Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Crit Care Med. 2018 Dec;46(12):2029-2035. doi: 10.1097/CCM.0000000000003402.
Use systematic review and meta-analytic methodology to estimate the pooled incidence, prevalence, and proportion of delirium cases for each delirium subtype (hypoactive, hyperactive, and mixed) in an adult ICU population.
We conducted a search of the MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, and PsycINFO databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards from database inception until October 22, 2017, with no restrictions.
We included original research conducted in adults admitted to any medical, surgical, or speciality ICU that reported incidence or prevalence estimates of delirium according to delirium subtype.
Data were extracted on sample size, population demographics, condition information, and reported delirium estimates.
Forty-eight studies (27,342 patients; 4,550 with delirium) with an overall pooled prevalence of 31% (95% CI, 24-41; I = 99%) met inclusion criteria. The pooled incidence (n = 18 studies) of delirium subtypes were hyperactive (4% [95% CI, 2-6]; I = 92%]), hypoactive (11% [95% CI, 8-17; I = 97%]), and mixed (7% [95% CI, 4-11; I = 97%]). The pooled prevalence (n = 31 studies) of delirium subtypes were hyperactive (4% [95% CI, 3-6; I = 94%]), hypoactive (17% [95% CI, 13-22; I = 97%]), and mixed (10% [95% CI, 6-16; I = 99%]). The pooled prevalence of hypoactive delirium in study populations with a similarly high severity of illness or mechanically ventilated was higher (severity of illness: 29% [95% CI, 18-46%; I = 95%], 100% mechanically ventilated: 35% [95% CI, 23-55%; I = 93%]) compared with the pooled prevalence of hypoactive delirium.
Despite significant heterogeneity between studies, these data show the majority of delirious ICU patients to have hypoactive delirium, a finding with potential monitoring, management, and prognostic implications. The prevalence of hypoactive delirium varies between-study populations and is higher in patients with greater severity of illness.
采用系统评价和荟萃分析方法，估算成人 ICU 人群中每种谵妄亚型（低活动型、高活动型和混合性）的谵妄病例的总发生率、患病率和比例。
我们按照系统评价和荟萃分析的首选报告项目标准，从各数据库建立之初至 2017 年 10 月 22 日，对 MEDLINE、EMBASE、CINAHL、SCOPUS、Web of Science 和 PsycINFO 数据库进行了检索，未设置任何限制。
我们纳入了在任何内科、外科或专科 ICU 接受治疗且根据谵妄亚型报告了谵妄发生率或患病率估计值的成年人的原始研究。
我们提取了样本量、人群人口统计学特征、病情信息和报告的谵妄估计值等数据。
48 项研究（27342 例患者；4550 例患有谵妄）的总患病率为 31%（95%CI，24-41；I=99%），符合纳入标准。谵妄亚型的总发生率（n=18 项研究）为高活动型（4%[95%CI，2-6]；I=92%]）、低活动型（11%[95%CI，8-17；I=97%]）和混合性（7%[95%CI，4-11；I=97%]）。谵妄亚型的总患病率（n=31 项研究）为高活动型（4%[95%CI，3-6；I=94%]）、低活动型（17%[95%CI，13-22；I=97%]）和混合性（10%[95%CI，6-16；I=99%]）。在疾病严重程度或机械通气相似的研究人群中，低活动型谵妄的总患病率较高（疾病严重程度：29%[95%CI，18-46%；I=95%]，100%机械通气：35%[95%CI，23-55%；I=93%]），而低活动型谵妄的总患病率较低。
尽管研究间存在显著的异质性，但这些数据表明，大多数患有谵妄的 ICU 患者存在低活动型谵妄，这一发现可能对监测、管理和预后具有重要意义。低活动型谵妄的患病率在不同研究人群中有所不同，在病情更严重的患者中更高。
