Persistence of Delirium after Cessation of Sedatives and Analgesics and Impact on Clinical Outcomes in Critically Ill Patients.
Persistence of Delirium after Cessation of Sedatives and Analgesics and Impact on Clinical Outcomes in Critically Ill Patients.
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DOI：
10.1002/phar.2021
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发表时间：
2017-11
期刊：
影响因子：
4.1
通讯作者：
Pandharipande PP
中科院分区：
文献类型：
--
作者：
Kenes MT;Stollings JL;Wang L;Girard TD;Ely EW;Pandharipande PP
As delirium is a common manifestation in critically ill patients and is associated with worse clinical outcomes, we sought to characterize the reversibility of delirium after discontinuation of sedation and to determine whether sedation-associated delirium that rapidly reverses impacts clinical outcomes. Post hoc subgroup analysis of prospectively collected data from a previously published study. Seventy adults admitted to a medical intensive care unit (ICU) between March and July 2012 who required mechanical ventilation with continuous analgesia and/or sedation and underwent a spontaneous awakening trial (SAT). Patients were grouped into four categories: delirium free, rapidly reversible delirium (RRD; defined as delirium always resolving within 4 hours of stopping sedatives), persistent delirium (PD; defined as delirium always persisting for 4 or more hours after stopping sedatives), or mixed delirium (consisting of RRD and PD episodes). The incidence of the four delirium subtypes and their associations with clinical outcomes were evaluated. A validated, guideline-recommended, bedside delirium monitoring instrument—the Confusion Assessment Method for the ICU (CAM-ICU)—was used to assess for the presence or absence of delirium. Clinical outcomes included ventilator-free days at day 28, ICU and hospital length of stay, 28-day mortality, and patient disposition; time to first CAM-ICU becoming negative (delirium free) for a continuous 48-hour duration was also assessed. A total of 103 SATs were performed in the 70 patients. Of the 103 SATs, 28 (27.2%) were CAM-ICU negative prior to the SAT. Of the remaining 75 SATs, PD was present for the majority of SATs (62 [82.7%]); RRD was present after 13 (17.3%) SATs. On a patient level, 17 patients (24.3%) were always delirium free prior to cessation of medications for continuous sedation. Of the 53 patients with delirium before undergoing an SAT, 11 (20.8%) had RRD, 2 (3.8%) had mixed delirium, and 40 (75.5%) had PD. Proportional odds logistic regression adjusting for age, Acute Physiology and Chronic Health Evaluation II score, sepsis, and preexisting hypertension showed that patients with PD had a higher probability of longer ICU length of stay (odds ratio 4.01 [95% confidence interval 1.36–11.77], p=0.011), but those with RRD did not. Despite the cessation of medications for continuous sedation, delirium persisted for the majority of patients and was associated with worse outcomes, which attests to the importance of strategies to minimize sedation.
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DOI：
10.1056/nejmoa1301372
发表时间：
2013-10-03
期刊：
The New England journal of medicine
影响因子：
--
作者：
Pandharipande PP;Girard TD;Jackson JC;Morandi A;Thompson JL;Pun BT;Brummel NE;Hughes CG;Vasilevskis EE;Shintani AK;Moons KG;Geevarghese SK;Canonico A;Hopkins RO;Bernard GR;Dittus RS;Ely EW;BRAIN-ICU Study Investigators
通讯作者：
BRAIN-ICU Study Investigators
影响因子：
39
作者：
Hshieh, Tammy T.;Yue, Jirong;Oh, Esther;Puelle, Margaret;Dowal, Sarah;Travison, Thomas;Inouye, Sharon K.
通讯作者：
Inouye, Sharon K.
影响因子：
8.8
作者：
Pandharipande, P;Shintani, A;Ely, EW
通讯作者：
Ely, EW
影响因子：
8.8
作者：
Balas MC;Vasilevskis EE;Olsen KM;Schmid KK;Shostrom V;Cohen MZ;Peitz G;Gannon DE;Sisson J;Sullivan J;Stothert JC;Lazure J;Nuss SL;Jawa RS;Freihaut F;Ely EW;Burke WJ
通讯作者：
Burke WJ
影响因子：
38.9
作者：
Dubois, MJ;Bergeron, N;Skrobik, Y
通讯作者：
Skrobik, Y