Associazione Nazionale Medici Cardiologi Ospedalieri



Multidisciplinary project for delirium in CICU

Lauretani Fulvio Parma (Parma ) – Azienda Ospedaliero Universitaria Parma | Maggio Marcello Giuseppe Parma(Parma) – Azienda Ospedaliero Universitaria Parma | Ardissino Diego Parma(PR)


Delirium could be considered a geriatric syndrome encompassing an array of neuropsychiatric symptoms, which represents a disarrangement of the cerebral function in response to one or more pathophysiological stressors. The prevalence of delirium is high even in Intensive Care Units, where this condition may reach 80% in patients undergoing invasive technique. An estimated 30-40% of cases of delirium are preventable, and prevention is the most effective strategy to minimize the manifestation of delirium and its adverse outcomes. However, predictable episodes of delirium do not seem to be managed effectively.

Aim and methods of the study

Between May 2022 and June 2023, all patients aged 65 years or older admitted to the cardiac intensive care unit (CICU) were enrolled and followed for 1 year. This study is prospective observational cohort study aimed at evaluating the incidence of delirium in CICU patients and the relationship between delirium and predisposing and precipitating risk factors for example restraints, comorbidities. Multidisciplinary evaluation was realized for all patients who admitted in cardiac intensive care unit (CICU). The study was approved by the local ethics committee and was carried out in accordance with the Helsinki declaration. All patients provided written informed consent. Exclusion criteria were terminal status and patient refusal to participate in the study. A physician specialist in cardiology recorded all relevant information related to the patient ‘s acute clinical conditions, baseline medical history mental, sociodemographic status and comorbidity through Cumulative Illness Rating Scale. Functional, nutritional and risk for delirium was assessed by a nurse.


During the study period, 105 patients aged 65 years or older were assessed in CICU. The majority (n. 56, 53,33%) was male, the delirium incidence rate was 15 (14,29%). In the multivariable model, age (p 0.004), CIRS_ severity index (p 0.008), ADL (p 0.007), BMI ≥ 35 (p 0.01), BDZ (p 0.001), SSRI (p 0.05) were significantly associated with 4AT.


In our study, CICU patients with delirium showed worse short and long-term clinical outcomes; similar data were shown in other studies (Falsini et al., 2018; Zipser et al., 2021). The presence of delirium itself had a strong clinical impact.


The results of the study allowed us to prepare a quality improvement plan for elderly CICU patients at risk of delirium.