PREVALENCIA DEL DELIRIUM EN EL PACIENTE CRÍTICO EN UCI

Abstract

Introduction. Delirium is a syndrome that presents with an acute and fluctuating alteration of the level of consciousness and cognitive capacity, accompanied by agitation and/or lethargy, which can appear in critically ill patients admitted to the ICU._x000D_ Objectives. Primary: To know the prevalence or incidence of delirium in the ICU in our environment. Secondary: to detect possible factors that influence the variability of prevalence; to know aspects of delirium management in different ICUs._x000D_ Methodology. Four prevalence/incidence studies were conducted. The first one was carried out by sending a survey-form to all Spanish ICUs in two consecutive years on the characteristics of each ICU and the sedoanalgesia and delirium practices that were carried out on two selected days. The second study, observational and multicenter, called AID-ICU, recruited patients with delirium after performing a validated diagnostic scale at all admissions for two weeks in European ICUs. The third was a sub-analysis of the Spanish cohort of the AID-ICU study. The fourth was a period prevalence study in the ICU of the HUAV of Lleida._x000D_ Results. The first study included 1567 patients from 166 Spanish ICUs; 21.1% of the ICUs carried out a validated diagnostic scale and a prevalence of 9.1% was obtained with respect to the total number of patients. 99 ICUs from 13 European countries participated in the AID-ICU; 1260 patients were recruited, resulting in a prevalence of 24.9%; haloperidol was the most used pharmacological treatment. In the Spanish cohort of the AID-ICU, made up of 193 patients from 16 ICUs, a prevalence of 18.6% was obtained with respect to the total number of patients and 29.2% once non-assessable patients were excluded; haloperidol was also the most used drug. Mechanical restraints were used in 52.8% of patients with delirium and in 14.6% of patients without delirium. In the Lleida ICU study, the prevalence was 31.6% of evaluable patients, that is, those who did not present acquired brain injury, coma, or deep sedation._x000D_ Conclusions: The prevalence or incidence of delirium in our environment varies depending on whether the diagnostic scales are performed routinely, because if they are not, the perceived prevalence of delirium could be underestimated. When the scales are performed routinely or for scientific reasons when recruiting patients for a study or clinical trial, the detected prevalence or incidence increases. The prevalence also varies if the patients with delirium refer to the total number of patients admitted or to the number of patients assessable for detecting delirium, excluding patients in coma or deep sedation. Despite the low scientific evidence, in real clinical practice haloperidol is the most widely used drug to control this syndrome. Mechanical restraint continues to be applied to both patients with delirium and patients without delirium. It is necessary to improve and standardize the detection of delirium in the ICU.

Date of Award	26 Sept 2023
Original language	Spanish
Supervisor	Ricard Ferrer Roca (Director) & Juan Carlos Ruiz Rodríguez (Director)