Prevalence and management of delirium in adult ICU patients in the Netherlands: an observational multicenter study

Abstract

Prevalence and management of delirium in adult ICU patients in the Netherlands: an observational multicenter study

Abstract

Background: Delirium is a common disorder in intensive care units (ICUs) and is associated with an increased length of stay in ICUs. In the past, guidelines describing interventions for prevention, assessment and treatment of delirium were published. Many studies have been performed on the prevalence and management of delirium in ICUs in other countries, but the current prevalence and management of delirium at various levels of ICUs in the Netherlands is unknown. Aim: To determine the prevalence and management of delirium in adult ICU patients in the Netherlands, the predisposing and precipitating risk factors for delirium and variation between the ICU levels. Method: A multicenter observational study was performed. The point-prevalence of delirium was measured on March 14th 2018. The period-prevalence was the period since admission, March 14th and the seven days thereafter. Questionnaires regarding delirium were set of in participating ICUs. Results: In total, 26 out of 84 hospitals participated in the study. After excluding patients who were not assessed on March 14th, 383 patients were analysed. The delirium point-prevalence was 23%, and the period-prevalence 42%. Hypertension was the only predisposing risk factor that occurred more often in patients with delirium, precipitating factors were more present in patients with delirium. Regarding delirium management, protocols were present in nearly 90% of the ICUs. On March 14th, 88% of the delirium assessments was performed. Haloperidol was the most commonly used treatment for delirium. There were no patients with delirium on level 1 ICUs on March 14th and the period-prevalence was also lower. Conclusion and recommendation: The prevalence of delirium in this study was substantial and shows the need to further improve the quality of delirium management. This can be reached by revising the guidelines and implementation of delirium management in ICUs.