Korean J Psychosom Med.  2019 Jun;27(1):35-41. 10.22722/KJPM.2019.27.1.35.

Incidence and Procedure-Related Risk Factors of Delirium in Patients Admitted to an Intensive Care Unit

Affiliations
  • 1Graduate Program in Cognitive Science, Yonsei University, Seoul, Korea.
  • 2Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea. empathy@yuhs.ac
  • 3Department of Psychiatry, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea.
  • 4Department of Psychiatry, National Health Insurance Ilsan Hospital, Goyang, Korea.
  • 5Department of Psychiatry, Severance Hospital, Yonsei University Health System, Seoul, Korea.

Abstract


OBJECTIVES
Although delirium is a common complication among patients hospitalized in intensive care units(ICUs), little is known about the roles that diagnostic and therapeutic procedures play in its development. This study investigates the procedure-related risk factors of delirium in ICU patients.
METHODS
All the consecutive patients admitted to the ICU between June 2016 and May 2017 were routinely evaluated for delirium by psychiatrists. In total, 1156 patients met the inclusion criteria and were retrospectively analyzed. A multiple logistic regression analysis was conducted to investigate independent risk factors of delirium development while adjusting for other characteristics.
RESULTS
The age, Acute Physiology and Chronic Health Evaluation (APACHE II) score, proportion of patients who had undergone an operation, and proportion of patients who were foley catheterized, mechanically ventilated, and physically restrained were higher in the delirium group. The multiple logistic regression analysis confirmed that the use of restraint was an independent risk factor of delirium (odds ratio : 10.006 ; 95% confidence interval : 6.120-16.360 ; p<0.001). The patient factors independently associated with delirium were an advanced age and a higher APACHE II score. The incidence of delirium was 15.3%.
CONCLUSIONS
There is a high prevalence of delirium influenced by potentially harmful procedures in patients in ICU settings. The use of physical restraint had the strongest association with the development of delirium. These findings advocate the need to target procedure-related risk factors such as the use of restraints as preventive intervention measures for ICU delirium.

Keyword

Delirium; Intensive care unit; Risk factors; Restraint

MeSH Terms

APACHE
Catheters
Critical Care*
Delirium*
Humans
Incidence*
Intensive Care Units*
Logistic Models
Prevalence
Psychiatry
Restraint, Physical
Retrospective Studies
Risk Factors*
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