CARING FOR THE CRITICALLY ILL PATIENT Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit

IN THE UNITED STATES, 55000 PAtients are cared fordaily in more than 6000 intensive care units (ICUs). The most common reason for ICU admission is respiratory failure and the need for a mechanical ventilator. Although hospital mortality for such patients ranges from 30% to 50%, only 16% of patients receiving mechanical ventilation die directly of respiratory failure. In fact, nonpulmonary acute organ dysfunction contributes importantly to mortality. Delirium is one of these nonpulmonary considerations yet remains understudied in critically ill patients. Although scoring systems for severity of illness have included the Glasgow Coma Scale as an important predictor of outcome, there has been no in-depth analysis focusing on the direct contribution of delirium to clinical outcomes in critically ill ICU patients. Management of patients with sepsis and multiorgan failure has traditionAuthor Affiliations are listed at the end of this article. Corresponding Author: E. Wesley Ely, MD, MPH, Division of Allergy/Pulmonary/Critical Care Medicine, Center for Health Services Research, Sixth Floor Medical Center East #6109, Vanderbilt University Medical Center, Nashvi l le, TN 37232-8300 ([email protected]; www.icudelirium.org). Caring for the Critically Ill Patient Section Editor: Deborah J. Cook, MD, Consulting Editor, JAMA. Advisory Board: David Bihari, MD; Christian BrunBuisson, MD; Timothy Evans, MD; John Heffner, MD; Norman Paradis, MD; Adrienne Randolph, MD. Context In the intensive care unit (ICU), delirium is a common yet underdiagnosed form of organ dysfunction, and its contribution to patient outcomes is unclear.