Time trends of delirium rates in the intensive care unit.
Sikandar H Khan, Heidi Lindroth, Kyle Hendrie and 7 others
PMID 32220395WHAT IT FOUND
ICU delirium rates fell from 23% to 10% over five years, but benzodiazepine orders did not change and the study cannot prove why.
Mechanical ventilation, renal failure, low albumin and benzodiazepine exposure were linked to more delirium.
Key findings
01Any delirium rates decreased from 23% to 10%, but benzodiazepine orders did not change over time.
02ICU-acquired delirium decreased from 8% in 2010 to 4% in 2014 (p = 0.014).
03Mechanical ventilation, acute renal failure, hypoalbuminemia, alcohol abuse and benzodiazepine exposure were associated with higher odds of any delirium.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single academic hospital in Indianapolis, so findings may not apply to other ICUs. Only patients eligible for a delirium screening cohort were included, not all ICU admissions, which may underestimate true delirium rates. Patients with persistent coma throughout ICU stay were excluded, and assessments stopped after the first positive delirium screen, so mixed delirium subtypes were not reported. The study did not record patient-level sedation and awakening protocol adherence or medication doses, so it cannot show that sedation or awakening practices caused the trend. It did not adjust for illness severity or sepsis. Exclusions such as non-English speakers, severe hearing or vision loss, alcohol intoxication, incarceration, active psychiatric disorder and pregnancy limit generalizability.
Declared interests
No financial or other conflicts of interest were declared. The article is marked as supported by NIH extramural research.
The easy way to misread this
Do not conclude that reduced benzodiazepine use caused the fall in delirium rates. Benzodiazepine orders did not change over time, and the study did not measure protocol adherence or medication doses, so it cannot attribute the trend to a specific ICU practice.