Delirium in an intensive care unit: a study of risk factors
Abstract
Objectives (1) To establish risk factors for the development of delirium in an intensive care unit (ICU) and (2) to determine the effect of delirium on morbidity, mortality and length of stay.Design Prospective study.Setting Sixteen-bed medical/surgical ICU in a university hospital.Patients Two hundred and sixteen consecutive patients admitted to the ICU for more than 24 h during 5 months were included in the study.Interventions Medical history, selected laboratory values, drugs received and factors that may influence patient psychological and emotional well-being were noted. All patients were screened with a delirium scale. A psychiatrist confirmed the diagnosis of delirium. Major complications such as self-extubation and removal of catheters, as well as mortality and length of stay were recorded.Results Forty patients (19%) developed delirium; of these, one-third were not agitated. In the multivariate analysis hypertension, smoking history, abnormal bilirubin level, epidural use and morphine were statistically significantly associated with delirium. Traditional factors associated with the development of delirium on general ward patients were not significant in our study. Morbidity (self-extubation and removal of catheters), but not mortality, was clearly increased.Conclusion Predictive risk factors for the development of delirium in studies outside the ICU may not be applicable to critically ill patients. Delirium is associated with increased morbidity. Awareness of patients at risk may lead to better recognition and earlier intervention.
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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 [8]
Few data exist regarding the behavioral impact of sudden nicotine abstinence in the ICU setting, except one study that identified smoking history as a risk factor for delirium in critically ill patients.
“Few data exist in the literature regarding the behavioral impact of sudden nicotine abstinence in the ICU setting, except for one study, which identified smoking history as a risk factor for delirium in critically ill patients [8].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [8]
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 [8]
We found no association between nicotine withdrawal and delirium.
“In contrast to the finding of Dubois and colleagues [8], we found no association between nicotine withdrawal and delirium.”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [8]
The incidence of delirium recorded in our study was 28%, at the low level of the range cited in the literature (13% to 70%).
“The 28% incidence of delirium we recorded at the low level of the wide range cited in the literature (13% to 70%) [8,11,38-40].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [8]
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“Some moderate-quality studies reported a strong relationship between benzodiazepine use and the development of delirium (332, 405), while others found no significant relationship (322, 368, 401-404).”
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“Chronic obstructive pulmonary disease 2 (4) 2 (4) .”
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BackgroundMethodInfluentialDelirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients
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“Between admission and randomization 18 (10) 20 (10) 22 (12)”
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“Demographic data Age (yrs) 48 (36–60) 55 (46–67) 41 (25–50) Sex (male) 52% (50) 38% (17) 63% (33) Race (white) 88% (84) 93% (42) 84% (42) Charlson Comorbidity Index 0 (0–2) 1 (0–3) 0 (0–0) APACHE II 24 (18–28) 25 (18–29) 23 (19–27) SOFA 8 (7–10) 9 (7–10) 8 (7–9) Injury Severity Score NA NA 20 (16–29) Revised Trauma Sc…”
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“Nicotine use (20) (36) (25, 35) (27, 33, 35) Inconclusive”
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“4 days [3– 8]; p .”
Self-citationDelirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients*
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BackgroundThe impact of delirium on the survival of mechanically ventilated patients*
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“31 Admission to intensive care unit at any time 14 (25) 7 (12) .”
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“Benzodiazepines, in particular, enhance the risk of developing acute brain dysfunction [6,16-18].”
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“smoking history (smoker, previous smoker, never smoker), premorbid hypertension (drug treatment) [15] and alcohol or drug abuse.”
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“Sedation Protocol Has protocol 959 (71) Does not have protocol 396 (29) Sedation scales used None 160 (12) Ramsay 495 (38) RASS 342 (26) SAS 111 (8) Other 215 (16) Written policy on SATs Has a written policy 990 (76) Does not have a written policy 319 (24) Percentage of ICU days SATs are practiced 10% 129 (13) 10–25%…”
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“expert guidelines [5] have fostered initiatives [1–3] for reliable, easily applicable screening tools.”
