Rapidly Reversible, Sedation-related Delirium versus Persistent Delirium in the ICU.
Am J Respir Crit Care Med. 2014 Jan 14;
Authors: Patel SB, Poston JT, Pohlman A, Hall JB, Kress JP
Background: ICU delirium is associated with ventilator, ICU and hospital days; discharge functional status; and mortality. Whether rapidly reversible, sedation-related delirium (delirium that abates shortly after sedative interruption) occurs with the same frequency and portends the same prognosis as persistent delirium (delirium that persists despite a short period of sedative interruption) is unknown. Methods: To compare rapidly reversible, sedation-related delirium and persistent delirium. Prospective cohort study of 102 adult, intubated MICU subjects in a tertiary care teaching hospital. CAM-ICU evaluation before and after daily interruption of continuous sedation (DIS). Investigators blinded to each other's assessments and to whether evaluations were before or after DIS. Primary outcome: proportion of days with no delirium vs. rapidly reversible, sedation-related delirium vs. persistent delirium. Secondary outcomes: ventilator, ICU, and hospital days; discharge disposition; one-year mortality. Findings: Median proportion of ICU days with delirium: 0.57 before vs. 0.50 after DIS (p<0.001). CAM-ICU assessment: 10.5 times more likely to indicate delirium prior to DIS versus after (p<0.001). Rapidly reversible, sedation-related delirium; fewer ventilator (p<0.001), ICU (p=0.001), and hospital days (p<0.001) than persistent delirium. No delirium and rapidly reversible, sedation-related delirium subjects: more likely to discharge home (p<0.001). Persistent delirium: increased one-year mortality vs. no delirium and rapidly reversible, sedation-related delirium (p<0.001). Interpretation: Rapidly reversible, sedation-related delirium does not signify the same poor prognosis as persistent delirium. Degree of sedation should be considered in delirium assessments. Coordinating delirium assessments with daily sedative interruption will improve such assessments' ability to prognosticate ICU delirium outcomes.
PMID: 24423152 [PubMed - as supplied by publisher]