OBJECTIVE: Delirium, an acute organ dysfunction, is common among critically ill patients leading to significant morbidity and mortality; its epidemiology in a mixed cardiology and cardiac surgery ICU is not well established. We sought to determine the prevalence and risk factors for delirium among cardiac surgery ICU patients. DESIGN: Prospective observational study. SETTING: Twenty-seven-bed medical-surgical cardiac surgery ICU. PATIENTS: Two hundred consecutive patients with an expected cardiac surgery ICU length of stay >24 hrs. INTERVENTIONS: None. MEASUREMENTS: Baseline demographic data and daily assessments for delirium using the validated and reliable Confusion Assessment Method for the ICU were recorded, and quantitative tracking of delirium risk factors were conducted. Separate analyses studied the role of admission risk factors for occurrence of delirium during the cardiac surgery ICU stay and identified daily occurring risk factors for the development of delirium on a subsequent cardiac surgery ICU day. MAIN RESULTS: Prevalence of delirium was 26%, similar among cardiology and cardiac surgical patients. Nearly all (92%) exhibited the hypoactive subtype of delirium. Benzodiazepine use at admission was independently predictive of a three-fold increased risk of delirium (odds ratio 3.1 [1, 9.4], p = 0.04) during the cardiac surgery ICU stay. Of the daily occurring risk factors, patients who received benzodiazepines (2.6 [1.2, 5.7], p = 0.02) or had restraints or devices that precluded mobilization (2.9 [1.3, 6.5], p < 0.01) were more likely to have delirium the following day. Hemodynamic status was not associated with delirium. CONCLUSIONS: Delirium occurred in one in four patients in the cardiac surgery ICU and was predominately hypoactive in subtype. Chemical restraints via use of benzodiazepines or the use of physical restraints/restraining devices predisposed patients to a greater risk of delirium, pointing to areas of quality improvement that would be new to the vast majority of cardiac surgery ICUs.
OBJECTIVE:Delirium, an acute organ dysfunction, is common among critically illpatients leading to significant morbidity and mortality; its epidemiology in a mixed cardiology and cardiac surgery ICU is not well established. We sought to determine the prevalence and risk factors for delirium among cardiac surgery ICU patients. DESIGN: Prospective observational study. SETTING: Twenty-seven-bed medical-surgical cardiac surgery ICU. PATIENTS: Two hundred consecutive patients with an expected cardiac surgery ICU length of stay >24 hrs. INTERVENTIONS: None. MEASUREMENTS: Baseline demographic data and daily assessments for delirium using the validated and reliable Confusion Assessment Method for the ICU were recorded, and quantitative tracking of delirium risk factors were conducted. Separate analyses studied the role of admission risk factors for occurrence of delirium during the cardiac surgery ICU stay and identified daily occurring risk factors for the development of delirium on a subsequent cardiac surgery ICU day. MAIN RESULTS: Prevalence of delirium was 26%, similar among cardiology and cardiac surgical patients. Nearly all (92%) exhibited the hypoactive subtype of delirium. Benzodiazepine use at admission was independently predictive of a three-fold increased risk of delirium (odds ratio 3.1 [1, 9.4], p = 0.04) during the cardiac surgery ICU stay. Of the daily occurring risk factors, patients who received benzodiazepines (2.6 [1.2, 5.7], p = 0.02) or had restraints or devices that precluded mobilization (2.9 [1.3, 6.5], p < 0.01) were more likely to have delirium the following day. Hemodynamic status was not associated with delirium. CONCLUSIONS:Delirium occurred in one in four patients in the cardiac surgery ICU and was predominately hypoactive in subtype. Chemical restraints via use of benzodiazepines or the use of physical restraints/restraining devices predisposed patients to a greater risk of delirium, pointing to areas of quality improvement that would be new to the vast majority of cardiac surgery ICUs.
