Sikandar H Khan1, Heidi Lindroth2, Kyle Hendrie3, Sophia Wang4, Sundus Imran5, Anthony J Perkins6, Sujuan Gao7, Farhaan S Vahidy8, Malaz Boustani9, Babar A Khan10. 1. Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA. Electronic address: sikhan@iu.edu. 2. Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA. Electronic address: hlindrot@iu.edu. 3. IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA. Electronic address: khendrie668@marian.edu. 4. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA; Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA. Electronic address: sophwang@iu.edu. 5. IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA. Electronic address: sunimran@iu.edu. 6. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA. Electronic address: antperki@iupui.edu. 7. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA. Electronic address: sgao@iu.edu. 8. Institute for Stroke and Cerebrovascular Diseases and the Department of Neurology at University of Texas Health Science Center at Houston, Texas, USA. Electronic address: Farhaan.Vahidy@uth.tmc.edu. 9. IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, Indiana, USA; Division of Geriatrics and General Internal Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA. Electronic address: mboustan@iu.edu. 10. Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Indiana University Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, Indiana, USA. Electronic address: bakhan@iu.edu.
Abstract
BACKGROUND: Effects of clinical practice changes on ICU delirium are not well understood. OBJECTIVES: Determine ICU delirium rates over time. METHODS: Data from a previously described screening cohort of the Pharmacological Management of Delirium trial was analyzed. Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU) were assessed twice daily. We defined: Any delirium (positive CAM-ICU at any time during ICU stay) and ICU-acquired delirium (1st CAM-ICU negative with a subsequent positive CAM-ICU). Mixed-effects logistic regression models were used to test for differences. RESULTS: 2742 patient admissions were included. Delirium occurred in 16.5%, any delirium decreased [22.7% to 10.2% (p < 0.01)], and ICU-acquired delirium decreased [8.4% to 4.4% (p = 0.01)]. Coma decreased from 24% to 17.4% (p = 0.04). Later ICU years and higher mean RASS scores were associated with lower odds of delirium. CONCLUSIONS: Delirium rates were not explained by the measured variables and further prospective research is needed.
BACKGROUND: Effects of clinical practice changes on ICU delirium are not well understood. OBJECTIVES: Determine ICU delirium rates over time. METHODS: Data from a previously described screening cohort of the Pharmacological Management of Delirium trial was analyzed. Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU) were assessed twice daily. We defined: Any delirium (positive CAM-ICU at any time during ICU stay) and ICU-acquired delirium (1st CAM-ICU negative with a subsequent positive CAM-ICU). Mixed-effects logistic regression models were used to test for differences. RESULTS: 2742 patient admissions were included. Delirium occurred in 16.5%, any delirium decreased [22.7% to 10.2% (p < 0.01)], and ICU-acquired delirium decreased [8.4% to 4.4% (p = 0.01)]. Coma decreased from 24% to 17.4% (p = 0.04). Later ICU years and higher mean RASS scores were associated with lower odds of delirium. CONCLUSIONS:Delirium rates were not explained by the measured variables and further prospective research is needed.
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