A Prospective Study of Agitation in a Medical-Surgical ICU
Abstract
Study objectives Although agitation is thought to be common in the ICU, it has been poorly studied. We evaluated the incidence, risks factors, and outcomes of agitation in ICU.Design Prospective observational study.Interventions None.Method All consecutive ICU admissions over an 8-month period were analyzed.Measurements and results Two hundred eleven patients were admitted a total of 216 times during the period of the study. Twenty-nine patients were excluded from the study because their pathology findings did not allow an evaluation of their level of consciousness; 182 patients were actually enrolled. Agitation developed in 95 of 182 patients (52%). Agitation began 4.4 +/- 5.6 days (+/- SD) after admission to the ICU and lasted 3.9 +/- 4.1 days. Patients with agitation had a higher Simplified Acute Physiology Score II on ICU admission than those who did not have agitation (40 +/- 16 vs 33 +/- 13, p < 0.01). By stepwise logistic regression, the independent risks factors for development of agitation included psychoactive drug use at the time of ICU admission (odds ratio, 5.63; 95% confidence interval [CI], 1.32 to 23.70), history of alcohol abuse (odds ratio, 3.32; 95% CI, 1.12 to 10.00), dysnatremia (odds ratio, 4.95; 95% CI, 1.95 to 12.54), fever (odds ratio, 4.52; 95% CI, 1.80 to 11.49), use of sedatives in the ICU (odds ratio, 4.03; 95% CI, 1.62 to 10.40), and sepsis (odds ratio, 2.61; 95% CI, 1.03 to 6.58). Agitation was associated with a prolonged ICU stay (16 +/- 19 days vs 6 +/- 6 days, p = 0.0001), nosocomial infections (34% vs 7%, p < 0.0001), unplanned extubations (17% vs 2%, p = 0.003), and unplanned central venous catheter removal (16% vs 1%, p = 0.001), but not with mortality (12% in the agitation group vs 8% in patients without agitation).Conclusions Agitation is a common event in a mixed medical-surgical ICU. It is associated with adverse outcomes including prolonged stay, nosocomial infections, and unplanned extubations. A better knowledge of incidence and risk factors should facilitate identification of patients at risk and decrease the incidence of agitation.
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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 [28]
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 [28]
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 [28]
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References 41 · Cited by 154
- Authors
- Jaber, S., Chanques, G., Altairac, C., Sebbane, M., Vergne, C., Perrigault, P.-F., & Eledjam, J.-J.
- Affiliations
- Université de Montpellier (FR)
- Corresponding author
- Jaber, Samir
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2005-10
- Volume
- 128
- Issue
- 4
- Pages
- 2749-2757
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W2145624064
- Cited by
- 154
- References
- 41
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 5 · 2023: 8 · 2022: 5 · 2021: 7 · 2020: 10 · 2019: 5 · 2018: 8 · 2017: 8 · 2016: 10 · 2015: 6 · 2014: 8 · 2013: 7 · 2012: 6
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Keywords
- medical-surgical intensive care unit, risk factors, incidence, drug use, alcohol abuse, dysnatremia, fever, sedatives, sepsis, nosocomial infections, unplanned extubation, central venous catheter removal, ICU length of stay, mortality, level of consciousness, SAPS II, mechanical ventilation, delirium
- MeSH terms
- Documentation, Female, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Psychomotor Agitation, Risk Factors, Incidence, Multivariate Analysis, Treatment Outcome
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