Incidence, characteristics, and outcomes of delirium in patients with noninvasive ventilation: a prospective observational study

Abstract Background Factors that may increase the risk for delirium and the firm knowledge around mechanism for delirium in noninvasive ventilation (NIV) patients is lacking. We investigated the incidence, characteristics, and outcomes of delirium in NIV patients. Methods A prospective observational study was performed in an intensive care unit (ICU) of a teaching hospital. Patients in whom NIV was used as a first-line intervention were enrolled. During NIV intervention, delirium was screened using the Confusion Assessment Method for the ICU each day. The association between delirium and poor outcomes (e.g., NIV failure, ICU and hospital mortality) was investigated using forward stepwise multivariate logistic regression analyses. Results We enrolled 1083 patients. Of these, 196 patients (18.1%) experienced delirium during NIV intervention. Patients with delirium had higher NIV failure rates (37.8% vs. 21.0%, p < 0.01), higher ICU mortality (33.2% vs. 14.3%, p < 0.01), and higher hospital mortality (37.2% vs. 17.0%, p < 0.01) than subjects without delirium. They also had a longer duration of NIV (median 6.3 vs. 3.7 days, p < 0.01), and stayed longer in the ICU (median 9.0 vs. 6.0 days, p < 0.01) and the hospital (median 14.5 vs. 11.0 days, p < 0.01). These results were confirmed in COPD and non-COPD cohorts. According to subtype, compared to hyperactive delirium patients, hypoactive and mixed delirium patients spent more days and many more days on NIV (median 3.4 vs. 6.5 vs. 10.1 days, p < 0.01). Similar outcomes were found for length of stay in the ICU and hospital. However, NIV failure, ICU mortality, and hospital mortality did not differ among the three subtypes. Conclusions Delirium is associated with increases in poor outcomes (NIV failure, ICU mortality, and hospital mortality) and the use of medical resources (duration of NIV, and lengths of stay in the ICU and hospital). Regarding subtype, hypoactive and mixed delirium are associated with higher, and much higher, consumption of medical resources, respectively, compared to hyperactive delirium.

Download Full-text

Incidence, characteristics, and outcomes of delirium in patients with noninvasive ventilation: A prospective observational study

10.21203/rs.3.rs-60456/v3 ◽

2021 ◽

Author(s):

Rui Zhang ◽

Linfu Bai ◽

Xiaoli Han ◽

Shicong Huang ◽

Lintong Zhou ◽

...

Keyword(s):

Observational Study ◽

Hospital Mortality ◽

Noninvasive Ventilation ◽

Prospective Observational Study ◽

Confusion Assessment Method ◽

Assessment Method ◽

Icu Mortality ◽

Medical Resources ◽

Lengths Of Stay ◽

Poor Outcomes

Abstract Background: Factors that may increase the risk for delirium and the firm knowledge around mechanism for delirium in noninvasive ventilation (NIV) patients is lacking. We investigated the incidence, characteristics, and outcomes of delirium in NIV patients. Methods: A prospective observational study was performed in an intensive care unit (ICU) of a teaching hospital. Patients in whom NIV was used as a first-line intervention were enrolled. During NIV intervention, delirium was screened using the Confusion Assessment Method for the ICU each day. The association between delirium and poor outcomes (e.g., NIV failure, ICU and hospital mortality) was investigated using forward stepwise multivariate logistic regression analyses.Results: We enrolled 1083 patients. Of these, 196 patients (18.1%) experienced delirium during NIV intervention. Patients with delirium had higher NIV failure rates (37.8% vs. 21.0%, p < 0.01), higher ICU mortality (33.2% vs. 14.3%, p < 0.01), and higher hospital mortality (37.2% vs. 17.0%, p < 0.01) than subjects without delirium. They also had a longer duration of NIV (median 6.3 vs. 3.7 days, p < 0.01), and stayed longer in the ICU (median 9.0 vs. 6.0 days, p < 0.01) and the hospital (median 14.5 vs. 11.0 days, p < 0.01). These results were confirmed in COPD and non-COPD cohorts. According to subtype, compared to hyperactive delirium patients, hypoactive and mixed delirium patients spent more days and many more days on NIV (median 3.4 vs. 6.5 vs. 10.1 days, p < 0.01). Similar outcomes were found for length of stay in the ICU and hospital. However, NIV failure, ICU mortality, and hospital mortality did not differ among the three subtypes.Conclusions: Delirium is associated with increases in poor outcomes (NIV failure, ICU mortality, and hospital mortality) and the use of medical resources (duration of NIV, and lengths of stay in the ICU and hospital). Regarding subtype, hypoactive and mixed delirium are associated with higher, and much higher, consumption of medical resources, respectively, compared to hyperactive delirium.

