Monday 07 / October / 2024
MUSCAT: A groundbreaking study conducted in Oman has revealed alarming rates of delirium among intensive care unit (ICU) patients, underscoring the urgent need for better prevention and management strategies.
The research, conducted by Rasha Khamis Hamdan Al Hoodar, a staff nurse at Sultan Qaboos University Hospital, has been hailed as the first of its kind in the Sultanate to explore the incidence and impact of delirium in ICUs.
It found that over one-quarter of ICU patients in Oman are affected by this often-overlooked condition, which can significantly worsen health outcomes.
The study, “Incidence, associated factors, and outcomes of delirium among patients admitted to ICUs in Oman,” was conducted as part of Al Hoodar’s MSN thesis and was supervised by Dr. Eilean Lazarus Rathinasamy, Assistant Professor at the College of Nursing, Sultan Qaboos University, alongside co-supervisor Prof. Omar Al Omari, Professor at the Department of Fundamentals and Administration, College of Nursing, Sultan Qaboos University.
It is the first comprehensive research project to delve into delirium within Omani hospitals, providing critical data on a condition that is known to increase ICU stays, healthcare costs, and patient mortality if left untreated.
A serious but overlooked Issue
“Delirium affects up to 50% of older hospitalised patients globally and nearly 80% of those in ICUs,” explained Dr. Rathinasamy.
“In Oman, the condition has received little research attention despite its significant implications for patient health and healthcare costs.”
The study, conducted over three months at two major hospitals—Sultan Qaboos University Hospital and Royal Hospital—involved 153 ICU patients.
The research aimed to identify the incidence of delirium, its predisposing and precipitating factors, and its impact on ICU length of stay and mortality rates.
Using the validated Intensive Care Delirium Screening Checklist (ICDSC), the study revealed that 26.1% of patients developed delirium, with several key factors linked to its occurrence, including sepsis, mechanical ventilation, sedation, metabolic acidosis, and the use of nasogastric tubes.
Significant findings and recommendations
The findings were striking: patients with delirium experienced notably longer ICU stays and higher mortality rates compared to those without. Delirium was also positively associated with the severity of illness, as indicated by the APACHE II and SOFA scores, which are used to measure the severity of disease and organ failure in ICU patients.
“Sepsis, metabolic acidosis, and the use of nasogastric tubes were strong predictors of delirium,” Dr. Rathinasamy noted, emphasising that these findings provide crucial insights into preventing and managing the condition.
In response to the findings, the study recommends several strategies to reduce the incidence and impact of delirium in Oman’s ICUs.
Key among these is the routine daily screening of ICU patients using validated tools, along with the implementation of the ABCDE Bundle, a comprehensive care approach that includes awakening and breathing coordination, delirium monitoring, and early nobility. The study also stresses the need for enhanced training programmes in both Arabic and English for ICU staff, along with annual competency assessments.
Shaping healthcare policy
The study’s authors also call for multidisciplinary collaboration in ICU care, with an emphasis on minimising physical restraints, promoting early mobilisation, and ensuring timely weaning from sedation. These measures are expected to not only improve patient outcomes but also significantly reduce the financial burden on healthcare systems in Oman.
“Delirium is a serious syndrome that needs to be recognized as such by the ICU team. Changing ICU culture to prioritise delirium management can lead to better patient care and reduce ICU stays and costs,” said Dr. Rathinasamy.
The study’s findings were published in two prestigious journals, Anesthesiology Research and Practice and Critical Care Research and Practice. It was supported by the Ministry of Higher Education, Research, and Innovation’s Publication Support Programme, which aims to promote high-quality research publication in Oman.
