Delirium in the Cardiovascular ICU

作者：John McPherson, Chad E. Wagner, Leanne M. Boehm, Jennifer D. Hall, Daniel Johnson, Leanna R. Miller, Kathleen Burns, Jennifer L. Thompson, Ayumi Shintani, Eugene Wesley Ely, Pratik P. Pandhvaripande · 发表于：Critical Care Medicine · 年份：2012 · DOI：10.1097/ccm.0b013e31826ab49b · 被引用次数：279 · 研究领域：Intensive Care Unit Cognitive Disorders、Nosocomial Infections in ICU、Family and Patient Care in Intensive Care Units

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 devic...