Volume 17 Supplement 2
Current practices in ICU delirium management: a prospective multicenter study in the Netherlands
© Trogrlic et al.; licensee BioMed Central Ltd. 2013
Published: 19 March 2013
As part of a multicenter prospective study on barriers and facilitators for implementation of protocolled care for delirious critically ill patients, we aimed to describe current practices in delirium management in a representative cohort of ICU patients.
We included consecutively admitted patients during a 4-month period in a prospective multicenter study in six ICUs (one academic, teaching and nonteaching hospitals) in the southwest of the Netherlands. We assessed: percentage of patients screened for delirium with validated screening tools; pharmacological treatment with haloperidol or other antipsychotic drugs; psychohygiene (use of hearing aids and or glasses, preventing sleep disturbances); and access to early mobilization and physiotherapy. Delirium was pragmatically defined as administration of haloperidol and/or delirium reported by physicians or ICU nurses in patient records, as assessed by a designated research nurse. Differences between centers were tested with non-parametric tests.
We assessed 1,576 patients, corresponding with 8,150 ICU treatment days with a median length of stay of 3 days (IQR 2 to 5). The mean age of the patients was 62 years (SD = 16) and 58% were male. Delirium occurred in 23% (356/1,576) of patients with a median duration of 3 days (IQR 2 to 7) and ranged from 11 to 40% for each ICU. Delirium assessment with the CAM-ICU at any point during ICU stay was performed in 38% of all patients. Screening with CAM-ICU was applied in three ICUs, in 29 to 96% of the patients in these centers. Of 3,564 documented screening days with the CAM-ICU, it was positive in 1,459 (41%); in only 120 (8%) of these CAM-ICU-positive days there was a documented action or treatment started for delirium. However, patients still received haloperidol on 52% (n = 766) of all CAM-ICU-positive days. Patients received benzodiazepines in 49% (n = 1,141) of patient sedation days. Delirium preventive interventions were physiotherapy (19% of 8,150 ICU days), mobilization (10%), glasses use (2.6%) and hearing aid use (0.3%). Presence of hearing or visual impairment at admission was not documented in 65% of patients.
Daily screening for ICU delirium with a validated screening instrument is applied in less than one-half of the time in critically ill patients and management of delirium is often not guided by this screening. Haloperidol was used as the first-choice medication. Measures aimed at delirium prevention (psychohygiene and early mobilization) were carried only in a small minority or were not documented. To implement protocolled delirium care in the region at study, a multifaceted tailored implementation program is needed.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.