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. 2012 Dec 31;2(1):51.
doi: 10.1186/2110-5820-2-51.

Delirium in postoperative nonventilated intensive care patients: risk factors and outcomes

Rodrigo Bernardo Serafim  1 , Maximiliano F Dutra, Felipe Saddy, Bernardo Tura, Jose Eduardo Couto de Castro, Luciana C Villarinho, Maria da Gloria Santos, Fernando Augusto Bozza, José Rodolfo Rocco
Affiliations

Delirium in postoperative nonventilated intensive care patients: risk factors and outcomes

Rodrigo Bernardo Serafim et al. Ann Intensive Care. .

Abstract

Background: Delirium features can vary greatly depending on the postoperative population studied; however, most studies focus only on high-risk patients. Describing the impact of delirium and risk factors in mixed populations can help in the development of preventive actions.

Methods: The occurrence of delirium was evaluated prospectively in 465 consecutive nonventilated postoperative patients admitted to a surgical intensive care unit (SICU) using the confusion assessment method (CAM). Patients with and without delirium were compared. A multiple logistic regression was performed to identify the main risk factors for delirium in the first 24 h of admission to the SICU and the main predictors of outcomes.

Results: Delirium was diagnosed in 43 (9.2%) individuals and was more frequent on the second and third days of admission. The presence of delirium resulted in longer lengths of SICU and hospital stays [6 days (3-13) vs. 2 days (1-3), p < 0.001 and 26 days (12-39) vs. 6 days (3-13), p <0.001, respectively], as well as higher hospital and SICU mortality rates [16.3% vs. 4.0%, p = 0.004 and 6.5% vs. 1.7%, p = 0.042, respectively]. The risk factors for delirium were age (odds ratio (OR), 1.04 [1.02-1.07]), Acute Physiologic Score (APS; OR, 1.11 [1.04-1.2]), emergency surgery (OR, 8.05 [3.58-18.06]), the use of benzodiazepines (OR, 2.28 [1.04-5.00]), and trauma (OR, 6.16 [4.1-6.5]).

Conclusions: Delirium negatively impacts postoperative nonventilated patients. Risk factors can be used to detect high-risk patients in a mixed population of SICU patients.

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Figures

Figure 1
Figure 1
Fluxogram of patient inclusion. RASS, Richmond Agitation-Sedation Scale.
Figure 2
Figure 2
Cumulative number of days until delirium diagnosis. This figure shows the percentage of cumulative delirium. Approximately 91% of delirium cases occurred within the first 3 days after SICU admission. There were 9 (21.4%) cases in the first 24 h, 17 (40.5%) on the second day, and 12 (28.6%) on the third day after admission.
Figure 3
Figure 3
Influence of delirium on the probability of death related to the APACHE II score. This figure describes the increase in the probability of hospital mortality according to each point of APACHE II score. APACHE, Acute Physiology and Chronic Health Evaluation II.
See this image and copyright information in PMC

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