background


Benzodiazepine and Opioid Use and the Duration of Intensive Care Unit Delirium in an Older Population

 

Margaret A. Pisani, Terrence E. Murphy, Katy L. B. Araujo, Patricia Slattum, Peter H. Van Ness, Sharon K. Inouye

 

 

 Crit Care Med 2009; 37:177–183 

 

 

 

Objective: there is a high prevalence of delirium in older medical intensive care unit (ICU) patients and this is associated with adverse outcomes. We need to identify changeable risks factors for delirium, such as medication use, in the ICU. The objective of this study was to examine the impact of benzodiazepine or opioid use on the duration of ICU delirium in an older medical population.

Design: prospective cohort study.

Setting: fourteen-bed medical intensive care unit in an urban university teaching hospital.

Patients: 304 consecutive admissions age 60 and older.

Interventions: none.

Main Outcome Measurements: the main outcome measure was duration of ICU delirium, specifically the first episode of ICU delirium. Patients were assessed daily for delirium with the Confusion Assessment Method for the ICU and a validated chart review method. Our main predictor was receiving benzodiazepines or opioids during ICU stay. A multivariable model was developed using Poisson rate regression.

Results: delirium occurred in 239 of 304 patients (79%). The median duration of ICU delirium was 3 days with a range of 1–33 days. In a multivariable regression model, receipt of a benzodiazepine or opioid (rate ratio [RR] 1.64, 95% confidence interval [CI] 1.27- 2.10) was associated with increased delirium duration. Other variables associated with delirium duration in this analysis include preexisting dementia (RR 1.19, 95% CI 1.07–1.33), receipt of haloperidol (RR 1.35, 95% CI 1.21–1.50), and severity of illness (RR 1.01, 95% CI 1.00 –1.02).

Conclusions: the use of benzodiazepines or opioids in the ICU is associated with longer duration of a first episode of delirium. Receipt of these medications may represent modifiable risk factors for delirium. Clinicians caring for ICU patients should carefully evaluate the need for benzodiazepines, opioids, and haloperidol.

 

fulltext

chi siamo_nostre pubblicazioni_sedazione_pz_critico

In Terapia Intensiva collaborano molte persone con ruoli diversi. Solo grazie al contributo di tutti, pazienti compresi, si possono raggiungere risultati eccellenti.

Link veloci

Gestire il dolore

ico-flowchartdoloreFlowchart dolore
ico-vnrVNR
ico-bpsBPS

Gestire la sedazione

ico-flowchart-sedaz-agitFlowchart sedaz/agitaz
ico-rassRASS

Gestire il delirium

ico-flowchart-deliriumFlowchart Delirium
ico-manuale-cam-icuManuale CAM-ICU
ico-schedalavoro-cam-icuScheda di lavoro CAM-ICU
ico-icdscICDSC

 

Questo sito è stato realizzato grazie al contributo di:

regionelombardia

Finanziamento per la Ricerca Indipendente
(Decreto DGS 13456 del 22 dicembre 2010)


Design by Pixelsparadise