Journal
CRITICAL CARE MEDICINE
Volume 37, Issue 1, Pages 177-183Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0b013e318192fcf9
Keywords
delirium; critical care; risk factors; aged; benzodiazepines; opioids; haloperidol
Categories
Funding
- American Lung Association [CG-002-N]
- Connecticut Thoracic Society
- Claude D. Pepper Older Americans Independence Center [P30AG21342]
- The CHEST Foundation
- ASP
- Hartford Foundaton
- National Institute on Aging [R21AG025193, K24AG000949]
- NIH K23 Mentored Career Development Award [K23 AG 23023-01A1]
- NATIONAL INSTITUTE ON AGING [K23AG023023, R21AG025193, P30AG021342, K24AG000949] Funding Source: NIH RePORTER
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Objective: There is a high prevalence of delirium in older medical intensive care unit (ICU) patients and delirium is associated with adverse outcomes. We need to identify modifiable risk 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% Cl 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. (Crit Care Med 2009; 37:177-183)
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