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The Importance of Diagnosing and Managing ICU Delirium
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Routine Use of the Confusion Assessment Method for the Intensive Care Unit: A Multicenter Study
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Vasilevskis, E. E., Ely, E. W., Speroff, T., Pun, B. T., Boehm, L. M., & Dittus, R. S. (2010) · CHEST Journal · doi:10.1378/chest.10-0466 · Cited by 280 · see citing works
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“In another study, hypertension was a risk factor for delirium in 198 medical and surgical ICU [82].”
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“6 mg compared to nonusers [48].”
Characteristics Associated With Delirium in Older Patients in a Medical Intensive Care Unit
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“One other group has examined risk for ICU delirium in patients 18 years or older and found that hypertension, alcoholism, severity of illness, and clinical effects of sedative and analgesic drugs were associated with delirium.(11,13) We do not have data on hypertension, but severity of illness and use of benzodiazepin…”
BackgroundGamberini, M., Bolliger, D., Buse, G. L., Burkhart, C. S., Grapow, M. T. R., Gagneux, A., Filipovic, M., Seeberger, M. D., Pargger, H., Siegemund, M., et al. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e31819da780 · Cited by 262 · see citing works
“Of the many risk factors described in the literature referring to intensive care patients (20, 21), only arterial hypertension was present in a relevant number of our patients; and based on our baseline data, our cohort was relatively healthy.”
BackgroundPrevention and Management of Delirium in the Intensive Care Unit
Mart, M. F., Roberson, S. W., Salas, B., Pandharipande, P. P., & Ely, E. W. (2020) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0040-1710572 · Cited by 262 · see citing works
Benzodiazepine-associated delirium in critically ill adults
Zaal, I. J., Devlin, J. W., Hazelbag, C. M., Klouwenberg, P. M. C. K., van der Kooi, A. W., Ong, D. S. Y., Cremer, O. L., Groenwold, R. H. H., & Slooter, A. J. C. (2015) · Intensive Care Medicine · doi:10.1007/s00134-015-4063-z · Cited by 247 · see citing works
van den Boogaard, M., Schoonhoven, L., van der Hoeven, J. G., van Achterberg, T., & Pickkers, P. (2011) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2011.11.016 · Cited by 231 · see citing works
“The high delirium incidence in ICU patients in this large prospective cohort study is in accordance with various studies (Balas et al., 2007; Dubois et al., 2001; Lin et al., 2004; Ouimet et al., 2007), but was lower than some authors reported (Ely et al., 2001a, 2007; Granberg Axell et al., 2002;…”
BackgroundResultInfluentialRapidly Reversible, Sedation-related Delirium versus Persistent Delirium in the Intensive Care Unit
Patel, S. B., Poston, J. T., Pohlman, A. S., Hall, J. B., & Kress, J. P. (2014) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201310-1815oc · Cited by 224 · see citing works
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Delirium assessment in the critically ill
Devlin, J. W., Fong, J. J., Fraser, G. L., & Riker, R. R. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0603-5 · Cited by 222 · see citing works
“The list of major risk factors is as follows [3, 14–17]:”
BackgroundMorandi, A., Rogers, B. P., Gunther, M. L., Merkle, K. L., Pandharipande, P. P., Girard, T. D., Jackson, J. C., Thompson, J. L., Shintani, A., Geevarghese, S. K., et al. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e318250acdc · Cited by 220 · see citing works
“Age at enrollment, years 58 (48, 65) Female, % (n) 38% (18) Education, years 12 (12, 14) Short informant questionnaire of cognitive decline in the elderly 3 (3, 3.”
BackgroundPreventing Delirium in the Intensive Care Unit
Brummel, N. E., & Girard, T. D. (2012) · Critical Care Clinics · doi:10.1016/j.ccc.2012.10.007 · Cited by 214 · see citing works
Critical Care Nurses’ Role in Implementing the “ABCDE Bundle” Into Practice
Balas, M. C., Vasilevskis, E. E., Burke, W. J., Boehm, L. M., Pun, B. T., Olsen, K. M., Peitz, G. J., & Ely, E. W. (2012) · Critical Care Nurse · doi:10.4037/ccn2012229 · Cited by 214 · see citing works
Validity and Reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients
Guenther, U., Popp, J., Koecher, L., Muders, T., Wrigge, H., Ely, E. W., & Putensen, C. (2009) · Journal of Critical Care · doi:10.1016/j.jcrc.2009.08.005 · Cited by 213 · see citing works
“Routine monitoring is the basis for early diagnosis and intervention against delirium, a serious condition that independently worsens patients' outcomes [29,52,53].”
