The Association Between ARDS, Delirium, and In-hospital Mortality in ICU Patients.
Am J Respir Crit Care Med. 2014 Nov 13;
Authors: Hsieh SJ, Soto GJ, Hope AA, Ponea A, Gong MN
RATIONALE: Both acute respiratory distress syndrome (ARDS) and ICU delirium are associated with significant morbidity and mortality. However, the risk of delirium and its impact on mortality in ARDS patients is unknown.
OBJECTIVES: To determine if ARDS is associated with a higher risk for delirium compared to respiratory failure without ARDS, and to determine the association between ARDS and in-hospital mortality after adjusting for delirium. Methods: Prospective observational cohort study of adult ICU patients admitted to two urban academic hospitals.
MEASUREMENTS: Delirium was assessed daily using the Confusion Assessment Method for the Intensive Care Unit and Richmond Agitation and Sedation Scale.
MAIN RESULTS: Of the 564 patients in our cohort, 48 had ARDS (9%). Intubated patients with ARDS had to highest prevalence of delirium compared to intubated patients without ARDS and non-intubated patients (73% vs 52% vs 21%, respectively; p<0.001). After adjusting for common risk factors for delirium, ARDS was associated with a higher risk for delirium compared to mechanical ventilation without ARDS (OR 6.55 [1.56, 27.54], p=0.01) vs (OR 1.98 [1.16, 3.40], p<0.013); reference was non-intubated patients. While ARDS was significantly associated with hospital mortality (OR 10.44 [3.16-34.50]), the effect was largely reduced after adjusting for delirium and persistent coma (OR 5.63 [1.55 - 20.45]).
CONCLUSIONS: Our findings suggest that ARDS is associated with a greater risk for ICU delirium than mechanical ventilation alone, and that the association between ARDS and in-hospital mortality is weakened after adjusting for delirium and coma. Future studies are needed to determine if prevention and reduction of delirium in ARDS patients can improve outcomes.
PMID: 25393331 [PubMed - as supplied by publisher]