"improving intensive care in Scotland"

Delirium in ICU

Predisposing factors

In the critical care population predisposing causes are often multiple, with many patients having more than 10 risk factors.

These include:

1. Co-existing patient factors:

    • Old age
    • Alcoholism/Substance abuse
    • Drug withdrawal especially alcohol and benzodiazepines
    • Hypertension: hypertensive encephalopathy, stroke, arrhythmias
    • Vitamin deficiencies: Vitamin B12, folate, niacin, thiamine
    • Endocrine disorders: hyper/hypoadrenocorticism, hyper/hypoglycaemia, myxoedema, hyperparathyroidism
    • Depression
    • Smoking
    • Vision/hearing impairment
    • Cognitive impairment

 

2. Factors relating to critical illness:

    • Acidosis
    • Hypoxaemia: anaemia, pulmonary or cardiac failure
    • Sepsis/Fever
    • Hypotension
    • Metabolic and electrolyte disturbances.
    • Hepatic and renal failure
    • Poisons: carbon monoxide, metabolic blockade, pesticides, solvents, mercury, lead
    • CNS pathology: abscesses, haemorrhage, hydrocephalus, subdural haematoma, infections, seizures, stroke, tumours, metastases, vasculitis, encephalitis, meningitis.

 

3. Iatrogenic factors

    • Medication: Most commonly sedative, anaesthetic and analgesic agents, but also psychotropic drugs
    • Sleep disturbance
    • Immobilisation

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