Incidence and factors related to delirium in an intensive care unit

To identify the incidence of delirium, compare the demographic and clinical characteristics of patients with and without delirium, and verify factors related to delirium in critical care patients.

METHOD

Prospective cohort with a sample made up of patients hospitalized in the Intensive Care Unit (ICU) of a university hospital. Demographic, clinical variables and evaluation with the Confusion Assessment Method for Intensive Care Unit to identify delirium were processed to the univariate analysis and logistic regression to identify factors related to the occurrence of delirium.

RESULTS

Of the total 149 patients in the sample, 69 (46.3%) presented delirium during ICU stay, whose mean age, severity of illness and length of ICU stay were statistically higher. The factors related to delirium were: age, midazolam, morphine and propofol.

CONCLUSION

Results showed high incidence of ICU delirium associated with older age, use of sedatives and analgesics, emphasizing the need for relevant nursing care to prevent and identify early, patients presenting these characteristics.

Descriptors
Delirium; Intensive Care Units; Nursing Care

Variables	With delirium	Without delirium	p
Variables	(n=69)	(n=80)
Age, median (IQ^* * Interquartile interval )	65 (22.0)	54 (24.25)	0.001^† † Mann-Witney
Sex: Women, n (%)	27 (39.1)	31 (38.8)	1^‡ ‡ Fischer
Men, n (%)	42 (60.9)	49 (61.2)
SAPS-III^§ § Simplified Acute Physiology Score III , mean (SD^\|\| \|\| Standard deviation )	58.2 (+16.1)	44.5 (+16.8)	<0.00^¶ ¶ t test
ACCI^ Age-adjusted Charlson's Comorbidity Index , median (IQ^* * Interquartile interval )	3 (3.0)	2 (2.25)	0.001 ^† † Mann-Witney
ICU admission type: Surgical, n (%) Medical, n (%)	7 (10.0) 62 (90.0)	33 (41.0) 47 (59.0)	<0.00^‡ ‡ Fischer
ICU^†† †† Intensive Care Unit. stay, median (IQ^* * Interquartile interval )	11 (16.0)	4 (4.0)	<0.00^† † Mann-Witney
Death, n (%)	16 (23.2)	9 (11.2)	0.077 ^‡ ‡ Fischer

Variables	With delirium	Without delirium	p^* * Fischer
Variables	(n=69) n (%)	(n=80) n (%)
MPV ^† † mechanical pulmonary ventilation.	54 (78.3)	15 (18.8)	<0.001
Physical restraint	57 (82.6)	8 (10.0)	<0.001
Midazolam	41 (59.4)	9 (11.3)	<0.001
Fentanyl	48 (69.6)	16 (20.0)	<0.001
Propofol	23 (33.3)	6 (7.5)	<0.001
Tramal	48 (69.6)	32 (40.0)	<0.001
Morphine	20 (29.0)	11 (13.8)	0.027

Variable	Estimate	Standard error	OR^* * Odds ratio	CI^† † Confidence interval. 95%	p
Interceptor	-3.85	0.98	0.02	0.00 - 0.15	<0.001
Age	0.04	0.02	1.04	1.01 - 1.07	0.019
Physical restraint	3.79	0.51	44.30	16.15 - 121.48	<0.001

Variable	Estimate	Standard error	OR^* * Odds ratio	CI^† † Confidence interval. 95%	p
Interceptor	-3.87	1.01	0.02	0.00 - 0.15	<0.001
Age	0.04	0.02	1.04	1.01 - 1.07	0.019
Physical restraint	3.70	0.73	40.41	9.74 - 167.62	<0.001
Midazolam	0.55	0.85	1.73	0.32 - 9.20	0.522
Fentanil	-0.48	0.87	0.62	0.11 - 3.38	0.578
Propofol	0.24	0.74	1.27	0.30 - 5.44	0.747

Variable	Estimate	Standard error	OR^* * Odds Ratio.	CI^† † Confidence Interval. 95%	p
Interceptor	-3.52	0.88	0.03	0.01 - 0.17	<0.001
Age	0.04	0.01	1.04	1.01 - 1.07	0.004
Midazolam	1.96	0.46	7.09	2.86 - 17.57	<0.001
Morphine	1.08	0.52	2.95	1.07 - 8.12	0.036
Propofol	1.58	0.59	4.85	1.54 - 15.30	0.007

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Iveth Yamaguchi Whitaker. Escola Paulista de Enfermagem, Universidade Federal de São Paulo. Rua Napoleão de Barros, 754 - Vila Clementino. CEP 04024-002 - São Paulo, SP, Brazil. iveth.whitaker@unifesp.br