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Cited by 3,073Intensive Care Unit Cognitive DisordersNosocomial Infections in ICUClinical Nutrition and Gastroenterology

Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit

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Ely, E. Wesley·2004·JAMA
DOI 10.1001/jama.291.14.1753
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Abstract

CONTEXT: In the intensive care unit (ICU), delirium is a common yet underdiagnosed form of organ dysfunction, and its contribution to patient outcomes is unclear. OBJECTIVE: To determine if delirium is an independent predictor of clinical outcomes, including 6-month mortality and length of stay among ICU patients receiving mechanical ventilation. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study enrolling 275 consecutive mechanically ventilated patients admitted to adult medical and coronary ICUs of a US university-based medical center between February 2000 and May 2001. Patients were followed up for development of delirium over 2158 ICU days using the Confusion Assessment Method for the ICU and the Richmond Agitation-Sedation Scale. MAIN OUTCOME MEASURES: Primary outcomes included 6-month mortality, overall hospital length of stay, and length of stay in the post-ICU period. Secondary outcomes were ventilator-free days and cognitive impairment at hospital discharge. RESULTS: Of 275 patients, 51 (18.5%) had persistent coma and died in the hospital. Among the remaining 224 patients, 183 (81.7%) developed delirium at some point during the ICU stay. Baseline demographics including age, comorbidity scores, dementia scores, activities of daily living, severity of illness, and admission diagnoses were similar between those with and without delirium (P>.05 for all). Patients who developed delirium had higher 6-month mortality rates (34% vs 15%, P =.03) and spent 10 days longer in the hospital than those who never developed delirium (P<.001). After adjusting for covariates (including age, severity of illness, comorbid conditions, coma, and use of sedatives or analgesic medications), delirium was independently associated with higher 6-month mortality (adjusted hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.4-7.7; P =.008), and longer hospital stay (adjusted HR, 2.0; 95% CI, 1.4-3.0; P<.001). Delirium in the ICU was also independently associated with a longer post-ICU stay (adjusted HR, 1.6; 95% CI, 1.2-2.3; P =.009), fewer median days alive and without mechanical ventilation (19 [interquartile range, 4-23] vs 24 [19-26]; adjusted P =.03), and a higher incidence of cognitive impairment at hospital discharge (adjusted HR, 9.1; 95% CI, 2.3-35.3; P =.002). CONCLUSION: Delirium was an independent predictor of higher 6-month mortality and longer hospital stay even after adjusting for relevant covariates including coma, sedatives, and analgesics in patients receiving mechanical ventilation.

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  • Delirium and agitation occur frequently in critically ill patients, with reported frequencies of 15% to 80%.

    “Behavioral disorders such as delirium and agitation in the critically ill occur with a high frequency, ranging from 15% to 80% of patients, and have been associated with increased morbidity and risk of mortality [7-13].”

    From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [10]

  • Delirium and agitation in critically ill patients are associated with increased morbidity and risk of mortality.

    “Behavioral disorders such as delirium and agitation in the critically ill occur with a high frequency, ranging from 15% to 80% of patients, and have been associated with increased morbidity and risk of mortality [7-13].”

    From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [10]

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Authors
Ely, E. W.
Affiliations
VA Tennessee Valley Healthcare System (US)
Corresponding author
Ely, E. Wesley
ORCID
Ely, E. Wesley
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2004-04-14
Volume
291
Issue
14
Pages
1753
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.291.14.1753
OpenAlex
W2037614372
Cited by
3,073
References
109
Citations by year
2026: 120 · 2025: 122 · 2024: 135 · 2023: 144 · 2022: 162 · 2021: 214 · 2020: 195 · 2019: 183 · 2018: 159 · 2017: 173 · 2016: 170 · 2015: 148 · 2014: 161 · 2013: 167 · 2012: 171
FWCI
53.28
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
National Institute on Aging (K24 AG00949, K23AG001023, K23 AG-01023-01A1, K24AG000949)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords
delirium, mechanical ventilation, intensive care unit, mortality prediction, length of hospital stay, post-ICU recovery, cognitive impairment, persistent coma, organ dysfunction, sedation, ventilator-free days, Confusion Assessment Method for the ICU, Richmond Agitation-Sedation Scale, critically ill patients, prognostic factors
MeSH terms
Adult, Aged, Coma, Delirium, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Prospective Studies, Respiration, Artificial, Risk Factors, Proportional Hazards Models, Survival Analysis, Critical Illness, APACHE

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