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A425 Prospective study to determine the incidence and risk factors for delirium in cancer patients in ICU

In Intensive Care Medicine Experimental
By: Myatra SN.
Contributor(s): Harish MM | Prabu NR | Siddiqui S | Kulkarni AP | Divatia JV.
Material type: materialTypeLabelArticlePublisher: Germany : Springer-Verlag 2016Description: .Subject(s): Cancer patients | ICU | ICU deliriumOnline resources: PDF In: Intensive Care Medicine Experimental Vol.4, Supplement no.1, p.221Summary: Introduction: Delirium in ICU associated with both short and long term adverse outcomes. Cancer patients admitted to ICU have several risk factors to develop delirium. Most published data on delirium are about general ICU patients and there are no large studies in cancer patients in ICU. Objectives: We conducted prospective study to know the incidence and risk factors associated with delirium in cancer patients. Methods: Adult cancer patients in ICU were included over a period of 6 months. Demographic data, type/stage of cancer, treatment details including drugs administered were noted. Hemodynamic status, mechanical ventilation, presence of sepsis, patient's sleep and mobilization status were also noted for the assessment of risk factors associated with delirium. Sedation was scored using the Richmond Agitation-Sedation Scale (RASS) and delirium was assessed using the Confusion Assessment Method (CAM-ICU) per shift by the bedside nurses, if they were responsive to verbal commands (RASS score of −3 or lighter level of sedation). If delirium was positive even in one shift in a day, it was considered as a delirium day. Results: Patients with comorbidities showed higher incidence of ICU delirium as compared to those without {73(63.5 %) vs 42(36.5 %)}. Tobacco consumers showed higher incidence of delirium as compared to those without {85(73.1 %) vs 30(26.1 %)}. Recent chemotherapy showed positive correlation with delirium as compared to those who did not receive chemotherapy or received it more than one month back {63(54.8 %) vs 51(44.3 %) vs 1(0.9 %)}. Sleep deprived patients had higher incidence of delirium as compared to patients without {90(78.3 %) vs 25(21.7 %)}. There was a significant association of Midazolam with delirium as compared to those who did not receive the drug{104(90.4 %) vs 11(9.6 %), p- 0.000}. Patients who had delirium had median length of stay 7 days as compared to 3 days among without delirium. On multivariate analysis of the risk factors comorbidity(P-0.003,OR-13.3), tobacco consumption(P-0.015,OR-5.95), Midazolam(P-0.000,OR-47.50), mechanical ventilation(P-0.022,OR-9.09) and sleep deprivation (P-0.030,OR- 7.18) showed statistically significant association with the delirium. Delirium also showed significant association with increased length of both ICU (P-0.000,OR-1.73) and hospital stay (P-0.004,OR-1.02). Conclusion: Incidence of ICU delirium among cancer patients was 70.6 %. Recent chemotherapy mechanical ventilation, Midazolam, comorbidities, tobacco and sleep deprivation were the independent predictor of ICU delirium in cancer patients. ICU delirium increase both ICU and hospital length of stay
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Published in Intensive Care Medicine Experimental 2016

Introduction: Delirium in ICU associated with both short and long
term adverse outcomes. Cancer patients admitted to ICU have several
risk factors to develop delirium. Most published data on delirium
are about general ICU patients and there are no large studies in cancer
patients in ICU.
Objectives: We conducted prospective study to know the
incidence and risk factors associated with delirium in cancer
patients.
Methods: Adult cancer patients in ICU were included over a period
of 6 months. Demographic data, type/stage of cancer, treatment
details including drugs administered were noted. Hemodynamic
status, mechanical ventilation, presence of sepsis, patient's sleep
and mobilization status were also noted for the assessment of risk
factors associated with delirium. Sedation was scored using the
Richmond Agitation-Sedation Scale (RASS) and delirium was
assessed using the Confusion Assessment Method (CAM-ICU) per
shift by the bedside nurses, if they were responsive to verbal commands
(RASS score of −3 or lighter level of sedation). If delirium
was positive even in one shift in a day, it was considered as a delirium
day.
Results: Patients with comorbidities showed higher incidence of
ICU delirium as compared to those without {73(63.5 %) vs
42(36.5 %)}. Tobacco consumers showed higher incidence of delirium
as compared to those without {85(73.1 %) vs 30(26.1 %)}.
Recent chemotherapy showed positive correlation with delirium as
compared to those who did not receive chemotherapy or received
it more than one month back {63(54.8 %) vs 51(44.3 %) vs 1(0.9 %)}.
Sleep deprived patients had higher incidence of delirium as compared
to patients without {90(78.3 %) vs 25(21.7 %)}. There was a
significant association of Midazolam with delirium as compared to
those who did not receive the drug{104(90.4 %) vs 11(9.6 %), p-
0.000}. Patients who had delirium had median length of stay 7 days
as compared to 3 days among without delirium. On multivariate
analysis of the risk factors comorbidity(P-0.003,OR-13.3), tobacco consumption(P-0.015,OR-5.95),
Midazolam(P-0.000,OR-47.50), mechanical
ventilation(P-0.022,OR-9.09) and sleep deprivation (P-0.030,OR-
7.18) showed statistically significant association with the
delirium. Delirium also showed significant association with increased
length of both ICU (P-0.000,OR-1.73) and hospital stay
(P-0.004,OR-1.02).
Conclusion: Incidence of ICU delirium among cancer patients was
70.6 %. Recent chemotherapy mechanical ventilation, Midazolam,
comorbidities, tobacco and sleep deprivation were the independent
predictor of ICU delirium in cancer patients. ICU delirium increase
both ICU and hospital length of stay

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