Download Full-text

Incidence, characteristics, and outcomes of delirium in patients with noninvasive ventilation: A prospective observational study

10.21203/rs.3.rs-60456/v2 ◽

2020 ◽

Author(s):

Rui Zhang ◽

Linfu Bai ◽

Xiaoli Han ◽

Shicong Huang ◽

Lintong Zhou ◽

...

Keyword(s):

Observational Study ◽

Hospital Mortality ◽

Noninvasive Ventilation ◽

Prospective Observational Study ◽

Confusion Assessment Method ◽

Assessment Method ◽

Icu Mortality ◽

Medical Resources ◽

Lengths Of Stay ◽

Poor Outcomes

Abstract Background: Knowledge of delirium in noninvasive ventilation (NIV) patients is lacking. We investigated the incidence, characteristics, and outcomes of delirium in NIV patients. Methods: A prospective observational study was performed in an intensive care unit (ICU) of a teaching hospital. Patients in whom NIV was used as a first-line intervention were enrolled. During NIV intervention, delirium was screened using the Confusion Assessment Method for the ICU each day. The association between delirium and poor outcomes (e.g., NIV failure, ICU and hospital mortality) was investigated using forward stepwise multivariate logistic regression analyses.Results: We enrolled 1083 patients. Of these, 196 patients (18.1%) experienced delirium during NIV intervention. Patients with delirium had higher NIV failure rates (37.8% vs. 21.0%, p < 0.01), higher ICU mortality (33.2% vs. 14.3%, p < 0.01), and higher hospital mortality (37.2% vs. 17.0%, p < 0.01) than subjects without delirium. They also had a longer duration of NIV (median 6.3 vs. 3.7 days, p < 0.01), and stayed longer in the ICU (median 9.0 vs. 6.0 days, p < 0.01) and the hospital (median 14.5 vs. 11.0 days, p < 0.01). Furthermore, delirium was independently associated with NIV failure, ICU mortality, and hospital mortality (OR = 1.97, 2.58, and 2.55, respectively; all p values < 0.01). These results were confirmed in COPD and non-COPD cohorts. According to subtype, compared to hyperactive delirium patients, hypoactive and mixed delirium patients spent more days and many more days on NIV (median 3.4 vs. 6.5 vs. 10.1 days, p < 0.01). Similar outcomes were found for length of stay in the ICU and hospital. However, NIV failure, ICU mortality, and hospital mortality did not differ among the three subtypes.Conclusions: Delirium is associated with increases in poor outcomes (NIV failure, ICU mortality, and hospital mortality) and the use of medical resources (duration of NIV, and lengths of stay in the ICU and hospital). Regarding subtype, hypoactive and mixed delirium are associated with higher, and much higher, consumption of medical resources, respectively, compared to hyperactive delirium.

Download Full-text

Incidence, Characteristics and Outcomes of Delirium in Patients With Noninvasive Ventilation: A Prospective Observational Study

10.21203/rs.3.rs-60456/v1 ◽

2020 ◽

Author(s):

Rui Zhang ◽

Linfu Bai ◽

Xiaoli Han ◽

Shicong Huang ◽

Lintong Zhou ◽

...

