysis, the t-test and the Chi-square test was carried out. the majority presented subsyndromal delirium (49.7%). Mortality was 21.7%. The relationship between delirium and its subsyndromal with hospitalization time was statistically significant for both (p=0.035 and p <0.001), while age was significant only in the subsyndromal delirium (p=0.009). the majority of the patients presented subsyndromal delirium. The length of hospital stay was statistically significant in delirium and subsyndroma delirium. Age was significant only in subsyndromal delirium. The mortality of patients with delirium was higher than the others.

Pharmacological interventions for prevention and management of delirium in intensive care patients: a systematic overview of reviews and meta-analyses

ObjectivesWe assessed the evidence from reviews and meta-analyses of randomised clinical trials on the effects of pharmacological prevention and management of delirium in intensive care unit (ICU) patients.MethodsWe searched for...

Delirium in intensive care patients

Delir ist die haufigste Form einer zerebralen Dysfunktion bei Patienten auf der Intensivstation und ein medizinischer Notfall, der vermieden oder zeitnah diagnostiziert und therapiert werden muss. Nach heutigem Kenntnisstand scheint die Entwicklung eines Delirs durch ein Zusammenspiel von erhohter Vulnerabilitat (Pradisposition) und der gleichzeitigen Exposition gegenuber delirogenen Faktoren bedingt zu sein. Da in der klinischen Routine ein Delir haufig ubersehen wird, sollte engmaschig ein Delirscreening erfolgen. Wegen der engen Verknupfung zwischen Delir, Agitation und Schmerz muss analog zum Delirscreening mindestens alle 8 h zusatzlich eine Evaluation der Sedierung und der Analgesie erfolgen. In der Pravention und Therapie des Delirs wird nach heutigem Kenntnisstand ein multifaktorielles und multiprofessionelles Vorgehen favorisiert. Hierbei hat die nichtmedikamentose Intervention durch Fruhmobilisation, Reorientierung, Schlafverbesserung, adaquate Schmerztherapie und Vermeidung einer Polypharmazie einen hohen Stellenwert. In der symptomorientierten medikamentosen Delirtherapie finden, in Abhangigkeit von dem klinischen Bild, unterschiedliche Substanzen Anwendung. Um diese diagnostischen und therapeutischen Ziele zu erreichen, ist ein interdisziplinares Behandlungsteam, bestehend aus Intensivpflege, Intensivarzten, Stationsapothekern, Physiotherapeuten, Ernahrungsspezialisten und Psychiatern notwendig, um den Anforderungen des Patienten und deren Angehorigen gerecht zu werden.

Delirium in intensive care patients : Amultiprofessional challenge

Delirium is the most common form of cerebral dysfunction in intensive care patients and is amedical emergency that must be avoided or promptly diagnosed and treated. According to current knowledge the development of delirium seems to be caused by an interplay between increased vulnerability (predisposition) and simultaneous exposure to delirogenic factors. Since delirium is often overlooked in the clinical routine, a continuous screening for delirium should be performed. Due to the close connection between delirium, agitation and pain, sedation and analgesia must be evaluated at least every 8 h analogous to delirium screening. According to current knowledge, amultifactorial and multiprofessional approach is favored in the prevention and treatment of delirium. Non-pharmaceutical interventions through early mobilization, reorientation, sleep improvement, adequate pain therapy and avoidance of polypharmacy are of great importance. Depending on the clinical picture, different substances are used in symptom-oriented drug treatment of delirium. In order to achieve these diagnostic and therapeutic goals, an interdisciplinary treatment team consisting of intensive care, intensive care physicians, ward pharmacists, physiotherapists, nutrition specialists and psychiatrists is necessary in order to meet the requirements of the patient and their relatives.

Pharmacological interventions for delirium in intensive care patients: a protocol for an overview of reviews.

BackgroundThe prevalence of delirium in intensive care unit (ICU) patients is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer ICU stay, increased long-term mortality and cognitive impairment. Thus, the burden of delirium for patients, relatives and societies is considerable.Today, reviews of randomised clinical trials are produced in large scales sometimes making it difficult to get an overview of the available evidence. A preliminary search identified several reviews investigating the effects of pharmacological interventions for the management and prevention of delirium in ICU patients. The conclusions of the reviews showed conflicting results. Despite this unclear evidence, antipsychotics, in particular, haloperidol is often the recommended pharmacological intervention for delirium in ICU patients.The objective of this overview of reviews is to critically assess the evidence of reviews of randomised clinical trials on the effect of pharmacological management and prevention of delirium in ICU patients.Methods/designWe will search for reviews in the following databases: Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, and Allied and Complementary Medicine Database.Two authors will independently select references for inclusion using Covidence, extract data and assess the methodological quality of the included systematic reviews using the ROBIS tool. Any disagreement will be resolved by consensus.We will present the data as a narrative synthesis and summarise the main results of the included reviews. In addition, we will present an overview of the bias risk assessment of the systematic reviews.DiscussionResults of this overview may establish a way forward to find and update or to design a high quality systematic review assessing the effects of the most promising pharmacological intervention for delirium in ICU patients.Systematic review registrationPROSPERO - CRD42016046628.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0391-5) contains supplementary material, which is available to authorized users.

