Delirium in critically ill patients

Incidence, risk factors and outcomes

Lavitha Vyveganathan, Azarinah Izaham, Wan Rahiza Wan Mat, Shereen Tang Suet Peng, Raha Abdul Rahman, Norsidah Abdul Manap

Research output: Contribution to journalArticle

Abstract

Objective: To determine the incidence, and evaluate the risk factors and outcomes of delirium in general Intensive Care Unit (ICU). Design: Prospective cross-sectional observational study. Setting: Teaching hospital in Kuala Lumpur, Malaysia. Patients and participants: Patients ages of 18 and above admitted for more than 24 hours in general ICU were recruited into the study. Measurements and results: The demographic data, predisposing and precipitating factors, and environmental factors were collected. Confu-sional Assessment Method (CAM-ICU) was done daily to assess delirium, when the patient had a sedation score of above Richmond Agitation and Sedation Scale (RASS)-3. Patients were followed up till discharged from ICU. Length of mechanical ventilation and length of ICU stay were recorded. A total of 139 patients were recruited with overall incidence of delirium was 42%. Among patients who had delirium, 68% were of hypo-. active delirium, 25% of mixed delirium and 7% were hyperactive delirium. The significant predisposing risk factors for developing delirium were age, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, visual or hearing impairment, smoking, renal impairment, diabetes, and hypertension. The factors detected precipitating delirium were sepsis, use of vasopressors, renal replacement therapies, and acute respiratory distress syndrome (ARDS). The presence of catheters, higher Sequential Organ Failure Assessment (SOFA) scores, and abnormal urea and bilirubin levels further significantly increased risk of delirium. Environmental conditions increasing the risk of delirium included absence of daylight exposure and visible clocks, and use of physical restraints. As a result of delirium, patients had longer length of mechanical ventilation and ICU stay. Conclusions: Recognizing predisposing factors and optimizing the modifiable risk factors will improve the length of mechanical ventilation and ICU stay.

Original languageEnglish
Pages (from-to)25-40
Number of pages16
JournalCritical Care and Shock
Volume22
Issue number1
Publication statusPublished - 1 Feb 2019

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Delirium
Critical Illness
Incidence
Intensive Care Units
Artificial Respiration
Causality
Precipitating Factors
Physical Restraint
Organ Dysfunction Scores
APACHE
Renal Replacement Therapy
Malaysia
Vision Disorders
Adult Respiratory Distress Syndrome
Hearing Loss
Bilirubin
Teaching Hospitals
Observational Studies
Urea
Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Delirium in critically ill patients : Incidence, risk factors and outcomes. / Vyveganathan, Lavitha; Izaham, Azarinah; Wan Mat, Wan Rahiza; Peng, Shereen Tang Suet; Abdul Rahman, Raha; Abdul Manap, Norsidah.

In: Critical Care and Shock, Vol. 22, No. 1, 01.02.2019, p. 25-40.

Research output: Contribution to journalArticle

Vyveganathan, Lavitha ; Izaham, Azarinah ; Wan Mat, Wan Rahiza ; Peng, Shereen Tang Suet ; Abdul Rahman, Raha ; Abdul Manap, Norsidah. / Delirium in critically ill patients : Incidence, risk factors and outcomes. In: Critical Care and Shock. 2019 ; Vol. 22, No. 1. pp. 25-40.
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