The Relationship Among Obesity, Nutritional Status, and Mortality in the Critically Ill

Abstract

risk factors for the development of delirium. Numerous risk factors have been studied in the past, with conflicting results. Therefore, the authors of the current study took upon themselves to conduct a systematic review of the literature for proven risk factors. They found 33 articles that studied delirium in the ICU either in patient cohorts or in randomized controlled trials. The investigators evaluated the results of these studies to locate risk factors for delirium that were found in either univariate or multivariate analysis. Risk factors that were repeatedly shown by multivariate analysis to be associated with delirium are suggested to be the most important ones and should be evaluated in any future trial of delirium. Most of the risk factors having a strong association with delirium cannot be modified and include the following: age, dementia, hypertension, worse severity of illness, coma, emergency surgery, mechanical ventilation, and polytrauma. The only modifiable variables that predispose to delirium are metabolic acidosis and delirium during the previous day. Dexmedetomidine was found to protect against delirium. Although this is an important study, the data cannot be used to modify treatment. In order to prevent delirium, we have to better understand its development and thus find ways to prevent it. Although the list of risk factors appears extensive, the role of environmental conditions in the development of delirium in the ICU has not been sufficiently studied. Outside the ICU, delirium could be prevented by repeated orientation of the patients, reduction of noise, use of hearing aids and glasses, early mobilization, and better sleep patterns. All of these factors may play an important role in delirium in critical care patients. Our research into delirium at present is still limited to the descriptive and not to the analytical. We have to better understand the biological process of delirium in order to better study and control it.