Hyperactive delirium in patients after non-traumatic subarachnoid hemorrhage.

Tytuł:: Hyperactive delirium in patients after non-traumatic subarachnoid hemorrhage.
Autorzy:: Reimann F; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Rinner T; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Lindner A; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Kofler M; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Ianosi BA; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; Institute of Medical Informatics, UMIT: University for Health Sciences, Biomedical Informatics and Mechatronics, Medical Informatics and Technology, Eduard Wallnoefer-Zentrum 1, 6060 Hall i.T, Austria.
Schiefecker AJ; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Beer R; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Schmutzhard E; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Pfausler B; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Helbok R; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Electronic address: .
Rass V; Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Źródło:: Journal of critical care [J Crit Care] 2021 Aug; Vol. 64, pp. 45-52. Date of Electronic Publication: 2021 Mar 08.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: Philadelphia Pa : W.B. Saunders
Original Publication: Orlando, FL : Grune & Stratton, c1986-
MeSH Terms:: Delirium*/epidemiology
Delirium*/etiology
Subarachnoid Hemorrhage*/epidemiology
Aged ; Critical Care ; Humans ; Middle Aged ; Psychomotor Agitation ; Respiration, Artificial
Grant Information:: P 29076 Austria FWF_ Austrian Science Fund FWF
Contributed Indexing:: Keywords: Critical care; Delirium; Intensive care delirium screening checklist; Subarachnoid hemorrhage
Entry Date(s):: Date Created: 20210401 Date Completed: 20211018 Latest Revision: 20220302
Update Code:: 20240104
DOI:: 10.1016/j.jcrc.2021.02.010
PMID:: 33794466
: Czasopismo naukowe

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Purpose: Hyperactive delirium is common after subarachnoid hemorrhage (SAH). We aimed to identify risk factors for delirium and to evaluate its impact on outcome.
Methods: We collected daily Richmond Agitation Sedation Scale (RASS) and Intensive Care Delirium Screening Checklist (ICDSC) scores in 276 SAH patients. Hyperactive delirium was defined as ICDSC ≥4 when RASS was >0. We investigated risk factors for delirium and its association with 3-month functional outcome using generalized linear models.
Results: Patients were 56 (IQR 47-67) years old and had a Hunt&Hess (H&H) grade of 3 (IQR 1-5). Sixty-five patients (24%) developed hyperactive delirium 6 (IQR 3-16) days after SAH. In multivariable analysis, mechanical ventilation>48 h (adjOR = 4.46; 95%-CI = 1.89-10.56; p = 0.001), the detection of an aneurysm (adjOR = 4.38; 95%-CI = 1.48-12.97; p = 0.008), a lower H&H grade (adjOR = 0.63; 95%-CI = 0.48-0.83; p = 0.001) and a pre-treated psychiatric disorder (adjOR = 3.17; 95%-CI = 1.14-8.83; p = 0.027) were associated with the development of delirium. Overall, delirium was not associated with worse outcome (p = 0.119). Interestingly, patients with delirium more often had a modified Rankin Scale Score (mRS) of 1-3 (77%) compared to an mRS of 0 (14%) or 4-6 (9%).
Conclusion: Our data indicate that hyperactive delirium is common after SAH patients and requires a certain degree of brain connectivity based ono the highest prevalence found in SAH patients with intermediate outcomes.
Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Comment in: J Crit Care. 2022 Feb;67:208-209. (PMID: 34740481)
Comment in: J Crit Care. 2022 Feb;67:210-211. (PMID: 34740483)

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