Authors: Rita Katznelson; George N Djaiani; Michael A Borger; Zeev Friedman; Susan E Abbey; Ludwik Fedorko; Jacek Karski; Nicholas Mitsakakis; Jo Carroll; W Scott Beattie Journal: Anesthesiology Date: 2009-01 Impact factor: 7.892
Authors: José R Maldonado; Ashley Wysong; Pieter J A van der Starre; Thaddeus Block; Craig Miller; Bruce A Reitz Journal: Psychosomatics Date: 2009 May-Jun Impact factor: 2.386
Authors: William D Schweickert; Mark C Pohlman; Anne S Pohlman; Celerina Nigos; Amy J Pawlik; Cheryl L Esbrook; Linda Spears; Megan Miller; Mietka Franczyk; Deanna Deprizio; Gregory A Schmidt; Amy Bowman; Rhonda Barr; Kathryn E McCallister; Jesse B Hall; John P Kress Journal: Lancet Date: 2009-05-14 Impact factor: 79.321
Authors: Richard R Riker; Yahya Shehabi; Paula M Bokesch; Daniel Ceraso; Wayne Wisemandle; Firas Koura; Patrick Whitten; Benjamin D Margolis; Daniel W Byrne; E Wesley Ely; Marcelo G Rocha Journal: JAMA Date: 2009-02-02 Impact factor: 56.272
Authors: Chris Burtin; Beatrix Clerckx; Christophe Robbeets; Patrick Ferdinande; Daniel Langer; Thierry Troosters; Greet Hermans; Marc Decramer; Rik Gosselink Journal: Crit Care Med Date: 2009-09 Impact factor: 7.598
Authors: Ishaq Lat; Wes McMillian; Scott Taylor; Jeff M Janzen; Stella Papadopoulos; Laura Korth; As'ad Ehtisham; Joe Nold; Suresh Agarwal; Ruben Azocar; Peter Burke Journal: Crit Care Med Date: 2009-06 Impact factor: 7.598
Authors: Maarten M J van Eijk; Rob J van Marum; Ine A M Klijn; Nelleke de Wit; Jozef Kesecioglu; Arjen J C Slooter Journal: Crit Care Med Date: 2009-06 Impact factor: 7.598
Authors: Pratik P Pandharipande; E Wesley Ely; Rakesh C Arora; Michele C Balas; Malaz A Boustani; Gabriel Heras La Calle; Colm Cunningham; John W Devlin; Julius Elefante; Jin H Han; Alasdair M MacLullich; José R Maldonado; Alessandro Morandi; Dale M Needham; Valerie J Page; Louise Rose; Jorge I F Salluh; Tarek Sharshar; Yahya Shehabi; Yoanna Skrobik; Arjen J C Slooter; Heidi A B Smith Journal: Intensive Care Med Date: 2017-06-13 Impact factor: 17.440
Authors: Dae H Kim; Krista F Huybrechts; Elisabetta Patorno; Edward R Marcantonio; Yoonyoung Park; Raisa Levin; Abdurrahman Abdurrob; Brian T Bateman Journal: J Am Geriatr Soc Date: 2017-02-10 Impact factor: 5.562
Authors: Chani Traube; Gabrielle Silver; Ron W Reeder; Hannah Doyle; Emily Hegel; Heather A Wolfe; Christopher Schneller; Melissa G Chung; Leslie A Dervan; Jane L DiGennaro; Sandra D W Buttram; Sapna R Kudchadkar; Kate Madden; Mary E Hartman; Mary L deAlmeida; Karen Walson; Erwin Ista; Manuel A Baarslag; Rosanne Salonia; John Beca; Debbie Long; Yu Kawai; Ira M Cheifetz; Javier Gelvez; Edward J Truemper; Rebecca L Smith; Megan E Peters; A M Iqbal O'Meara; Sarah Murphy; Abdulmohsen Bokhary; Bruce M Greenwald; Michael J Bell Journal: Crit Care Med Date: 2017-04 Impact factor: 7.598
Authors: Anita K Patel; Katherine V Biagas; Eunice C Clarke; Linda M Gerber; Elizabeth Mauer; Gabrielle Silver; Paul Chai; Rozelle Corda; Chani Traube Journal: Pediatr Crit Care Med Date: 2017-02 Impact factor: 3.624
Authors: Christopher G Hughes; Christina S Boncyk; Deborah J Culley; Lee A Fleisher; Jacqueline M Leung; David L McDonagh; Tong J Gan; Matthew D McEvoy; Timothy E Miller Journal: Anesth Analg Date: 2020-06 Impact factor: 5.108
Authors: Matthew P Schreiber; Elizabeth Colantuoni; Oscar J Bienvenu; Karin J Neufeld; Kuan-Fu Chen; Carl Shanholtz; Pedro A Mendez-Tellez; Dale M Needham Journal: Crit Care Med Date: 2014-06 Impact factor: 7.598
Authors: Patrick J Smith; James A Blumenthal; Benson M Hoffman; Sarah K Rivelli; Scott M Palmer; Robert D Davis; Joseph P Mathew Journal: Ann Am Thorac Soc Date: 2016-02