BackgroundThe Comparative Risk of Delirium with Different Opioids: A Systematic Review
Swart, L. M., van der Zanden, V., Spies, P. E., de Rooij, S. E., & Munster, B. C. V. (2017) · Drugs & Aging · doi:10.1007/s40266-017-0455-9 · Cited by 222 · see citing works
“Delirium is associated with poor functional recovery [3] and leads to increased morbidity, mortality, and healthcare costs [4, 5].”
BackgroundApolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients*
Ely, W., Girard, T. D., Shintani, A., Jackson, J. C., Gordon, S. M., Thomason, J. W. W., Pun, B. T., Canonico, A. E., Light, R. W., Pandharipande, P. P., et al. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000251925.18961.ca · Cited by 200 · see citing works
“If coupled with known mechanisms leading to delirium during critical illness such as sepsis or sedative agents, APOE4 could be a particularly hazardous risk factor for a longer duration of delirium (20, 26).”
BackgroundMorandi, A., Pandharipande, P. P., Trabucchi, M., Rozzini, R., Mistraletti, G., Trompeo, A. C., Gregoretti, C., Gattinoni, L., Ranieri, M. V., Brochard, L. J., et al. (2008) · Intensive Care Medicine · doi:10.1007/s00134-008-1177-6 · Cited by 201 · see citing works
“, acute change or fluctuation in mental status and inattention, accompanied by either disorganized thinking or an altered level of consciousness) [1] occurs in 20–40% of non-critically ill, hospitalized patients with rates as high as 80% in critically ill surgical and medical ICU patients [2–10], depending on the seve…”
BackgroundSelf-citationThe attributable mortality of delirium in critically ill patients: prospective cohort study
Klouwenberg, P. M. C. K., Zaal, I. J., Spitoni, C., Ong, D. S. Y., van der Kooi, A. W., Bonten, M. J. M., Slooter, A. J. C., & Cremer, O. L. (2014) · BMJ · doi:10.1136/bmj.g6652 · Cited by 197 · see citing works
Psychoactive Medications and Risk of Delirium in Hospitalized Cancer Patients
Gaudreau, J., Gagnon, P. R., Harel, F., et al. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.05.140 · Cited by 193 · see citing works
Prevalence and Risk Factors for Development of Delirium in Burn Intensive Care Unit Patients
Agarwal, V., O’Neill, P. J., Cotton, B. A., Pun, B. T., Haney, S., Thompson, J. L., Kassebaum, N. J., Shintani, A., Guy, J., Ely, E. W., et al. (2010) · Journal of Burn Care & Research · doi:10.1097/bcr.0b013e3181eebee9 · Cited by 185 · see citing works
“Meperidine has almost universally been shown to be associated with delirium,(21,23,37) whereas data on fentanyl and morphine have been mixed.(6,7,21,23,37) Additionally, sedTable 3.”
BackgroundResultIndependent Vascular and Cognitive Risk Factors for Postoperative Delirium
Rudolph, J. L., Jones, R. N., Rasmussen, L. S., Silverstein, J. H., Inouye, S. K., & Marcantonio, E. R. (2007) · The American Journal of Medicine · doi:10.1016/j.amjmed.2007.02.026 · Cited by 177 · see citing works
Pathophysiology of Delirium in the Intensive Care Unit
Gunther, M. L., Morandi, A., & Ely, E. W. (2008) · Critical Care Clinics · doi:10.1016/j.ccc.2007.10.002 · Cited by 177 · see citing works
Delirium: acute cognitive dysfunction in the critically ill
Pandharipande, P. P., Jackson, J. C., & Ely, E. W. (2005) · Current Opinion in Internal Medicine · doi:10.1097/01.ccx.0000170503.76528.4b · Cited by 170 · see citing works
Pandharipande, P. P., & Ely, E. W. (2006) · Critical Care Clinics · doi:10.1016/j.ccc.2006.02.010 · Cited by 167 · see citing works
“Dubois and coworkers [49] have shown that opiates (morphine and meperidine) administered intravenously or via an epidural catheter may be associated with the development of delirium in medical or surgical ICU patients.”
