Risk factors and outcomes among delirium subtypes in adult ICUs: A systematic review

Karla D Krewulak; Henry T Stelfox; E Wesley Ely; Kirsten M Fiest

doi:10.1016/j.jcrc.2020.01.017

Risk factors and outcomes among delirium subtypes in adult ICUs: A systematic review

J Crit Care. 2020 Apr:56:257-264. doi: 10.1016/j.jcrc.2020.01.017. Epub 2020 Jan 15.

Authors

Karla D Krewulak¹, Henry T Stelfox², E Wesley Ely³, Kirsten M Fiest⁴

Affiliations

¹ Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
² Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada.
³ Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (VA GRECC), Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, United States.
⁴ Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada. Electronic address: kmfiest@ucalgary.ca.

PMID: 31986369
DOI: 10.1016/j.jcrc.2020.01.017

Abstract

Purpose: Use systematic review methodology to summarize risk factors and outcomes for each delirium subtype (hypoactive, hyperactive and mixed) in an adult ICU population.

Materials and methods: We searched the MEDLINE, Embase, CINAHL, SCOPUS, Web of Science and PsycINFO databases from database inception until August 13, 2018, with no restrictions.

Results: Of 9635 abstracts, 20 studies were included. Older age was not associated with any delirium subtype in 4/7 (57%) studies. Sex was not associated with any delirium subtype in 4/4 (100%) studies. Mortality was consistently associated with hypoactive delirium in 4/7 (57%) studies. The evidence supporting the association of APACHE-II score, mechanical ventilation, length of stay, duration of delirium and removal of tubes were inconsistent across studies.

Conclusions: Although included studies reported on many subtype-specific risk factors and outcomes, heterogeneity in reporting and methodological quality limited the generalizability of the results and the evidence for many subtype-specific risk factors or outcomes is inconsistent across studies. Standardized methodology and the creation of a universal template for collecting data in ICU delirium studies are essential moving forward; helping to identify subtype-specific risk factors or outcomes and strengthen the association of potential risk factors or outcomes.

Keywords: Critical care; Delirium; Risk factors; Subtype; Systematic review.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Aged
Critical Care / methods*
Delirium / diagnosis
Delirium / epidemiology*
Delirium / therapy*
Female
Humans
Intensive Care Units*
Length of Stay
Male
Middle Aged
Psychomotor Agitation*
Respiration, Artificial / mortality*
Risk Factors
Treatment Outcome