Clinical Features of Delirium among Patients in the Intensive Care Unit According to Motor Subtype Classification: A Retrospective Longitudinal Study

다국어 초록 (Multilingual Abstract)

Purpose: Delirium in the intensive care unit (ICU) poses a significant safety and socioeconomic burden to patients and caregivers. However, invasive interventions for managing delirium have severe drawbacks. To reduce unnecessary interventions during ICU hospitalization, we aimed to investigate the features of delirium among ICU patients according to the occurrence of hypoactive symptoms, which are not expected to require invasive intervention.
Materials and Methods: Psychiatrists assessed all patients with delirium in the ICU during hospitalization. Patients were grouped into two groups: a “non-hypoactive” group that experienced the non-hypoactive motor subtype once or more or a “hypoactive only” group that only experienced the hypoactive motor subtype. Clinical variables routinely gathered for clinical management were collected from electronic medical records. Group comparisons and logistic regression analyses were conducted.
Results: The non-hypoactive group had longer and more severe delirium episodes than the hypoactive only group. Although the non-hypoactive group was prescribed more antipsychotics and required restraints longer, the hypoactive only group also re ceived both interventions. In multivariable logistic regression analysis, BUN [odds ratio (OR): 0.993, pH OR: 0.202], sodium (OR: 1.022), RASS score (OR: 1.308) and whether restraints were applied [OR: 1.579 (95% confidence interval 1.194–2.089), p<0.001] were significant predictors of hypoactive only group classification.
Conclusion: Managing and predicting delirium patients based on whether patients experienced non-hypoactive delirium may be clinically important. Variables obtained during the initial 48 hours can be used to determine which patients are likely to re quire invasive interventions.

참고문헌 (Reference)

1 Scholtens RM, "Variability of delirium motor subtype scale–defined delirium motor subtypes in elderly adults with hip fracture : a longitudinal study" 65 : e45-e50, 2017

2 Meagher DJ, "The use of environmental strategies and psychotropic medication in the management of delirium" 168 : 512-515, 1996

3 Gunst J, "The urea-creatinine ratio as a novel biomarker of critical illness-associated catabolism" 45 : 1813-1815, 2019

4 Peterson JF, "The prevalence of delirium subtypes in medical ICU patients" 51 : S174-, 2003

5 Cerejeira J, "The cholinergic system and inflammation : common pathways in delirium pathophysiology" 60 : 669-675, 2012

6 Sessler CN, "The Richmond Agitation-Sedation Scale : validity and reliability in adult intensive care unit patients" 166 : 1338-1344, 2002

7 Simons KS, "Temporal biomarker profiles and their association with ICU acquired delirium : a cohort study" 22 : 137-, 2018

8 Albrecht JS, "Stability of postoperative delirium psychomotor subtypes in individuals with hip fracture" 63 : 970-976, 2015

9 Krewulak KD, "Risk factors and outcomes among delirium subtypes in adult ICUs : a systematic review" 56 : 257-264, 2020

10 Andrews PS, "Relationship between intensive care unit delirium severity and 2-year mortality and health care utilization" 29 : 311-317, 2020

11 Sauvigny T, "Rate and risk factors for a hyperactivity delirium in patients with aneurysmal subarachnoid haemorrhage" 42 : 481-488, 2019

12 Wang HF, "Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital : a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era" 11 : 393-406, 2015

13 Collet MO, "Prevalence and risk factors related to haloperidol use for delirium in adult intensive care patients : the multinational AIDICU inception cohort study" 44 : 1081-1089, 2018

14 Guo Y, "Prevalence and risk factors of postoperative delirium in elderly hip fracture patients" 44 : 317-327, 2016

15 Noimark D, "Predicting the onset of delirium in the post-operative patient" 38 : 368-373, 2009

16 Park WR, "Potential usefulness of blood urea nitrogen to creatinine ratio in the prediction and early detection of delirium motor subtype in the intensive care unit" 11 : 5073-, 2022

17 Lahariya S, "Phenomenology of delirium among patients admitted to a coronary care unit" 70 : 626-632, 2016

18 Boncyk CS, "Pharmacologic management of intensive care unit delirium : clinical prescribing practices and outcomes in more than 8500 patient encounters" 133 : 713-722, 2021

19 Mufti HN, "Perioperative prediction of agitated(hyperactive)delirium after cardiac surgery in adults-The development of a practical scorecard" 42 : 192-199, 2017

