• Kathleen Kerber, Jessica Zangmeister, and Molly McNett.
• Kathleen Kerber is a clinical nurse specialist in the medical intensive care unit and the medical step-down unit, MetroHealth Medical Center, Cleveland, Ohio. Jessica Zangmeister is a clinical nurse in the medical intensive care unit, MetroHealth Medical Center. Molly McNett is Professor of Clinical Nursing and Assistant Director of Implementation Science, College of Nursing, The Ohio State University, Columbus, Ohio.
• Crit Care Nurse. 2020 Apr 1; 40 (2): 24-31.

BackgroundDelirium is a common neuropsychiatric diagnosis in intensive care units and often leads to extended hospital stays and an increased rate of complications. Delirium can be classified as hypoactive, hyperactive, or mixed. Hyperactive delirium is often accompanied by agitation, which is a predictive factor for unplanned extubation. Hypoactive delirium does not include outward agitation; its incidence and relationship to ventilatory outcomes, specifically unplanned extubation and duration of mechanical ventilation, are relatively unexplored.ObjectiveTo determine the occurrence rate of each delirium type in the first 7 days after intensive care unit admission and explore the relationship between delirium type and ventilatory outcomes.MethodsThis was a retrospective cohort study that enrolled adult patients consecutively admitted to a medical intensive care unit over 12 months. Data were abstracted on patient demographic variables, daily clinical variables (morning and evening delirium, coma, and sedation scores), and outcome variables (unplanned extubation, length of stay, and duration of mechanical ventilation).ResultsWe enrolled 171 patients in the study. Hypoactive delirium occurred in up to 44% of patients. Of 25 instances of unplanned extubation, up to 74% of patients had hypoactive delirium. Delirium was not a predictor of unplanned extubation; smoking history, chronic obstructive pulmonary disease, and failed breathing trials best predicted unplanned extubation (odds ratios = 3.2, 5.2, and 12.6, respectively; P < .05).ConclusionsHypoactive delirium is common among intensive care unit patients and may precede unplanned extubation. Patient history and comorbidities remain the strongest predictors of unplanned extubation.©2020 American Association of Critical-Care Nurses.

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