Open Access Research

Delirium in postoperative nonventilated intensive care patients: risk factors and outcomes

Rodrigo Bernardo Serafim123*, Maximiliano F Dutra4, Felipe Saddy1, Bernardo Tura2, Jose Eduardo Couto de Castro4, Luciana C Villarinho4, Maria da Gloria Santos4, Fernando Augusto Bozza25 and José Rodolfo Rocco3

Author Affiliations

1 Ventilatory Care Unit, Copa D’Or Hospital, Rio de Janeiro, Brazil

2 D’Or Institute of Research and Education, Rio de Janeiro, Brazil

3 Department of Internal Medicine and Post-graduated Program, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

4 Surgical Intensive Care Unit, Copa D’Or Hospital, Rio de Janeiro, Brazil

5 ICU, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil

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Annals of Intensive Care 2012, 2:51  doi:10.1186/2110-5820-2-51

Published: 31 December 2012

Abstract

Background

Delirium features can vary greatly depending on the postoperative population studied; however, most studies focus only on high-risk patients. Describing the impact of delirium and risk factors in mixed populations can help in the development of preventive actions.

Methods

The occurrence of delirium was evaluated prospectively in 465 consecutive nonventilated postoperative patients admitted to a surgical intensive care unit (SICU) using the confusion assessment method (CAM). Patients with and without delirium were compared. A multiple logistic regression was performed to identify the main risk factors for delirium in the first 24 h of admission to the SICU and the main predictors of outcomes.

Results

Delirium was diagnosed in 43 (9.2%) individuals and was more frequent on the second and third days of admission. The presence of delirium resulted in longer lengths of SICU and hospital stays [6 days (3–13) vs. 2 days (1–3), p < 0.001 and 26 days (12–39) vs. 6 days (3–13), p <0.001, respectively], as well as higher hospital and SICU mortality rates [16.3% vs. 4.0%, p = 0.004 and 6.5% vs. 1.7%, p = 0.042, respectively]. The risk factors for delirium were age (odds ratio (OR), 1.04 [1.02-1.07]), Acute Physiologic Score (APS; OR, 1.11 [1.04-1.2]), emergency surgery (OR, 8.05 [3.58-18.06]), the use of benzodiazepines (OR, 2.28 [1.04-5.00]), and trauma (OR, 6.16 [4.1-6.5]).

Conclusions

Delirium negatively impacts postoperative nonventilated patients. Risk factors can be used to detect high-risk patients in a mixed population of SICU patients.

Keywords:
Delirium; Postoperative; Surgery; Confusion assessment method