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Insomnia in the ICU—and After
A cultural shift is leading to more interest in improving the quality of life in the intensive care unit.
It should be no surprise that delirium, a problem long acknowledged in general intensive care unit (ICU) patients, would be increasingly prevalent in the cardiac ICU (CICU) as well, say researchers from University of North Carolina (UNC) Chapel Hill: Patients are sicker than ever before, with more comorbidities and more critical illness. But although emerging data have highlighted the growing critical care burden in the contemporary CICU, they say, much less is known about delirium in this setting.
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To help clarify, they analyzed records for CICU patients admitted to the UNC CICU between December 2012 and March 2014. Of 670 patients, 590 (88%) had a documented delirium score. Of those, 120 (20%) were diagnosed with delirium, as measured by the Confusion Assessment Method for the ICU (CAM-ICU).
Patients with delirium were more likely to be older, to have a history of end-stage renal disease, and to be more severely ill at baseline. Patients admitted after cardiac arrest or with acute valvular disease or acute respiratory failure were more likely to be CAM-ICU positive.
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Patients with delirium in the CICU had longer median ICU stays (5 vs 2 days). The researchers say they found no significant interaction between disease severity and the CAM-ICU score. Only delirium, history of chronic heart failure, and the APACHE II score were significantly associated with CICU length of stay.
The researchers say delirium was a “robust” predictor of mortality. If patients survived to discharge, they were more likely to transfer to a skilled nursing facility, rehabilitation center, or long-term acute care hospital.
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This is the first study, the researchers say, to evaluate nonsurgical CICU patients regardless of age or diagnosis. It is also the first time a study has shown the incremental prognostic value of delirium in the CICU. Ultimately, delirium was independently prognostic even when more traditional severity-of-illness measures were available.
Source
Pauley E, Lishmanov A, Schumann S, Gala GJ, van Diepen S, Katz JN. Am Heart J. 2015;170(1):79-86.e1.
doi: 10.1016/j.ahj.2015.04.013.