A clinical perspective of sepsis-associated delirium.

The term sepsis-associated encephalopathy (SAE) has been applied to animal models, postmortem studies in patients, and severe cases of sepsis. SAE is considered to include all types of brain dysfunction, including delirium, coma, seizure, and focal neurological signs. Clinical data for sepsis-associated delirium (SAD) have been accumulating since the establishment of definitions of coma or delirium and the introduction of validated screening tools. Some preliminary studies have examined the etiology of SAD. Neuroinflammation, abnormal cerebral perfusion, and neurotransmitter imbalances are the main mechanisms underlying the development of SAD. However, there are still no specific diagnostic blood, electrophysiological, or imaging tests or treatments specific for SAD. The duration of delirium in intensive care patients is associated with long-term functional disability and cognitive impairment, although this syndrome usually reverses after the successful treatment of sepsis. Once the respiratory and hemodynamic states are stabilized, patients with severe sepsis or septic shock should receive rehabilitation as soon as possible because early initiation of rehabilitation can reduce the duration of delirium. We expect to see further pathophysiological data and the development of novel treatments for SAD now that reliable and consistent definitions of SAD have been established.

Dynamic light application therapy to reduce the incidence and duration of delirium in intensive-care patients: a randomised controlled trial

Disturbed circadian rhythm is a potentially modifiable cause of delirium among patients in intensive-care units (ICUs). Bright-light therapy in the daytime can realign circadian rhythm and reduce the incidence of delirium. We investigated whether a high-intensity dynamic light application (DLA) would reduce ICU-acquired delirium. This was a randomised, controlled, single-centre trial of medical and surgical patients admitted to the ICU of a teaching hospital in the Netherlands. Patients older than 18 years, expected to stay in the ICU longer than 24 h and who could be assessed for delirium were randomised to DLA or normal lighting (control), according to a computer-generated schedule. The DLA was administered through ceiling-mounted fluorescent tubes that delivered bluish-white light up to 1700 lux between 0900 h and 1600 h, except for 1130-1330 h, when the light was dimmed to 300 lux. The light could only be turned off centrally by investigators. Control light levels were 300 lux and lights could be turned on and off from inside the room. The primary endpoint was the cumulative incidence of ICU-acquired delirium. Analyses were by intention to treat and per protocol. The study was terminated prematurely after an interim analysis for futility. This study is registered with Clinicaltrials.gov, number NCT01274819. Between July 1, 2011, and Sept 9, 2013, 734 patients were enrolled, 361 in the DLA group and 373 in the control group. Delirium occurred in 137 (38%) of 361 DLA patients and 123 (33%) of 373 control patients (odds ratio 1·24, 95% CI 0·92-1·68, p=0·16). No adverse events were noted in patients or staff. DLA as a single intervention does not reduce the cumulative incidence of delirium. Bright-light therapy should be assessed as part of a multicomponent strategy. None.

Development of Korean Intensive Care Delirium Screening Tool (KICDST)

This study was done to develop of the Korean intensive care delirium screening tool (KICDST). The KICDST was developed in 5 steps: Configuration of conceptual frame, development of preliminary tool, pilot study, reliability and validity test, development of final KICDST. Reliability tests were done using degree of agreement between evaluators and internal consistency. For validity tests, CVI (Content Validity Index), ROC (Receiver Operating Characteristics) analysis, known group technique and factor analysis were used. In the reliability test, the degree of agreement between evaluators showed .80~1.00 and the internal consistency was KR-20=.84. The CVI was .83~1.00. In ROC analysis, the AUC (Area Under the ROC Curve) was .98. Assessment score was 4 points. The values for sensitivity, specificity, correct classification rate, positive predictive value, and negative predictive value were found to be 95.0%, 93.7%, 94.4%, 95.0% and 93.7%, respectively. In the known group technique, the average delirium screening tool score of the non-delirium group was 1.25±0.99 while that of delirium group was 5.07±1.89 (t=-16.33, p<.001). The factors were classified into 3 factors (cognitive change, symptom fluctuation, psychomotor retardation), which explained 67.4% of total variance. Findings show that the KICDST has high sensitivity and specificity. Therefore, this screening tool is recommended for early identification of delirium in intensive care patients.

A shared language regarding sedation and delirium in critically ill patients.

