Delirium Screening and Pharmacotherapy in the ICU: The Patients Are Not the Only Ones Confused
<i>Background</i>: Delirium is difficult to measure in the Intensive Care Unit (ICU). It is possible that by considering the rate of screening, incidence, and rate of treatment with antipsychotic medications (APMs) for suspected delirium, a clearer picture can emerge. <i>Methods<...
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MDPI AG
2023-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/17/5671 |
| _version_ | 1797582294374940672 |
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| author | F. Eduardo Martinez Rebecca Tee Amber-Louise Poulter Leah Jordan Liam Bell Zsolt J. Balogh |
| author_facet | F. Eduardo Martinez Rebecca Tee Amber-Louise Poulter Leah Jordan Liam Bell Zsolt J. Balogh |
| author_sort | F. Eduardo Martinez |
| collection | DOAJ |
| description | <i>Background</i>: Delirium is difficult to measure in the Intensive Care Unit (ICU). It is possible that by considering the rate of screening, incidence, and rate of treatment with antipsychotic medications (APMs) for suspected delirium, a clearer picture can emerge. <i>Methods</i>: A retrospective, observational study was conducted at two ICUs in Australia, between April and June of 2020. All adult ICU patients were screened; those who spoke English and did not have previous neurocognitive pathology or intracranial pathology were included in the analysis. Data were collected from the hospitals’ electronic medical records. The primary outcome was incidence of delirium based on the use of the Confusion Assessment Method for ICU (CAM-ICU). Secondary outcomes included measures of screening for delirium, treatment of suspected delirium with APMs, and identifying clinical factors associated with both delirium and the use of APMs. <i>Results</i>: From 736 patients that were screened, 665 were included in the analysis. The incidence of delirium was 11.3% (75/665); on average, the Richmond Agitation and Sedation Scale (RASS) was performed every 2.9 h and CAM-ICU every 40 h. RASS was not performed in 8.4% (56/665) of patients and CAM-ICU was not performed in 40.6% (270/665) of patients. A total of 17% (113/665) of patients were prescribed an APM, with quetiapine being the most used. ICU length of stay (LOS), APACHE-III score, and the use of alpha-2 agonists were associated with the presence of delirium, while ICU LOS, the use of alpha-2 agonists, and the presence of delirium were associated with patients receiving APMs. <i>Conclusions</i>: The incidence of delirium was lower than previously reported, at 11.3%. The rate of screening for delirium was low, while the use of APMs for delirium was higher than the incidence of delirium. It is possible that the true incidence is higher than what was measured. Critical prospective assessment is required to optimize APM indications in the ICU. |
| first_indexed | 2024-03-10T23:20:02Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T23:20:02Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-f8cb2182eb0c42b489dbbf5eb989819c2023-11-19T08:23:47ZengMDPI AGJournal of Clinical Medicine2077-03832023-08-011217567110.3390/jcm12175671Delirium Screening and Pharmacotherapy in the ICU: The Patients Are Not the Only Ones ConfusedF. Eduardo Martinez0Rebecca Tee1Amber-Louise Poulter2Leah Jordan3Liam Bell4Zsolt J. Balogh5Intensive Care Unit, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2305, AustraliaIntensive Care Unit, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2305, AustraliaIntensive Care Unit, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2305, AustraliaIntensive Care Unit, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2305, AustraliaIntensive Care Unit, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2305, AustraliaSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia<i>Background</i>: Delirium is difficult to measure in the Intensive Care Unit (ICU). It is possible that by considering the rate of screening, incidence, and rate of treatment with antipsychotic medications (APMs) for suspected delirium, a clearer picture can emerge. <i>Methods</i>: A retrospective, observational study was conducted at two ICUs in Australia, between April and June of 2020. All adult ICU patients were screened; those who spoke English and did not have previous neurocognitive pathology or intracranial pathology were included in the analysis. Data were collected from the hospitals’ electronic medical records. The primary outcome was incidence of delirium based on the use of the Confusion Assessment Method for ICU (CAM-ICU). Secondary outcomes included measures of screening for delirium, treatment of suspected delirium with APMs, and identifying clinical factors associated with both delirium and the use of APMs. <i>Results</i>: From 736 patients that were screened, 665 were included in the analysis. The incidence of delirium was 11.3% (75/665); on average, the Richmond Agitation and Sedation Scale (RASS) was performed every 2.9 h and CAM-ICU every 40 h. RASS was not performed in 8.4% (56/665) of patients and CAM-ICU was not performed in 40.6% (270/665) of patients. A total of 17% (113/665) of patients were prescribed an APM, with quetiapine being the most used. ICU length of stay (LOS), APACHE-III score, and the use of alpha-2 agonists were associated with the presence of delirium, while ICU LOS, the use of alpha-2 agonists, and the presence of delirium were associated with patients receiving APMs. <i>Conclusions</i>: The incidence of delirium was lower than previously reported, at 11.3%. The rate of screening for delirium was low, while the use of APMs for delirium was higher than the incidence of delirium. It is possible that the true incidence is higher than what was measured. Critical prospective assessment is required to optimize APM indications in the ICU.https://www.mdpi.com/2077-0383/12/17/5671deliriumIntensive Care Unithospitalizationincidenceantipsychotic agents |
| spellingShingle | F. Eduardo Martinez Rebecca Tee Amber-Louise Poulter Leah Jordan Liam Bell Zsolt J. Balogh Delirium Screening and Pharmacotherapy in the ICU: The Patients Are Not the Only Ones Confused Journal of Clinical Medicine delirium Intensive Care Unit hospitalization incidence antipsychotic agents |
| title | Delirium Screening and Pharmacotherapy in the ICU: The Patients Are Not the Only Ones Confused |
| title_full | Delirium Screening and Pharmacotherapy in the ICU: The Patients Are Not the Only Ones Confused |
| title_fullStr | Delirium Screening and Pharmacotherapy in the ICU: The Patients Are Not the Only Ones Confused |
| title_full_unstemmed | Delirium Screening and Pharmacotherapy in the ICU: The Patients Are Not the Only Ones Confused |
| title_short | Delirium Screening and Pharmacotherapy in the ICU: The Patients Are Not the Only Ones Confused |
| title_sort | delirium screening and pharmacotherapy in the icu the patients are not the only ones confused |
| topic | delirium Intensive Care Unit hospitalization incidence antipsychotic agents |
| url | https://www.mdpi.com/2077-0383/12/17/5671 |
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