BackgroundImpact of delirium on clinical outcome in critically ill patients: a meta-analysis
Zhang, Z., Pan, L., & Ni, H. (2012) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2012.11.003 · Cited by 166 · see citing works
“Data on mortality were available in 14 studies [1,13–25], involving 5891 patients, 1809 in the delirium group and 4082 in the nondelirium group.”
BackgroundMethodInfluentialDelirium in Elderly People: A Review
Martins, S. P. V., & Fernandes, L. P. N. S. (2012) · Frontiers in Neurology · doi:10.3389/fneur.2012.00101 · Cited by 160 · see citing works
“Overall, delirium has been associated with the increase of hospital stay (Cole and Primeau, 1993; Dubois et al., 2001; McCusker et al., 2003; Koster et al., 2011; van den Boogaard et al., 2011; Shi et al., 2012), cognitive decline (Inouye et al., 1998; McCusker et al., 2001; Jackson et al., 2004;…”
BackgroundInfluentialPreventing Postoperative Complications in the Elderly
Sieber, F. E., & Barnett, S. R. (2011) · Anesthesiology Clinics · doi:10.1016/j.anclin.2010.11.011 · Cited by 156 · see citing works
“The use of opioids is strongly related to the development of ICU delirium.(40) Similarly, benzodiazepines such as lorazepam are an independent risk factor for the transitioningof patients in the ICU into delirium.”
BackgroundAltered Mental Status in Older Patients in the Emergency Department
Han, J. H., & Wilber, S. T. (2012) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2012.09.005 · Cited by 158 · see citing works
Smith, H. A. B., Gangopadhyay, M., Goben, C. M., Jacobowski, N., Chestnut, M. H., Thompson, J. L., Chandrasekhar, R., Williams, S. R., Griffith, K., Ely, E. W., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002515 · Cited by 157 · see citing works
Sieber, F. E., Neufeld, K. J., Gottschalk, A., et al. (2018) · JAMA Surgery · doi:10.1001/jamasurg.2018.2602 · Cited by 158 · see citing works
“The exclusion criteria included (1) receiving general anesthesia, (2) an inability to speak or understand English, (3) severe chronic obstructive pulmonary disease or congestive heart failure, (4) refusal to give informed consent, (5) a nonparticipating attending surgeon, (6) hip fractures in both hips at the same adm…”
BackgroundAlpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients
Chen, K., Lü, Z., Yi, X., Cai, Y., Chen, Y., & Pan, S. M. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010269.pub2 · Cited by 155 · see citing works
Depressive disorders during weaning from prolonged mechanical ventilation
Jubran, A., Lawm, G., Kelly, J., Duffner, L. A., Güngör, G., Collins, E. G., Lanuza, D. M., Hoffman, L. A., & Tobin, M. J. (2010) · Intensive Care Medicine · doi:10.1007/s00134-010-1842-4 · Cited by 154 · see citing works
“Several groups have reported that sedatives are associated with the development of delirium [27, 34, 35], longer ventilator duration and longer hospital stay [36].”
BackgroundDelirium in the Postoperative Cardiac Patient: A Review
Sockalingam, S., Parekh, N., Bogoch, I. I., Sun, J. C. J., Mahtani, R., Beach, C., Bollegalla, N., Turzanski, S., Seto, E., Kim, J., et al. (2005) · Journal of Cardiac Surgery · doi:10.1111/j.1540-8191.2005.00134.x · Cited by 152 · see citing works
McGrane, S., Girard, T. D., Thompson, J. L., Shintani, A., Woodworth, A. L., Ely, E. W., & Pandharipande, P. P. (2011) · Critical Care · doi:10.1186/cc10070 · Cited by 150 · see citing works
“Recent studies in this important area of critical care have focused on elucidating risk factors of delirium and developing strategies to reduce the prevalence and duration of delirium, but little work has been done to determine the mechanisms causing delirium in critically ill patients [3,7-14].”
