Factores asociados con el delírium en pacientes críticos de una institución de salud de Bucaramanga, Colombia / Factors associated with delirium in critical patients in a health institution in Bucaramanga, Colombia

Objetivo: Determinar la incidencia y los factores asociados con delírium en pacientes de la Unidad de Cuidados Intensivos. Métodos: Se condujo un estudio de cohortes en 134 pacientes de la unidad de cuidados intensivos en una clínica de Bucaramanga, Colombia. Quienes fueron reclutados en las primeras 24 h de ingreso y se les aplicaron las escalas de sedación y agitación de Richmond (RASS), PRE-DELIRIC versión en español y Confusion Assessment Method for Intensive Care Unit (CAM-ICU); el desenlace se evaluó a través de seguimiento diario con CAM-ICU. Resultados: La incidencia de delírium fue del 20,2%, predominando el de tipo hipoactivo 66,7%, seguido del hiperactivo 7,4% y mixto 25,9%. El 52% de los pacientes con delírium fallecieron. En el análisis bivariado, se identificaron como factores de riesgo para delírium, el uso de sedantes (riesgo relativo [RR] 2,4, intervalo de confianza del 95% [IC del 95%] = 1,2-4,5), infección (RR = 2,8, IC del 95% = 1,3-5,9), acidosis metabólica (RR = 4,3, IC del 95% = 2,3-8), ventilación mecánica (RR = 4,6, IC del 95% = 2-10,6), edad mayor a 60 años (RR = 2,3, IC del 95% = 1,09-5,3) y puntaje APACHE mayor a 14 (RR = 3, IC del 95% = 1,1-8,2). En el análisis multivariado, solo se encontró relación con la infección (RR = 3,8, IC del 95% = 1,6-9,1) y la edad mayor a 60 años (RR = 3,2, IC del 95% = 1,2-8,3). Conclusiones: El delírium es frecuente en los pacientes de la Unidad de Cuidado Intensivo, en especial el hipoactivo. La mitad de los pacientes con delírium fallecieron. Los principales factores de riesgo para delírium son infección y la edad mayor a 60 años, por lo tanto, las actividades de prevención de delírium deben ser enfocadas a estos pacientes críticos

Objective: To determine the incidence and the factors associated with delirium in intensive care unit patients. Methods: A cohort study conducted on 134 patients in the intensive care unit at a clinic in Bucaramanga, Colombia., who were recruited in the first 24 hours following admission and on whom the Richmond Agitation-Sedation Scale (RASS), PRE-DELIRIC version in Spanish, and Confusion Assessment method for Intensive Care Unit (CAM-ICU) were applied; the outcome was evaluated through daily monitoring with CAM-ICU. Results: The incidence of delirium was 20.2%, the predominating type was hypoactive at 66.7%, followed by the hyperactive type at 7.4% and mixed at 25.9%. Fifty-two percent of the patients with delirium died. In the bivariate analysis, the use of sedatives (Relative Risk(RR) 2.4, 95% confidence interval (95% CI) = 1.2-4.5), infection (RR = 2. 8, 95% CI=1.3-5.9), metabolic acidosis (RR = 4 3, 95% CI=2.3-8.0), mechanical ventilation (RR = 4 6, 95% CI=2.0-10.6), aged over 60 years (RR = 2 3, 95% CI=1.09-5.3) and APACHE score greater than 14 (RR = 3. 0) (95% CI=1.1-8.2) were identified as risk factors for delirium. The multivariate analysis only found a relationship with infection (RR = 3 8, 95% CI=1.6-9.1) and being aged over 60 years (RR = 3 2, 95% CI 1.2-8.3). Conclusions: delirium is frequent in patients in the intensive care unit, especially the hypoactive type. Half of the patients with delirium died. The main risk factors for delirium are infection and being over 60 years age, therefore, delirium prevention activities should focus on these critical patients

Factors associated with delirium in critical patients in a health institution in Bucaramanga, Colombia. / Factores asociados con el delírium en pacientes críticos de una institución de salud de Bucaramanga, Colombia.

OBJECTIVE: To determine the incidence and the factors associated with delirium in intensive care unit patients. METHODS: A cohort study conducted on 134 patients in the intensive care unit at a clinic in Bucaramanga, Colombia., who were recruited in the first 24hours following admission and on whom the Richmond Agitation-Sedation Scale (RASS), PRE-DELIRIC version in Spanish, and Confusion Assessment method for Intensive Care Unit (CAM-ICU) were applied; the outcome was evaluated through daily monitoring with CAM-ICU. RESULTS: The incidence of delirium was 20.2%, the predominating type was hypoactive at 66.7%, followed by the hyperactive type at 7.4% and mixed at 25.9%. Fifty-two percent of the patients with delirium died. In the bivariate analysis, the use of sedatives (Relative Risk(RR) 2.4, 95% confidence interval (95% CI) = 1.2-4.5), infection (RR = 2. 8, 95% CI=1.3-5.9), metabolic acidosis (RR = 4 3, 95% CI=2.3-8.0), mechanical ventilation (RR = 4 6, 95% CI=2.0-10.6), aged over 60 years (RR = 2 3, 95% CI=1.09-5.3) and APACHE score greater than 14 (RR = 3. 0) (95% CI=1.1-8.2) were identified as risk factors for delirium. The multivariate analysis only found a relationship with infection (RR = 3 8, 95% CI=1.6-9.1) and being aged over 60 years (RR = 3 2, 95% CI 1.2-8.3). CONCLUSIONS: delirium is frequent in patients in the intensive care unit, especially the hypoactive type. Half of the patients with delirium died. The main risk factors for delirium are infection and being over 60 years age, therefore, delirium prevention activities should focus on these critical patients.