Purpose
Delirium is common among mechanically ventilated intensive care unit (ICU) patients and is associated with adverse outcomes. Although opioid analgesia is central to sedation management, its effect on delirium remains uncertain. This study compared delirium outcomes between sufentanil- and fentanyl-based analgesia in mechanically ventilated surgical ICU patients.
Methods
In this prospective, multicenter, randomized exploratory trial conducted at three tertiary hospitals, adults requiring invasive mechanical ventilation and continuous opioid-based analgesia were randomized at enrollment in a 1:1 ratio to receive sufentanil or fentanyl. Delirium was assessed at least twice daily using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The primary outcome was delirium incidence during the ICU stay. Secondary outcomes included delirium duration, prolonged delirium (≥3 days), and other clinical outcomes. Delirium-related analyses were performed in a modified intention-to-treat population.
Results
A total of 252 patients were screened for eligibility: 217 were randomized to sufentanil (n=120) or fentanyl (n=97), and 199 were evaluable for delirium outcomes. Delirium occurred in 53 of 113 patients (46.9%) in the sufentanil group and 51 of 86 patients (59.3%) in the fentanyl group (relative risk for fentanyl vs. sufentanil, 1.26; 95% confidence interval [CI], 0.97–1.64; P=0.083). Delirium duration was shorter in the sufentanil group than in the fentanyl group (1.9±3.2 days vs. 2.9±3.9 days, P=0.034), and prolonged delirium (≥3 days) was less frequent (20.4% vs. 34.9%, P=0.022). In an exploratory multivariable analysis, opioid type was not significantly associated with delirium occurrence (adjusted odds ratio [aOR], 1.65; 95% CI, 0.88–3.09; P=0.118). Among patients who developed delirium, fentanyl use was associated with prolonged delirium (aOR, 2.35; 95% CI, 1.00–5.48; P=0.049). Other major clinical outcomes were comparable between the groups.
Conclusion
Overall delirium incidence did not differ significantly between sufentanil- and fentanyl-based analgesia. However, secondary analyses suggested that delirium duration may be shorter with sufentanil. Trial Registration: Registered in the Clinical Research Information Service (CRIS No. PRE20260212-006).

Purpose
This study aimed to investigate the incidence rate, types and risk factors for delirium in patients admitted to the surgical Step-Down Unit (SDU).
Methods
This study was a retrospective study of the electronic medical records of patients admitted to a surgical SDU from February 2020 to July 2020. The delirium assessment was conducted using the short Confusion Assessment Method (a tool that allows quick and easy screening of delirium) and the incidence and risk factors for delirium were determined.
Results
Among a total of 227 patients in the study, the incidence rate of delirium was 35 cases (16.7%). It predominantly occurred on the first day (n = 16, 45.7%) and the second day of admission (n = 15, 42.8%). The peak occurrence of delirium was between 14:00 and 22:00 (n = 30, 85.7%). The most common type of delirium was hypoactive (n = 19, 54.3%). The results of multiple logistic regression analysis indicated that the factors influencing the occurrence of delirium in the surgical step down unit (SDU) were age, hypertension, stroke, white blood cell count, and the use of restraints.
Conclusion
Considering the characteristics of high-risk groups for delirium in the surgical SDU, it is necessary to establish nursing practice guidelines to minimize delirium.

Citations

• A Systems Biology Approach to Understanding Delirium Pathophysiology and Identifying Natural Compounds for Potential Therapeutic Purposes
  Babak Sokouti
  OBM Neurobiology.2025; 09(01): 1.     CrossRef

Purpose
The occurrence of trauma-related delirium following postoperative abdominal surgery is associated with a poor prognosis. The purpose of this study was to identify predictive risk factors for trauma-related delirium.
Methods
Trauma patient data from a regional trauma center were retrospectively collected from August 2015 to December 2016. The primary inclusion criteria were patients diagnosed with traumarelated delirium following abdominal trauma surgery. Head trauma patients and those under 18 years of age were excluded from this study. A multivariate logistic regression analysis was performed to identify the risk factors associated with trauma-related delirium.
Results
Of the 255 trauma patients who met the inclusion criteria, 32 (12.5%) were diagnosed with delirium. The mean values for the age of the patients, Injury Severity Score, Glasgow Coma Scale score, and length of intensive care unit stay were 52.1 ± 17.8 years, 16.9, 14, and 7.1 days, respectively. Among the measured parameters, age [odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01-1.06; p = 0.022)], sex (OR, 0.125; 0.03-0.55; p = 0.006), hemoglobin level (OR, 0.875; CI, 0.68-0.98; p = 0.03), length of stay in the intensive care unit (OR, 1.12; CI, 1.03-1.22; p = 0.01), and having an abdominal operation (OR, 2.92; CI, 1.10-7.23; p = 0.011) showed strong correlations with trauma-related delirium.
Conclusion
This study showed that abdominal surgery was strongly associated with delirium in patients with traumatic abdominal injury. Thus, changes in consciousness should be carefully monitored following surgery.

Citations

• Management and Outcomes of Traumatic Liver Injury: A Retrospective Analysis from a Tertiary Care Center Experience
  Tariq Alanezi, Abdulmajeed Altoijry, Aued Alanazi, Ziyad Aljofan, Talal Altuwaijri, Kaisor Iqbal, Sultan AlSheikh, Nouran Molla, Mansour Altuwaijri, Abdullah Aloraini, Fawaz Altuwaijri, Mohammed Yousef Aldossary
  Healthcare.2024; 12(2): 131.     CrossRef