BackgroundCeriana, P., Carlucci, A., Navalesi, P., Rampulla, C., Delmastro, M., Piaggi, G., Mattia, E. D., & Nava, S. (2003) · Intensive Care Medicine · doi:10.1007/s00134-003-1689-z · Cited by 143 · see citing works
“This choice depends heavily on the clinical experience that a small group of professionals (i.e., intensive care specialists, otolaryngologists, and surgeons) have gained in a specific environment (ICU or operating theater).”
MethodInfluentialImpaired Executive Function Is Associated with Delirium After Coronary Artery Bypass Graft Surgery
Rudolph, J. L., Jones, R. N., Grande, L. J., Milberg, W., King, E. G., Lipsitz, L. A., Levkoff, S. E., & Marcantonio, E. R. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00735.x · Cited by 144 · see citing works
Burkhart, C. S., Dell‐Kuster, S., Gamberini, M., Moeckli, A., Grapow, M. T. R., Filipovic, M., Seeberger, M. D., Monsch, A. U., Strebel, S., & Steiner, L. A. (2010) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2010.01.003 · Cited by 146 · see citing works
Rengel, K. F., Pandharipande, P. P., & Hughes, C. G. (2018) · La Presse Médicale · doi:10.1016/j.lpm.2018.03.012 · Cited by 149 · see citing works
“Opioids have been directly associated with delirium in some postoperative and ICU settings [45].”
BackgroundDelirium After Cardiac Surgery and Predictive Validity of a Risk Checklist
Koster, S., Oosterveld, F. G. J., Hensens, A. G., Wijma, A., & van der Palen, J. A. M. (2008) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2008.08.020 · Cited by 143 · see citing works
Delayed Treatment of Delirium Increases Mortality Rate in Intensive Care Unit Patients
Heymann, A., Radtke, F. M., Schiemann, A., Luetz, A., MacGuill, M., Wernecke, K.-D., & Spies, C. (2010) · Journal of International Medical Research · doi:10.1177/147323001003800503 · Cited by 142 · see citing works
Micek, S. T., Anand, N. J., Laible, B. R., Shannon, W. D., & Kollef, M. H. (2005) · Critical Care Medicine · doi:10.1097/01.ccm.0000164540.58515.bf · Cited by 141 · see citing works
“It is a common, often unrecognized, organ dysfunction in the intensive care unit (ICU) setting that usually occurs in the face of a medical illness, drug use, or drug or alcohol withdrawal (3, 4).”
BackgroundMethodResultInfluentialSharma, A. D., Malhotra, S., Grover, S., & Jindal, S. K. (2012) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2012.06.009 · Cited by 138 · see citing works
“Previous studies have evaluated the risk factors for delirium in intensive care unit [11,13–15,46].”
BackgroundResultInfluentialOpioid Use Increases the Risk of Delirium in Critically Ill Adults Independently of Pain
Duprey, M. S., Dijkstra‐Kersten, S. M. A., Zaal, I. J., Briesacher, B. A., Saczynski, J. S., Griffith, J. L., Devlin, J. W., & Slooter, A. J. C. (2021) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202010-3794oc · Cited by 138 · see citing works
A research algorithm to improve detection of delirium in the intensive care unit
Pisani, M. A., Araujo, K. L. B., Ness, P. H. V., Zhang, Y., Ely, E. W., & Inouye, S. K. (2006) · Critical Care · doi:10.1186/cc5027 · Cited by 136 · see citing works
“In addition, our findings on the prevalence of delirium (80%) are similar to those other studies that reported on ICU delirium (40–87%) [1-3,24,25].”
