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Delirium in the Cardiac ICU
A diagnosis of delirium in the cardiac intensive care unit significantly affected length of stay and mortality in patients.

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.

Related: Insomnia in the ICU—and After

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.

Related: Using Light to Manage Sleep-Wake Issues in Patients With Dementia

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.

Related: Back to Basics: Practicing Our ABCDEs in the Intensive Care Unit

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.

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mental illness, delirium, cardiac ICU
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A diagnosis of delirium in the cardiac intensive care unit significantly affected length of stay and mortality in patients.
A diagnosis of delirium in the cardiac intensive care unit significantly affected length of stay and mortality in patients.

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.

Related: Insomnia in the ICU—and After

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.

Related: Using Light to Manage Sleep-Wake Issues in Patients With Dementia

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.

Related: Back to Basics: Practicing Our ABCDEs in the Intensive Care Unit

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.

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.

Related: Insomnia in the ICU—and After

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.

Related: Using Light to Manage Sleep-Wake Issues in Patients With Dementia

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.

Related: Back to Basics: Practicing Our ABCDEs in the Intensive Care Unit

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.

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Federal Practitioner - 32(10)
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Delirium in the Cardiac ICU
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Delirium in the Cardiac ICU
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mental illness, delirium, cardiac ICU
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mental illness, delirium, cardiac ICU
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