Prevalence, Risk Factors, and Outcomes of Delirium in Mechanically

Ventilated Adults*
Critical Care Medicine
Issue: Volume 43(3), March 2015, p 557566

SLEAP (JAMA 2012) was a multicenter trial in which mechanically ventilated

critically ill adults were randomised to either protocolised sedation or protocolised
sedation plus daily sedation interruption. No difference could be found in the
primary outcome of duration of MV or in secondary outcomes including lengths of
ICU and hospital stay and adverse events.
During the SLEAP trial, patients were also evaluated daily for delirium using the
Intensive Care Delirium Screening Checklist (ICDSC). Positive screening was defined
as ICDSC of 4 or more.
In this paper, the authors performed a secondary analysis on SLEAP data to
investigate the impact of presence delirium on the length of mechanical
ventilation and hospitalisation in the study patients (n=420).
Results:

The main finding was that patients with a delirium had a longer duration of
ventilation (13 vs 7 d; p < 0.001), ICU stay (12 vs 8 d; p < 0.0001) and also
longer stay
Delirium was common, with 54% (226 out of 420) of patients experiencing
at least 1 day of delirium. Only 4% of patients never had any features of
delirium.
Coma was identified in 32.7% of delirious compared with 22.7% of
nondelirious patients (p = 0.03)
Males were more likely to delirius (61.1% vs 46.6%; p = 0.005)
Tobacco use (31.5% vs 16.2%; p = 0.002) or alcohol use (34.6% vs 20.9%; p =
0.009) and a surgical diagnosis (21.2% vs 11.0%; p = 0.030) made the
patients more likely to have delirium
Tracheostomy (34.6% vs 15.5%; p < 0.0001) and physical restraint (86.3% vs
76.7%; p = 0.014)
Antecedent factor that was most significantly associated with delirium was
use of physical restraint (hazard ratio, 1.87; 95% CI, 1.332.63; p = 0.0003)

Comments:

In this study delirium screening was done only once in a day and therefore
the actual prevalence could be underestimated

Delirium screen was positive at ICDSC score 4 or more and therefore

patients with lesser score were not thought to have delirium although they
would have had some elements of that
There was some issue with the scoring system as well around the influence
of sedation on the scoring
However, for me the question remains whether delirium has a causal
relationship with poorer outcome or it is merely an association and this
question is yet to be answered. A previous meta-analysis failed to show that
limiting delirium has a positive impact on mortality reduction.