Keyword(s):

Observational Study ◽

Hospital Mortality ◽

Noninvasive Ventilation ◽

Prospective Observational Study ◽

Confusion Assessment Method ◽

Assessment Method ◽

Failure Rates ◽

Icu Mortality ◽

Hospital Patients ◽

Hypoactive Delirium

Abstract Background: Knowledge of delirium in noninvasive ventilation (NIV) is lacking. We aimed to report the incidence, characteristics and outcomes of delirium in NIV patients. Methods: A prospective observational study was performed in an intensive care unit (ICU) of a teaching hospital. Patients who used NIV as a fist-line intervention were enrolled. During NIV intervention, delirium was screened using Confusion Assessment Method for the ICU every day. Results: We enrolled 1083 patients. Of them, 196 patients (18.1%) experienced delirium during NIV intervention. Patients with delirium had higher NIV failure rates (37.8% vs. 21.0%, p ＜0.01), higher ICU mortality (33.2% vs. 14.3%, p ＜0.01) and higher hospital mortality (37.2% vs. 17.0%, p ＜0.01) than the subjects without delirium. They also spent longer time on NIV (median 6.3 vs. 3.7 days, p ＜0.01), and stayed longer in ICU (median 9.0 vs. 6.0 days, p ＜0.01) and hospital (median 14.5 vs. 11.0 days, p ＜0.01). Furthermore, delirium was independently associated with NIV failure, ICU mortality and hospital mortality (OR =1.97, 2.58 and 2.55, respectively; all p values ＜0.01). These results were confirmed in COPD and non-COPD cohorts. Compared with hyperactive delirium patients, the NIV days was longer in hypoactive delirium patients and much longer in mixed delirium patients (median 3.4 vs. 6.5 vs. 10.1 days, p ＜0.01). Similar outcomes were found in the length of stay in ICU and hospital. However, the NIV failure, ICU mortality and hospital mortality did not differ between three subtypes of delirium.Conclusions: Delirium increases the NIV failure rates, elevates the ICU and hospital mortality, prolongs the NIV days, and lengthens the ICU and hospital stay. Mixed delirium patients use more ICU resources than hypoactive delirium patients and much more than hyperactive delirium patients.

Download Full-text

Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study

Journal of Anesthesia ◽

10.1007/s00540-020-02805-8 ◽

2020 ◽

Vol 34 (5) ◽

pp. 675-687

Author(s):

Yan Zhang ◽

Shu-Ting He ◽

Bin Nie ◽

Xue-Ying Li ◽

Dong-Xin Wang

Keyword(s):

Observational Study ◽

General Anesthesia ◽

Postoperative Delirium ◽

Prospective Observational Study ◽

Confusion Assessment Method ◽

Assessment Method ◽

Emergence Delirium ◽

Confusion Assessment ◽

Increased Risk ◽

Pacu Stay

Abstract Background The clinical significance of emergence delirium remains unclear. The purpose of this study was to investigate the association between emergence delirium and postoperative delirium in elderly after general anesthesia and surgery. Methods This prospective observational study was done in a tertiary hospital in Beijing, China. Elderly patients (65–90 years) who underwent major noncardiac surgery under general anesthesia and admitted to the postanesthesia care unit (PACU) after surgery were enrolled. Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay. Postoperative delirium was assessed with the Confusion Assessment Method during the first 5 postoperative days. The association between emergence delirium and postoperative delirium was analyzed with a multivariable logistic regression model. Results A total of 942 patients were enrolled and 915 completed the study. Emergence delirium developed in 37.0% (339/915) of patients during PACU stay; and postoperative delirium developed in 11.4% (104/915) of patients within the first 5 postoperative days. After adjusted confounding factors, the occurrence of emergence delirium is independently associated with an increased risk of postoperative delirium (OR 1.717, 95% CI 1.078–2.735, P = 0.023). Patients with emergence delirium stayed longer in PACU and hospital after surgery, and developed more non-delirium complications within 30 days. Conclusions Emergence delirium in elderly admitted to the PACU after general anesthesia and major surgery is independently associated with an increased risk of postoperative delirium. Patients with emergence delirium had worse perioperative outcomes. Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR-OOC-17012734

Download Full-text

Predictive value of thyroxine for prognosis in pediatric septic shock: a prospective observational study

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0502 ◽

2020 ◽

Vol 33 (5) ◽

pp. 653-659

Author(s):

Jia Song ◽

Yun Cui ◽

Chunxia Wang ◽

Jiaying Dou ◽

Huijie Miao ◽

...