Patients in intensive care units who develop delirium, experience longer stay in intensive care as well as increased morbidity and mortality. A questionnaire in 2009 showed that there was no consensus in Denmark regarding the tools to be used to assess sedation or delirium, the patient groups they should be used in, or the frequency of assessment. The aims of this survey were to describe clinical practice regarding the assessment of sedation and delirium in intensive care patients and to compare the results with those obtained in 2009. A questionnaire was sent via e-mail to all intensive care units in Denmark caring for ventilated adult patients. An intensive care nurse with daily patient contact was asked to answer questions about the unit's practice regarding the tools used to assess sedation and delirium in adult patients. In all, 98% of the intensive care units responded. Richmond Agitation-Sedation Scale was the most used tool for sedation assessment, and Confusion Assessment Method for the Intensive Care Unit was used only for delirium assessment. A shared language for sedation and delirium assessment was identified as essential in supporting care delivery. A systematic use of a shared language according to sedation and delirium in intensive care units can minimize mistakes in transfer of patients and minimize the risk of doubly traumatising patients.

Pharmacologic prevention and treatment of delirium in intensive care patients: A systematic review

PurposeThe purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients. Materials and methodsWe performed a systematic search to identify publications (from January 1980 to September 2014) that evaluated the pharmacologic interventions to treat or prevent delirium in intensive care unit (ICU) patients. ResultsFrom 2646 citations, 15 studies on prevention (6729 patients) and 7 studies on treatment (1784 patients) were selected and analyzed. Among studies that evaluated surgical patients, the pharmacologic interventions were associated with a reduction in delirium prevalence, ICU length of stay, and duration of mechanical ventilation, but with high heterogeneity (respectively, I2 = 81%, P = .0013; I2 = 97%, P < .001; and I2 = 97%). Considering treatment studies, only 1 demonstrated a significant decrease in ICU length of stay using dexmedetomidine compared to haloperidol (Relative Risk, 0.62 [1.29-0.06]; I2 = 97%), and only 1 found a shorter time to resolution of delirium using quetiapine (1.0 [confidence interval, 0.5-3.0] vs 4.5 [confidence interval, 2.0-7.0] days; P = .001). ConclusionThe use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.

Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC

We hypothesized that reduced arousability (Richmond Agitation Sedation Scale, RASS, scores -2 to -3) for any reason during delirium assessment increases the apparent prevalence of delirium in intensive care patients. To test this hypothesis, we assessed delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) in intensive care patients during sedation stops, and related the findings to the level of sedation, as assessed with RASS score. We assessed delirium in 80 patients with ICU stay longer than 48 h using CAM-ICU and ICDSC during daily sedation stops. Sedation was assessed using RASS. The effect of including patients with a RASS of -2 and -3 during sedation stop ("light to moderate sedation", eye contact less than 10 s or not at all, respectively) on prevalence of delirium was analyzed. A total of 467 patient days were assessed. The proportion of CAM-ICU-positive evaluations decreased from 53 to 31 % (p < 0.001) if assessments from patients at RASS -2/-3 (22 % of all assessments) were excluded. Similarly, the number of positive ICDSC results decreased from 51 to 29 % (p < 0.001). Sedation per se can result in positive items of both CAM-ICU and ICDSC, and therefore in a diagnosis of delirium. Consequently, apparent prevalence of delirium is dependent on how a depressed level of consciousness after sedation stop is interpreted (delirium vs persisting sedation). We suggest that any reports on delirium using these assessment tools should be stratified for a sedation score during the assessment.

Postoperative Delirium in Intensive Care Patients: Risk Factors and Outcome

Postoperative delirium (POD) in Surgical Intensive Care patients is an important independent outcome determinant. The purpose of our study was to evaluate the incidence and determinants of POD. Prospective cohort study conducted during a period of 10 months in a Post-Anesthesia Care Unit (PACU) with five intensive care beds. All consecutive adult patients submitted to major surgery were enrolled. Demographic data, perioperative variables, length of stay (LOS) and the mortality at PACU, hospital and at 6-months follow-up were recorded. Postoperative delirium was evaluated using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive analyses were conducted and the Mann-Whitney test, Chi-square test or Fisher's exact test were used for comparisons. Logistic regression analysis evaluated the determinants of POD with calculation of odds ratio (OR) and its confidence interval 95% (95% CI). There were 775 adult PACU admissions and 95 patients had exclusion criteria. Of the remaining 680 patients, 128 (18.8%) developed POD. Independent determinants of POD identified were age, ASA-PS, emergency surgery and total amount of fresh frozen plasma administered during surgery. Patients with delirium had higher mortality rates, were more severely ill and stayed longer at the PACU and in the hospital. POD was an independent risk factor for hospital mortality There was a high incidence of delirium had a high incidence in intensive care surgical patients. POD was associated with worse severity of disease scores, longer LOS in hospital, and in PACU and higher mortality rates. The independent risk factors for POD were age, ASAPS, emergency surgery and the amount of plasma administered during surgery.