A Study on Pattern of Delirium in the Patients Admitted to Micu in a Tertiary Care Teaching Hospital
Corresponding Author(s) : Gangula Amareswara Reddy
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 3 No. 1 (2015): 2015 Volume 3- Issue -1
Abstract
Aim
To study the prevalence of various base line risk factors, precipitating and iatrogenicfactors in the study population and the effect of delirium on the outcome of patients admitted to the MICU.
Methods
This is a cross sectional, descriptive study conducted for a period of six months in the
Medical Intensive Care Unit (MICU). Socio-demographic data sheet, risk factor checklist, confusion assessment method (CAM), and Simplified acute physiology score (SAPS -II) were the instruments used in the study.
Results
Majority of the study group (63%) were males and uneducated. Mean days spent in delirium were high for males (4.92 days) when compared to females (3.72 days). The mean score of SAPS-II for development of delirium is 27 (26.95). Mean days spent in delirium (5.95 days) was high when there is no visible day light. 60% of study population were hyperactive and were forcibly restrained to cots. From the total study population, 18 were discharged from MICU (M=14, F=37); 62 were transferred to medical wards (M=37, F=25); 9 were transferred to other wards (M=5, F=4) and11 patients were dead (M=7, F=4).
Conclusion
Being male, lower socio-economic statuses, substance abuse (57%) were found as significant predisposing factors. Type of delirium had no statistically significant effect over outcome. Delirium outcomes were either in higher number of deaths or prolonged hospital stay. The mean SAP score was considerably higher in the death group compared to the other groups and the differences are also significant with P<0.001.
Keywords
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[1] Timothy D Girard, Pratik P Pandharipande and E Wesley Ely.Delirium in the intensive care unit Critical Care 2008, 12 (Suppl-3).
[2] Yu-Ling Chang, Yun-Fang Tsai, Pyng-Jing Lin, Min-Chi Chen and Chia-Yih Liu. Prevalence and Risk Factors for Postoperative Delirium in a Cardiovascular Intensive Care Unit.American Journal of Critical Care, November 2008, Volume 17, No. 6.
[3] Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA 1996; 275:852–857.
[4] Inouye SK: Deli0rium in older persons. N Engl J Med 2006, 354:1157-1165.
[5] Bart Van Rompaey et al. Risk factors for delirium in intensive care patients: a prospective cohort study, Critical Care 2009, 13:R77.
[6] Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1994 May 4; 271(17):1321.
[7] Brenda T. Pun and E. Wesley Ely, The Importance Of Diagnosing and Managing ICU Delirium Chest 2007; 132; 624-636.
[8] Webb JM, Carlton EF, and Geeham DM. Delirium in the intensive care unit: are we helping the patient? Crit Care Nurs Q 2000; 22:47–60.
[9] Ouimet S, Kavanagh BP, Gottfried SB, et al. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007; 33:66–73.
[10] Dubois MJ, Bergeron N, Dumont M, et al. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 2001; 27:1297–1304.
[11] Jacobson S, Dwyer P, Machan J, Carskadon M: Quantitative analysis of rest-activity patterns in elderly postoperative patients with delirium: support for a theory of pathologic wakefulness. J Clin Sleep Med 2008, 4:137-142.
[12] Taguchi T, Yano M, and Kido Y: Influence of bright light therapy on postoperative patients: A pilot study. Intensive Crit Care Nurs 2007, 23:289-297.
[13] Aldemir M, Ozen S, Kara I, Sir A, Bac B: Predisposing factors for delirium in the surgical intensive care unit. Crit Care 2001, 5:265-270.
[14] Pandharipande PP, Shintani A, Peterson JF, Pun BT, Wilkinson GR, Dittus RS, Bernard G, Ely EW: Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology2006, 104:21-26.
[15] Pisani MA, Murphy TE, Van Ness PH, Araujo KLB, and Inouye SK: Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 2007.
References
[2] Yu-Ling Chang, Yun-Fang Tsai, Pyng-Jing Lin, Min-Chi Chen and Chia-Yih Liu. Prevalence and Risk Factors for Postoperative Delirium in a Cardiovascular Intensive Care Unit.American Journal of Critical Care, November 2008, Volume 17, No. 6.
[3] Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA 1996; 275:852–857.
[4] Inouye SK: Deli0rium in older persons. N Engl J Med 2006, 354:1157-1165.
[5] Bart Van Rompaey et al. Risk factors for delirium in intensive care patients: a prospective cohort study, Critical Care 2009, 13:R77.
[6] Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1994 May 4; 271(17):1321.
[7] Brenda T. Pun and E. Wesley Ely, The Importance Of Diagnosing and Managing ICU Delirium Chest 2007; 132; 624-636.
[8] Webb JM, Carlton EF, and Geeham DM. Delirium in the intensive care unit: are we helping the patient? Crit Care Nurs Q 2000; 22:47–60.
[9] Ouimet S, Kavanagh BP, Gottfried SB, et al. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007; 33:66–73.
[10] Dubois MJ, Bergeron N, Dumont M, et al. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 2001; 27:1297–1304.
[11] Jacobson S, Dwyer P, Machan J, Carskadon M: Quantitative analysis of rest-activity patterns in elderly postoperative patients with delirium: support for a theory of pathologic wakefulness. J Clin Sleep Med 2008, 4:137-142.
[12] Taguchi T, Yano M, and Kido Y: Influence of bright light therapy on postoperative patients: A pilot study. Intensive Crit Care Nurs 2007, 23:289-297.
[13] Aldemir M, Ozen S, Kara I, Sir A, Bac B: Predisposing factors for delirium in the surgical intensive care unit. Crit Care 2001, 5:265-270.
[14] Pandharipande PP, Shintani A, Peterson JF, Pun BT, Wilkinson GR, Dittus RS, Bernard G, Ely EW: Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology2006, 104:21-26.
[15] Pisani MA, Murphy TE, Van Ness PH, Araujo KLB, and Inouye SK: Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 2007.