20 Evans D, "Patient injury and physical restraint devices : a systematic review" 41 : 274-282, 2003

21 Maldonado JR, "Pathoetiological model of delirium : a comprehensive understanding of the neurobiology of delirium and an evidence-based approach to prevention and treatment" 24 : 789-856, 2008

22 Oh J, "Mutual relationship between anxiety and pain in the intensive care unit and its effect on medications" 30 : 1043-1048, 2015

23 Robinson TN, "Motor subtypes of postoperative delirium in older adults" 146 : 295-300, 2011

24 Renneboog B, "Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits" 119 : 71-, 2006

25 Mitchell ML, "Long-term cognitive impairment and delirium in intensive care : a prospective cohort study" 31 : 204-211, 2018

26 Yanghyun Lee ; Jian Ryu ; Jinyoung Lee ; Hwi-Jung Kim ; Im Hee Shin ; 김정란 ; Paula T. Trzepacz, "Korean Version of the Delirium Rating Scale-Revised-98: Reliability and Validity" 대한신경정신의학회 8 (8): 30-38, 2011

27 Granberg Axèll AI, "Intensive care unit syndrome/delirium is associated with anemia, drug therapy and duration of ventilation treatment" 46 : 726-731, 2002

28 Thomason JW, "Intensive care unit delirium is an independent predictor of longer hospital stay : a prospective analysis of 261 non-ventilated patients" 9 : R375-R381, 2005

29 Pan Y, "Influence of physical restraint on delirium of adult patients in ICU : a nested case-control study" 27 : 1950-1957, 2018

30 Krewulak KD, "Incidence and prevalence of delirium subtypes in an adult ICU : a systematic review and meta-analysis" 46 : 2029-2035, 2018

31 Wilson MM, "Impaired cognitive function and mental performance in mild dehydration" 57 (57): S24-S29, 2003

32 Makiguchi T, "Impact of skeletal muscle mass on postoperative delirium in patients undergoing free flap repair after oral cancer resection" 54 : 161-166, 2020

33 Glynn K, "How do delirium motor subtypes differ in phenomenology and contributory aetiology? A cross-sectional, multisite study of liaison psychiatry and palliative care patients" 11 : e041214-, 2021

34 Saravay SM, "How do delirium and dementia increase length of stay of elderly general medical inpatients?" 45 : 235-242, 2004

35 Ospina JP, "Epidemiology, mechanisms, diagnosis, and treatment of delirium : a narrative review" 1 : 3-, 2018

36 Haines RW, "Elevated urea-to-creatinine ratio provides a biochemical signature of muscle catabolism and persistent critical illness after major trauma" 45 : 1718-1731, 2019

37 la Cour KN, "Distribution of delirium motor subtypes in the intensive care unit : a systematic scoping review" 26 : 53-, 2022

38 American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" American Psychiatric Association 2013

39 Meagher D, "Development of an abbreviated version of the delirium motor subtyping scale(DMSS-4)" 26 : 693-702, 2014

40 Evensen S, "Delirium motor subtypes and prognosis in hospitalized geriatric patients-A prospective observational study" 122 : 24-28, 2019

41 Maldonado JR, "Delirium in the acute care setting : characteristics, diagnosis and treatment" 24 : 657-722, 2008

42 Peterson JF, "Delirium and its motoric subtypes : a study of 614critically ill patients" 54 : 479-484, 2006

43 Hamano J, "Comparison of the prevalence and associated factors of hyperactive delirium in advanced cancer patients between inpatient palliative care and palliative home care" 10 : 1166-1179, 2021

44 O’Keeffe ST, "Clinical significance of delirium subtypes in older people" 28 : 115-119, 1999

45 Barr J, "Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit" 41 : 263-306, 2013

46 Morandi A, "Clinical features associated with delirium motor subtypes in older inpatients : results of a multicenter study" 25 : 1064-1071, 2017

47 Andreasen NC, "Antipsychotic dose equivalents and dose-years : a standardized method for comparing exposure to different drugs" 67 : 255-262, 2010

48 Pang H, "Acute kidney injury-associated delirium : a review of clinical and pathophysiological mechanisms" 26 : 258-, 2022

49 Knaus WA, "APACHE II : a severity of disease classification system" 13 : 818-829, 1985

50 Inouye SK, "A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics" 119 : 474-481, 1993

51 Meagher D, "A new data-based motor subtype schema for delirium" 20 : 185-193, 2008

52 Meagher DJ, "A longitudinal study of motor subtypes in delirium : frequency and stability during episodes" 72 : 236-241, 2012

53 Bellelli G, ""Delirium day" : a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool" 14 : 106-, 2016