Yonsei Med J.  2023 Dec;64(12):712-720. 10.3349/ymj.2023.0113.

Clinical Features of Delirium among Patients in the Intensive Care Unit According to Motor Subtype Classification: A Retrospective Longitudinal Study

• Kim J
• Oh J
• Ahn JS
• Chung K
• Kim MK
• Shin CS
• Park JY

• KMID: 2548471
• DOI: http://doi.org/10.3349/ymj.2023.0113

Abstract

Purpose
Delirium in the intensive care unit (ICU) poses a significant safety and socioeconomic burden to patients and caregivers. However, invasive interventions for managing delirium have severe drawbacks. To reduce unnecessary interventions during ICU hospitalization, we aimed to investigate the features of delirium among ICU patients according to the occurrence of hypoactive symptoms, which are not expected to require invasive intervention.
Materials and Methods
Psychiatrists assessed all patients with delirium in the ICU during hospitalization. Patients were grouped into two groups: a “non-hypoactive” group that experienced the non-hypoactive motor subtype once or more or a “hypoactive only” group that only experienced the hypoactive motor subtype. Clinical variables routinely gathered for clinical management were collected from electronic medical records. Group comparisons and logistic regression analyses were conducted.
Results
The non-hypoactive group had longer and more severe delirium episodes than the hypoactive only group. Although the non-hypoactive group was prescribed more antipsychotics and required restraints longer, the hypoactive only group also received both interventions. In multivariable logistic regression analysis, BUN [odds ratio (OR): 0.993, pH OR: 0.202], sodium (OR: 1.022), RASS score (OR: 1.308) and whether restraints were applied [OR: 1.579 (95% confidence interval 1.194–2.089), p<0.001] were significant predictors of hypoactive only group classification.
Conclusion
Managing and predicting delirium patients based on whether patients experienced non-hypoactive delirium may be clinically important. Variables obtained during the initial 48 hours can be used to determine which patients are likely to require invasive interventions.

Keyword

Delirium; intensive care unit; physical restraint; antipsychotics