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Recurrent delirium episodes within the intensive care unit: Incidence and associated factors
Christina Boncyk1, Kimberly Rengel1, Joanna Stollings2
1Department of Anesthesiology, Vanderbilt University Medical Center, United States of America; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, University Medical Center, Vanderbilt, United States of America.
Insights
Over 10% of intensive care unit (ICU) patients experienced recurrent delirium. Key factors included older age, longer mechanical ventilation, and certain medication exposures, highlighting areas for intervention in critical care settings.
Area of Science:
- Critical Care Medicine
- Neuroscience
- Geriatrics
Background:
- Delirium is a common and serious complication in intensive care units (ICUs).
- Recurrent delirium poses significant challenges to patient recovery and outcomes.
- Understanding factors contributing to delirium recurrence is crucial for effective management.
Purpose of the Study:
- To determine the incidence of recurrent delirium in intensive care unit (ICU) patients.
- To identify patient and hospital-related factors associated with recurrent delirium.
- To inform targeted interventions for preventing delirium recurrence.
Main Methods:
- Retrospective study analyzing data from 8591 ICU admissions with delirium.
- Delirium recurrence defined as a positive assessment after a 48-hour delirium-free period.
- Multivariable logistic regression used to identify independent predictors of recurrent delirium.
Main Results:
- 12.4% of ICU patients with delirium experienced recurrence.
- Factors associated with increased odds of recurrence included older age, shock, and admission to medical, surgical, or trauma ICUs.
- Prolonged mechanical ventilation, propofol use, and antipsychotic medications (haloperidol, quetiapine, olanzapine) were also linked to recurrence.
Conclusions:
- Recurrent delirium affects over 10% of critically ill patients.
- Age, duration of mechanical ventilation, and exposure to specific medications are significant risk factors.
- These findings underscore the need for vigilant monitoring and tailored prevention strategies in the ICU.
Purpose:
Describe the incidence and factors associated with recurrent delirium in the intensive care unit (ICU).
Materials And Methods:
Retrospective study of ICU patients diagnosed with delirium. Delirium clearance defined as 48 h of negative delirium assessments following initial episode and recurrent delirium as any positive delirium assessment following clearance. Multivariable logistic regression model assessed independent association of patient and hospital factors on development of recurrent delirium, adjusting for pre-defined covariates.
Results:
Among 8591 ICU admissions identified with delirium, 1067 (12.4%) had recurrent symptoms. Factors associated with increased odds of recurrent delirium were age (nonlinear; p = 0.02), shock (OR 1.45, 95% CI [1.20, 1.75]), admission to medical (OR 3.25, 95% CI [2.42, 4.37]), surgical (OR 3.00, 95% CI [2.21, 4.06]), or trauma (OR 2.17, 95% CI [1.58, 3.00]) ICU vs. cardiovascular ICU, increased duration of mechanical ventilation (OR 2.43, 95% CI [2.22, 2.65]), propofol use (OR 1.35, 95% CI [1.02, 1.80]), and antipsychotic medications (haloperidol OR 1.53, 95% CI [1.26, 1.86]; quetiapine OR 2.45, 95% CI [1.98, 3.02]; and olanzapine OR 1.54, 95% CI [1.25, 1.88]).
Conclusions:
Over 10% of delirious ICU patients had recurrent symptoms. Factors associated with recurrence included age, duration of mechanical ventilation and medication exposure.
Clinical Trial Number:
Not applicable.
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