The impact of delirium in the intensive care unit on hospital length of stay

By E. W. Ely, S. Gautam, R. Margolin, J. Francis, L. May, Theodore Speroff, B. Truman, Robert S. Dittus, Gordon R. Bernard, S. Inouye. Intensive Care Medicine, 2001

1,045 citations recorded by the source corpus.

Abstract.Study objective: To determine the relationship between delirium in the intensive care unit (ICU) and outcomes including length of stay in the hospital. Design: A prospective cohort study. Setting: The adult medical ICU of a tertiary care, university-based medical center. Participants: The study population consisted of 48 patients admitted to the ICU, 24 of whom received mechanical ventilation. Measurements: All patients were evaluated for the development and persistence of delirium on a daily basis by a geriatric or psychiatric specialist with expertise in delirium assessment using the Diagnostic Statistical Manual IV (DSM-IV) criteria of the American Psychiatric Association, the reference standard for delirium ratings. Primary outcomes measured were length of stay in the ICU and hospital. Results: The mean onset of delirium was 2.6 days (S.D.±1.7), and the mean duration was 3.4±1.9 days. Of the 48 patients, 39 (81.3%) developed delirium, and of these 29 (60.4%) developed the complication while still in the ICU. The duration of delirium was associated with length of stay in the ICU (r=0.65, P=0.0001) and in the hospital (r=0.68, P<0.0001). Using multivariate analysis, delirium was the strongest predictor of length of stay in the hospital (P=0.006) even after adjusting for severity of illness, age, gender, race, and days of benzodiazepine and narcotic drug administration. Conclusions: In this patient cohort, the majority of patients developed delirium in the ICU, and delirium was the strongest independent determinant of length of stay in the hospital. Further study and monitoring of delirium in the ICU and the risk factors for its development are warranted.

Subfields: Critical Care and Intensive Care Medicine, Radiological and Ultrasound Technology

View Paper: https://www.semanticscholar.org/paper/c0c2cd30dd839d3f2b0502bdda99cb1ac58c0052

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In Critical Care and Intensive Care Medicine

Citations in the corpus

Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. (2007, background): “Duration of brain organ dysfunction, d Delirium-free and coma-freeb 7 (1-10) 3 (1-6) .”
Incidence, risk factors and consequences of ICU delirium (2006, background): “Delirium incidence over 80% has been reported in critically ill patients [6, 7, 8, 9], as have threefold increases in the risk of mortality [9].”
Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. (2004, methodology): “Using these instruments, our pilot study showed that delirium in the ICU was an important determinant of length of hospital stay.(41) We undertook the current study to test the hypothesis that delirium in the ICU is an independent predictor of 6-month mortality and length of stay among patients rece”
Delirium as a Predictor of Long-Term Cognitive Impairment in Survivors of Critical Illness (2010, background): “Also, non-ICU patients are considered at high risk for delirium when they have 3 risk factors (59, 60), whereas patients in the ICU are exposed on average to 10 or more risk factors for delirium (61).”
Costs associated with delirium in mechanically ventilated patients* (2004, background): “On the other hand, little is known about the economic impact of delirium in critically ill patients, despite the fact that it occurs in the majority of those treated in the ICU (6, 7).”
Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit (2013, methodology): “It is therefore important that the predictive relationship between delirium and hospital LOS was also strong in seven of nine studies (318, 319, 322, 323, 361, 364, 367), including three high-quality studies that accounted for immortal time bias (318, 322, 368).”