CHEST Guidelines-Impact-of-Delirium-Among-Patients-Receiving-Tempor

Impact-of-Delirium-Among-Patients-Receiving-Tempor

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The study investigates the impact of delirium among patients with temporary mechanical circulatory support (MCS) during cardiac intensive care unit (CICU) admissions at the University of Michigan Health System between 2019 and 2021. Delirium is identified as a significant negative health outcome associated with prolonged hospital stays, increased costs, and higher mortality, especially in ICU settings. This retrospective cohort analysis focused on adult patients receiving MCS, such as extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), percutaneous axial heart pump, or tandem heart.<br /><br />Out of 379 patients, 24.3% experienced delirium. Delirium illness was found to increase the ICU and hospital length of stay (LOS) significantly. Patients with delirium were more likely to receive antipsychotic and sedative medications (e.g., haloperidol, lorazepam, olanzapine) and were often treated with mechanical ventilation. While delirium had an unexpected association with lower ICU mortality, thought to be a marker of survivorship, survivors with delirium often required further care post-discharge, such as rehabilitation or skilled nursing facilities.<br /><br />Delirium’s heightened incidence is attributed to prolonged immobility and necessary medical interventions, highlighting the need for early identification and preventive strategies, including adequate pain management and feasible early mobilization. The study emphasizes the complexity of managing delirium and associated risk factors, noting limitations like small sample size and retrospective study risks.<br /><br />In conclusion, delirium is prevalent among CICU patients on temporary MCS and is linked to extended treatment durations and increased use of antipsychotic medications. The study underscores the importance of exploring methods to mitigate risk factors for delirium to improve patient outcomes in this vulnerable cohort.

Keywords

delirium

mechanical circulatory support

cardiac intensive care

University of Michigan Health System

retrospective cohort analysis

extracorporeal membrane oxygenation

intra-aortic balloon pump

antipsychotic medications

length of stay

early mobilization