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.
Nitrous oxide occupational exposure in conscious sedation procedures in dental ambulatories: a pilot retrospective observational study in an Italian pediatric hospital
