Latin American survey on delirium in critical patients

Objectives: This study has aimed to establish the intensivist physician's concepts and practices in this region regarding the diagnosis, management and prevention of delirium in intensive care units (ICU). Design: A survey was distributed among the FEPIMCTI member societies for distribution among its medical members. Results: Eight hundred fifty-four intensive care physicians from 12 Latin America countries, most of them from Argentina, Mexico, Chile and Colombia, responded to the survey. There was a majority of academic ICUs (70.5%). A total of 56.55% responded that they always evaluated the diagnosis of delirium and only 10.2% answered never. A general clinical assessment was made by 69.5%, only 19.6% used the CAM-ICU scale and 9% the checklist assessment of delirium. It was agreed or strongly agreed by 88.3% that delirium was an expected event in the ICU and by 90.1% that delirium was underdiagnosed in ICU. A total of 97% responded that it was a problem that requires intervention and which is preventable (66.5%). It was considered that excessive sedation is given in the ICU by 74.5% and 70.5% believed that opiates are associated with the onset of delirium, while 87.1% considered that some sedatives are associated with its development. Ventilator-associated pneumonia (VAP) was considered as a risk factor by 70.2% of the respondents and 87.8% considered that it made extubation difficult. Conclusions: Although delirium is considered to be a common and preventable problem with serious implications for critically ill patients, the intensivist physicians surveyed do not use a tool for its evaluation in the ICU. Educational efforts are needed to disseminate the effectiveness and usefulness of the scales that allow for early and accurate diagnosis of delirium in the ICU. (C) 2010 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.