Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis
Abstract Background Subsyndromal delirium (SSD) is a frequent condition and has been commonly described as an intermediate stage between delirium and normal cognition. However, the true frequency of SSD and its impact on clinically relevant outcomes in the intensive care unit (ICU) remains unclear....
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-07-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-017-1765-3 |
| _version_ | 1819237495978590208 |
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| author | Rodrigo B. Serafim Marcio Soares Fernando A. Bozza José R. Lapa e Silva Felipe Dal-Pizzol Maria Carolina Paulino Pedro Povoa Jorge I. F. Salluh |
| author_facet | Rodrigo B. Serafim Marcio Soares Fernando A. Bozza José R. Lapa e Silva Felipe Dal-Pizzol Maria Carolina Paulino Pedro Povoa Jorge I. F. Salluh |
| author_sort | Rodrigo B. Serafim |
| collection | DOAJ |
| description | Abstract Background Subsyndromal delirium (SSD) is a frequent condition and has been commonly described as an intermediate stage between delirium and normal cognition. However, the true frequency of SSD and its impact on clinically relevant outcomes in the intensive care unit (ICU) remains unclear. Methods We performed a systematic search in PubMed, Embase, CINAHL, Cochrane Library, and PsychINFO, with no language restrictions, up to 1 October 2016 to identify publications that evaluated SSD in ICU patients. Results The six eligible studies were evaluated. SSD was present in 950 (36%) patients. Four studies evaluated only surgical patients. Four studies used the Intensive Care Delirium Screening Checklist (ICDSC) and two used the Confusion Assessment Method (CAM) score to diagnose SSD. The meta-analysis showed an increased hospital length of stay (LOS) in SSD patients (0.31, 0.12–0.51, p = 0.002; I 2 = 34%). Hospital mortality was described in two studies but it was not significant (hazard ratio 0.97, 0.61–1.55, p = 0.90 and 5% vs 9%, p = 0.05). The use of antipsychotics in SSD patients to prevent delirium was evaluated in two studies but it did not modify ICU LOS (6.5 (4–8) vs 7 (4–9) days, p = 0.66 and 2 (2–3) vs 3 (2–3) days, p = 0.517) or mortality (9 (26.5%) vs 7 (20.6%), p = 0.55). Conclusions SSD occurs in one-third of the ICU patients and has limited impact on the outcomes. The current literature concerning SSD is composed of small-sample studies with methodological differences, impairing a clear conclusion about the association between SSD and progression to delirium or worse ICU clinical outcomes. |
| first_indexed | 2024-12-23T13:21:15Z |
| format | Article |
| id | doaj.art-ad0615dda14f4ffabc0577d25994ebe1 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-23T13:21:15Z |
| publishDate | 2017-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-ad0615dda14f4ffabc0577d25994ebe12022-12-21T17:45:28ZengBMCCritical Care1364-85352017-07-012111710.1186/s13054-017-1765-3Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysisRodrigo B. Serafim0Marcio Soares1Fernando A. Bozza2José R. Lapa e Silva3Felipe Dal-Pizzol4Maria Carolina Paulino5Pedro Povoa6Jorge I. F. Salluh7Instituto D’Or de pesquisa e ensinoInstituto D’Or de pesquisa e ensinoInstituto D’Or de pesquisa e ensinoHospital Universitário Clementino Fraga Filho/Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Av. Prof. Rodolpho Paulo RoccoLaboratório de patofisiologia experimental, Programa de graduação em ciências médicas, Universidade do Extremos Sul CatarinenseUnidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa OcidentalUnidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa OcidentalInstituto D’Or de pesquisa e ensinoAbstract Background Subsyndromal delirium (SSD) is a frequent condition and has been commonly described as an intermediate stage between delirium and normal cognition. However, the true frequency of SSD and its impact on clinically relevant outcomes in the intensive care unit (ICU) remains unclear. Methods We performed a systematic search in PubMed, Embase, CINAHL, Cochrane Library, and PsychINFO, with no language restrictions, up to 1 October 2016 to identify publications that evaluated SSD in ICU patients. Results The six eligible studies were evaluated. SSD was present in 950 (36%) patients. Four studies evaluated only surgical patients. Four studies used the Intensive Care Delirium Screening Checklist (ICDSC) and two used the Confusion Assessment Method (CAM) score to diagnose SSD. The meta-analysis showed an increased hospital length of stay (LOS) in SSD patients (0.31, 0.12–0.51, p = 0.002; I 2 = 34%). Hospital mortality was described in two studies but it was not significant (hazard ratio 0.97, 0.61–1.55, p = 0.90 and 5% vs 9%, p = 0.05). The use of antipsychotics in SSD patients to prevent delirium was evaluated in two studies but it did not modify ICU LOS (6.5 (4–8) vs 7 (4–9) days, p = 0.66 and 2 (2–3) vs 3 (2–3) days, p = 0.517) or mortality (9 (26.5%) vs 7 (20.6%), p = 0.55). Conclusions SSD occurs in one-third of the ICU patients and has limited impact on the outcomes. The current literature concerning SSD is composed of small-sample studies with methodological differences, impairing a clear conclusion about the association between SSD and progression to delirium or worse ICU clinical outcomes.http://link.springer.com/article/10.1186/s13054-017-1765-3Subsyndromal deliriumDeliriumICUCritically ill |
| spellingShingle | Rodrigo B. Serafim Marcio Soares Fernando A. Bozza José R. Lapa e Silva Felipe Dal-Pizzol Maria Carolina Paulino Pedro Povoa Jorge I. F. Salluh Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis Critical Care Subsyndromal delirium Delirium ICU Critically ill |
| title | Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis |
| title_full | Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis |
| title_fullStr | Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis |
| title_full_unstemmed | Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis |
| title_short | Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis |
| title_sort | outcomes of subsyndromal delirium in icu a systematic review and meta analysis |
| topic | Subsyndromal delirium Delirium ICU Critically ill |
| url | http://link.springer.com/article/10.1186/s13054-017-1765-3 |
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