Keyword(s):

Septic Shock ◽

Thyroid Hormone ◽

Observational Study ◽

Hospital Mortality ◽

Predictive Value ◽

Prospective Observational Study ◽

Threshold Value ◽

Nonthyroidal Illness ◽

Hormone Levels ◽

Thyroid Hormone Levels

AbstractBackgroundThyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock.MethodsWe performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission.ResultsNinety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937–0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655–0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children.ConclusionsNonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.

Download Full-text

The prediction of in-hospital mortality by mid-upper arm circumference: a prospective observational study of the association between mid-upper arm circumference and the outcome of acutely ill medical patients admitted to a resource-poor hospital in sub-Saharan Africa

Clinical Medicine ◽

10.7861/clinmedicine.18-2-123 ◽

2018 ◽

Vol 18 (2) ◽

pp. 123-127 ◽

Cited By ~ 4

Author(s):

Martin Otyek Opio ◽

Teopista Namujwiga ◽

Imaculate Nakitende ◽

John Kellett ◽

Mikkel Brabrand

Keyword(s):

Observational Study ◽

Hospital Mortality ◽

Prospective Observational Study ◽

Sub Saharan Africa ◽

Medical Patients ◽

Upper Arm ◽

Arm Circumference ◽

Resource Poor ◽

Sub Saharan ◽

Mid Upper Arm Circumference

Download Full-text

Impact of ARDS Etiology on the Failure of Noninvasive Ventilation and 28-Day Mortality: A Multicenter Prospective Observational Study

10.21203/rs.3.rs-220238/v1 ◽

2021 ◽

Author(s):

Weiwei Shu ◽

Shuliang Guo ◽

Fuxun Yang ◽

Bicui Liu ◽

Zhongxing Zhang ◽

...

Keyword(s):

Observational Study ◽

Noninvasive Ventilation ◽

Prospective Observational Study ◽

Distress Syndrome ◽

Cox Regression ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Propensity Matching ◽

Multicenter Prospective Observational Study

Abstract Background: The failure rate of noninvasive ventilation (NIV) remains high in patients with acute respiratory distress syndrome (ARDS). The etiology of ARDS may play an important role in NIV failure.Methods: A multicenter prospective observational study was performed in 17 ICUs in China from September 2017 to December 2019. ARDS patients who used NIV as a first-line therapy were enrolled. The etiology of ARDS was recorded at study entry. Results: A total of 306 patients were enrolled. Of the patients, 146 were classified as having pulmonary ARDS (ARDSp) and 160 were classified as having extrapulmonary ARDS (ARDSexp). NIV improved PaO2/FiO2 from initiation to 24 h of NIV in both groups. However, it improved more slowly in patients with ARDSp than in those with ARDSexp (interaction effect: p < 0.01). ARDSp patients experienced more NIV failure (55% vs. 28%; p < 0.01) and higher 28-day mortality (47% vs. 14%; p < 0.01). The multivariate Cox regression also showed that ARDSp was independently associated with NIV failure (hazard ratio [HR] = 2.81, 95% confidence interval [CI]: 1.89-4.18) and 28-day mortality (HR = 7.49, 95% CI: 4.32-13.01). After propensity matching, 62 patients remained in each group. The baseline data were comparable between the two groups. ARDSp was still independently associated with NIV failure and 28-day mortality (HR = 2.62, 95%CI: 1.49-4.61; and 5.70, 2.59-12.55, respectively). Sensitivity analysis also confirmed these results. Conclusions: Among ARDS patients who used NIV as a first-line therapy, ARDSp was associated with slower improvement in oxygenation, more NIV failure, and higher 28-day mortality than ARDSexp.

Download Full-text

Evaluation of point-of-care thumb-size bispectral electroencephalography device to quantify delirium severity and predict mortality

The British Journal of Psychiatry ◽

10.1192/bjp.2021.101 ◽

2021 ◽

pp. 1-8

Author(s):

Takehiko Yamanashi ◽

Kaitlyn J. Crutchley ◽

Nadia E. Wahba ◽

Eleanor J. Sullivan ◽

Katie R. Comp ◽

...

