(386) Prospective Analysis of Delirium Trajectories in ICU: Implications for Tailored Management

Introduction: Delirium, an acute brain dysfunction, is seen in 20-70% of intensive care unit (ICU) patients and is associated with worse outcomes. While the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) detects delirium at the bedside, there is no test to understand its trajectory. We aim to prospectively analyze their delirium disease trajectory and correlate it with time of day.

Methods: In a prospective cohort of adult (≥50 years age) ICU patients, we analyzed Richmond Agitation and Sedation Scale (RASS) and CAM-ICU scores. We classified delirium as hypo, mixed and hyperactive delirium and followed their trajectory over 3 days. We identified the following trajectories of delirium: mild brief (MB), mild accelerating (MA), severe rapid recovers (SRR), severe slow recovers (SSR) and severe non recovers (SNR) based on their CAM-ICU trajectory going from initial reading of 3-5 to ≤2 in 12-24 hours, 3-5 to >3-5 in 24 hours, 6-7 to 0 in 0-60 hours, 6-7 to >0 in 0-60 hours and persisting as 6-7 persisting over 60 hours respectively. We also analyzed the behavior of CAM-ICU and RASS scores across time of day using ANOVA. We used Blue Sky (ver:7.40) for statistical analysis.

Results: Ten participants with median age of 70 years (IQR 56-75), 34% female, 90% Caucasian, with a mean of 9 ± 2.87 delirium assessments, had 80% hypoactive, 20% mixed, and no hyperactive delirium. Twenty percent of patients had MB, 40% MA, 10% SRR, 20% SSR and 10% SNR when reporting their delirium trajectories. The median times between changes in consecutive RASS and CAM-ICU scores were 6 hours (IQR 3.03 – 19.03) and 3.18 hours (IQR 2.30 – 16.06) respectively. Time of assessment was associated with both CAM-ICU (F=4.195, p=0.0012) and RASS values (F=3.393, p=0.0051).

Conclusions: Our study highlights the variability in delirium presentations and trajectories among ICU patients, emphasizing the need for tailored management approaches