Associations of markers of inflammation and coagulation with delirium during critical illness
Girard, T. D., Ware, L. B., Bernard, G. R., Pandharipande, P. P., Thompson, J. L., Shintani, A., Jackson, J. C., Dittus, R. S., & Ely, E. W. (2012) · Intensive Care Medicine · doi:10.1007/s00134-012-2678-x · Cited by 134 · see citing works
“In addition to promoting adverse events, such as self-extubation [3], delirium delays extubation [4] and discharge from the ICU [4] and hospital [5] and is independently associated with increases in mortality [6–8] and cognitive impairment months to years after critical illness [9].”
Haloperidol prophylaxis in critically ill patients with a high risk for delirium
van den Boogaard, M., Schoonhoven, L., van Achterberg, T., van der Hoeven, J. G., & Pickkers, P. (2013) · Critical Care · doi:10.1186/cc11933 · Cited by 133 · see citing works
“The incidence of delirium in intensive care (ICU) patients is high [2-5], up to 80%, and its occurrence is associated with prolonged duration of mechanical ventilation, increased ICU- and hospital length of stay [3,5], unplanned removal of tubes and catheters [5] and an increased mortality [5,6].”
BackgroundTobar, E. A., Romero, C. M., Galleguillos, T. G. B., Fuentes, P., Cornejo, R., Lira, M. T., de la Barrera, L., Sánchez, J. E., Bozán, F., Bugedo, G. J., et al. (2009) · Medicina Intensiva · doi:10.1016/j.medin.2009.04.003 · Cited by 131 · see citing works
The future of intensive care: delirium should no longer be an issue
Kotfis, K., Zaal, I. J., Roberson, S. W., Sietnicki, M., van den Boogaard, M., Shehabi, Y., & Ely, E. W. (2022) · Critical Care · doi:10.1186/s13054-022-04077-y · Cited by 135 · see citing works
Analgosedation: A Paradigm Shift in Intensive Care Unit Sedation Practice
Devabhakthuni, S., Armahizer, M. J., Dasta, J. F., & Kane‐Gill, S. L. (2012) · Annals of Pharmacotherapy · doi:10.1345/aph.1q525 · Cited by 130 · see citing works
van den Boogaard, M., Schoonhoven, L., Maseda, E., Plowright, C. I., Jones, C., Luetz, A., Sackey, P., Jorens, P. G., Aitken, L. M., van Haren, F. M. P., et al. (2014) · Intensive Care Medicine · doi:10.1007/s00134-013-3202-7 · Cited by 129 · see citing works
“Delirium is associated with a prolonged stay in the intensive care unit (ICU) and hospital, increased morbidity and mortality rate, higher costs [2, 3, 5] and adverse long-term outcome [6, 7].”
BackgroundRisk factors for intensive care delirium: A systematic review
Rompaey, B. V., Schuurmans, M. J., Shortridge‐Baggett, L. M., Truijen, S., & Bossaert, L. L. (2007) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2007.08.005 · Cited by 130 · see citing works
- Authors
- Dubois, M.-J., Bergeron, N., Dumont, M., Dial, S., & Skrobik, Y.
- Affiliations
- Université de Montréal (CA)
- McGill University (CA)
- Corresponding author
- Skrobik, Yoanna
- Venue
- Intensive Care Medicine
- Published
- 2001-07-17
- Volume
- 27
- Issue
- 8
- Pages
- 1297-1304
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- OpenAlex
- W2067617465
- Cited by
- 609
- References
- 0
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 10 · 2023: 17 · 2022: 17 · 2021: 33 · 2020: 26 · 2019: 18 · 2018: 33 · 2017: 29 · 2016: 22 · 2015: 30 · 2014: 28 · 2013: 41 · 2012: 53
- FWCI
- 10.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- 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 › Neurology › Alcoholism and Thiamine Deficiency
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Keywords
- delirium, intensive care unit, risk factors, critically ill patients, hypertension, smoking history, hyperbilirubinemia, epidural analgesia, morphine, self-extubation, catheter removal, morbidity, mortality, length of hospital stay, delirium screening
- MeSH terms
- Analysis of Variance, Delirium, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Prospective Studies, Quebec, Risk Factors, Multivariate Analysis, Logistic Models, Odds Ratio
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