Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018;9(2):105-112.
doi: 10.5847/wjem.j.1920-8642.2018.02.004.

Predisposing factors, clinical assessment, management and outcomes of agitation in the trauma intensive care unit

Saeed Mahmood  1 , Omaima Mahmood  2 , Ayman El-Menyar  3   4 , Mohammad Asim  3 , Hassan Al-Thani  1
Affiliations

Predisposing factors, clinical assessment, management and outcomes of agitation in the trauma intensive care unit

Saeed Mahmood et al. World J Emerg Med. 2018.

Abstract

Background: Agitation occurs frequently among critically ill patients admitted to the intensive care unit (ICU). We aimed to evaluate the frequency, predisposing factors and outcomes of agitation in trauma ICU.

Methods: A retrospective analysis was conducted to include patients who were admitted to the trauma ICU between April 2014 and March 2015. Data included patient's demographics, initial vitals, associated injuries, Ramsey Sedation Scale, Glasgow Coma Scale, head injury lesions, use of sedatives and analgesics, head interventions, ventilator days, and ICU length of stay. Patients were divided into two groups based on the agitation status.

Results: A total of 102 intubated patients were enrolled; of which 46 (45%) experienced agitation. Patients in the agitation group were 7 years younger, had significantly lower GCS and sustained higher frequency of head injuries (P<0.05). Patients who developed agitation were more likely to be prescribed propofol alone or in combination with midazolam and to have frequent ICP catheter insertion, longer ventilatory days and higher incidence of pneumonia (P<0.05). On multivariate analysis, use of propofol alone (OR=4.97; 95% CI=1.35-18.27), subarachnoid hemorrhage (OR=5.11; 95% CI=1.38-18.91) and ICP catheter insertion for severe head injury (OR=4.23; 95% CI=1.16-15.35) were independent predictors for agitation (P<0.01).

Conclusion: Agitation is a frequent problem in trauma ICU and is mainly related to the type of sedation and poor outcomes in terms of prolonged mechanical ventilation and development of nosocomial pneumonia. Therefore, understanding the main predictors of agitation facilitates early risk-stratification and development of better therapeutic strategies in trauma patients.

Keywords: Agitation; Head injury; Intensive care unit; Outcome; Propofol; Trauma.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: The authors declare that there are no conflicts of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
Frequency of Ramsey Sedation Scale in trauma ICU patients.
Figure 2
Figure 2
Types of TBI lesions by agitation status (*P=0.001).
See this image and copyright information in PMC

References

    1. Lombard LA, Zafonte RD. Agitation after traumatic brain injury: considerations and treatment options. Am J Phys Med Rehabil. 2005;84(10):797–812. - PubMed
    1. Sabzghabaee AM, Yaraghi A, Khalilidehkordi E, Mirhosseini SM, Beheshtian E, Eizadi-Mood N. The outcome of agitation in poisoned patients in an Iranian tertiary care university hospital. Neurol Res Int. 2014;2014:275064. - PMC - PubMed
    1. Crippen D. Agitation in the ICU: part one Anatomical and physiologic basis for the agitated state. Crit Care. 1999;3(3):R35–R46. - PMC - PubMed
    1. Chevrolet JC, Jolliet P. Clinical review: agitation and delirium in the critically ill--significance and management. Crit Care. 2007;11(3):214. - PMC - PubMed
    1. Treggiari MM, Romand JA, Yanez ND, Deem SA, Goldberg J, Hudson L, et al. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med. 2009;37(9):2527–34. - PubMed

LinkOut - more resources