Editorials

Delirium on the intensive care unit

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7265 (Published 28 November 2014) Cite this as: BMJ 2014;349:g7265
  1. Valerie J Page, consultant anaesthesia and critical care1,
  2. Tobias Kurth, research director2
  1. 1Intensive Care Unit, Watford General Hospital, Watford WD18 0HB, UK
  2. 2Inserm Research Center for Epidemiology and Biostatistics, Team Neuroepidemiology, Bordeaux, France
  1. Correspondence to: V J Page valerie.page{at}whht.nhs.uk

Deadly or not, delirium remains a serious threat to patients worldwide

Over the past few years the interest in delirium in patients on the intensive care unit has gathered pace, seemingly exponentially. Given that delirium is common, particularly in ventilated patients, a recurring question is, “does delirium increase mortality directly or is it an epiphenomenon?” In a linked paper (doi:10.1136/bmj.g6652) Klein Klouwenberg and colleagues try to answer this question.1 In their prospective cohort study the authors used sophisticated statistical modelling to show that delirium probably does not increase mortality directly, overturning findings from a large body of previous observational research.2 3

Dealing with clinical situations that change over time (such as severity of illness) is one of the key challenges when exploring associations between delirium and death in critically ill patients. Traditional analysis methods may result in incorrect estimates if the main exposure (delirium) influences important covariates such as treatment decisions or clinical complications during follow-up, and also if the main exposure itself (severity of delirium) changes over time.4 Both these problems occur in cohort studies linking delirium with mortality on the intensive care …

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