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Cited by 142Intensive Care Unit Cognitive DisordersAnesthesia and Sedative AgentsNosocomial Infections in ICU

Severe agitation among ventilated medical intensive care unit patients: frequency, characteristics and outcomes

Woods, Jeffery C., Mion, Lorraine C., Connor, Jason T., Viray, Florence, Jahan, Lisa, Huber, Cecilia, McHugh, Renee, Gonzales, Jeffrey P. +2 more·2004·Intensive Care Medicine
DOI 10.1007/s00134-004-2193-9
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Abstract

Objective To determine the frequency, characteristics and outcomes of severe agitation among ventilated medical intensive care unit (MICU) patients.Design Prospective cohort study.Setting Eighteen-bed MICU in 964-bed tertiary care center.Patients All ventilated patients, aged 18 years or older and admitted for more than 24 h between January 1, 2001 and May 8, 2001.Interventions None.Measurements Data were collected daily by concurrent chart abstractions. Variables included sociodemographic, clinical, laboratory, pharmacologic and non-pharmacologic interventions, ventilator settings and adverse events. Severe agitation, the main outcome variable, was defined as two or more Motor Activity Assessment Scale (MAAS) scores above 4 in a 24-h period and sedative and/or narcotic doses above the established sedation and analgesia protocol or a combination of two or more sedatives.Results Twenty-three (16.1%) of 143 enrolled patients exhibited severe agitation. Agitated patients were younger (hazard ratio [HR] 1.32), more likely to be admitted from an outside hospital ICU (HR 2.48), had lower pH (HR 1.55) and PaO(2)/FIO(2) less than 200 mmHg (HR 2.59). Agitated patients had longer MICU stays (median 12 versus 5 days, p<0.0001) and more ventilator days (median 14 versus 6, p<0.0001). Agitated patients were more likely to self-extubate (26% versus 6%, p=0.002). Benzodiazepines, narcotics and neuromuscular blocking agents were administered more frequently and at higher doses, but haloperidol was not.Conclusion Severe agitation occurs commonly in critically ill patients and is associated with adverse events including longer ICU stays, duration of mechanical ventilation and self-extubation.

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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 [13]

  • 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 [13]

  • The 42% incidence of agitation in this study agrees with previously reported rates in critically ill patients.

    “the 42% incidence of agitation in this study is in agreement with those previously reported in critically ill patients [13,26-28].”

    From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [13]

  • Patients with agitation were more likely to be given supplemental sedative and analgesic agents or physical restraints to prevent self-inflicted injuries and treatment interference.

    “Patients with agitation were, however, more likely to be given supplemental sedative and analgesic agents or physical restraints to prevent self-inflicted injuries and thus treatment interference [13,27,28].”

    From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [13]

  • In our study, smoking abstinence, even in patients with weak tobacco dependency, was associated with agitation and then self-removal of catheters and tubes.

    “In our study, smoking abstinence, even in patients with weak tobacco dependency, was associated with agitation and then self-removal of catheters and tubes, as already reported [13,26,28].”

    From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [13]

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Authors
Woods, J. C., Mion, L. C., Connor, J. T., Viray, F., Jahan, L., Huber, C., McHugh, R., Gonzales, J. P., Stoller, J. K., & Arroliga, A. C.
Affiliations
  • Huron Hospital (US)
  • MetroHealth Medical Center (US)
  • Cleveland Clinic (US)
Corresponding author
Arroliga, Alejandro C.
ORCID
Venue
Intensive Care Medicine
Publisher
Springer Science and Business Media LLC
Published
2004-02-14
Volume
30
Issue
6
Pages
1066-1072
ISSN
  • 0342-4642 (ISSN-L)
  • 1432-1238
DOI
10.1007/s00134-004-2193-9
OpenAlex
W2081972845
Cited by
142
References
44
Citations by year
2025: 7 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 9 · 2015: 9 · 2014: 11 · 2013: 12 · 2012: 7
FWCI
7.51
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Intensive Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords
mechanical ventilation, medical intensive care unit, critically ill patients, sedation, benzodiazepines, haloperidol, neuromuscular blocking agents, self-extubation, ICU length of stay, mechanical ventilation duration, adverse events
MeSH terms
Adult, Aged, Central Nervous System Depressants, Female, Humans, Intensive Care Units, Male, Middle Aged, Ohio, Prospective Studies, Psychomotor Agitation, Respiration, Artificial, Risk Factors, Multivariate Analysis, Proportional Hazards Models, Treatment Outcome

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