Keyword(s):

Rating Scale ◽

Point Of Care ◽

Confusion Assessment Method ◽

Assessment Method ◽

Negative Group ◽

Positive Group ◽

Prediction Of Mortality ◽

Eeg Data ◽

Poor Outcomes ◽

Screening Scale

Background We have developed the bispectral electroencephalography (BSEEG) method for detection of delirium and prediction of poor outcomes. Aims To improve the BSEEG method by introducing a new EEG device. Method In a prospective cohort study, EEG data were obtained and BSEEG scores were calculated. BSEEG scores were filtered on the basis of standard deviation (s.d.) values to exclude signals with high noise. Both non-filtered and s.d.-filtered BSEEG scores were analysed. BSEEG scores were compared with the results of three delirium screening scales: the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), the Delirium Rating Scale-Revised-98 (DRS) and the Delirium Observation Screening Scale (DOSS). Additionally, the 365-day mortalities and the length of stay (LOS) in the hospital were analysed. Results We enrolled 279 elderly participants and obtained 620 BSEEG recordings; 142 participants were categorised as BSEEG-positive, reflecting slower EEG activity. BSEEG scores were higher in the CAM-ICU-positive group than in the CAM-ICU-negative group. There were significant correlations between BSEEG scores and scores on the DRS and the DOSS. The mortality rate of the BSEEG-positive group was significantly higher than that of the BSEEG-negative group. The LOS of the BSEEG-positive group was longer compared with that of the BSEEG-negative group. BSEEG scores after s.d. filtering showed stronger correlations with delirium screening scores and more significant prediction of mortality. Conclusions We confirmed the usefulness of the BSEEG method for detection of delirium and of delirium severity, and prediction of patient outcomes with a new EEG device.

Download Full-text

Noninvasive Ventilation Initiation in Clinical Practice: A Six-Year Prospective, Observational Study

Canadian Respiratory Journal ◽

10.1155/2010/842543 ◽

2010 ◽

Vol 17 (3) ◽

pp. 123-131 ◽

Cited By ~ 2

Author(s):

Chris Harris ◽

Refik Saskin ◽

Karen EA Burns

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Clinical Practice ◽

Observational Study ◽

Noninvasive Ventilation ◽

Prospective Observational Study ◽

Obstructive Sleep ◽

Positive Airway Pressure Ventilation ◽

Over Time

BACKGROUND: Despite evidence supporting the role of noninvasive ventilation (NIV) in diverse populations, few publications describe how NIV is used in clinical practice.OBJECTIVE: To describe NIV initiation in a teaching hospital that has a guideline, and to characterize temporal changes in NIV initiation over time.METHODS: A prospective, observational study of continuous positive airway pressure ventilation (CPAP) or bilevel NIV initiation from January 2000 to December 2005 was conducted. Registered respiratory therapists completed a one-page data collection form at NIV initiation.RESULTS: Over a six-year period, NIV was initiated in 623 unique patients (531 bilevel NIV, 92 CPAP). Compared with bilevel NIV, CPAP was initiated more often using a nasal interface, with a machine owned by the patient, and for chronic conditions, especially obstructive sleep apnea. Whereas CPAP was frequently initiated and continued on the wards, bilevel NIV was most frequently initiated and continued in the emergency department, intensive care unit and the coronary care unit. Patients initiated on bilevel NIV were more likely to be female (OR 1.8, 95% CI 1.08 to 2.85; P=0.02) and to have an acute indication compared with CPAP initiations (OR 7.5, 95% CI 1.61 to 34.41; P=0.01). Bilevel NIV was initiated more often in the emergency department than in the intensive care unit (OR 5.8, 95% CI 0.89 to 38.17; P=0.07). Bilevel NIV initiation increased from 2000 to 2005.CONCLUSIONS: The present study illustrates how NIV is used in clinical practice and confirms that NIV initiation has increased over time.

Download Full-text