MUSCAT: A pioneering study conducted in Oman has unveiled concerning rates of delirium among patients in intensive care units (ICUs), highlighting the pressing need for enhanced prevention and management strategies.
This research, led by Rasha Khamis Hamdan Al Hoodar, a dedicated staff nurse at Sultan Qaboos University Hospital, is recognized as the inaugural study in the Sultanate to investigate the prevalence and consequences of delirium within ICUs.
The findings indicate that more than one-quarter of ICU patients in Oman suffer from this frequently neglected condition, which can significantly deteriorate health outcomes.
The study, titled “Incidence, Associated Factors, and Outcomes of Delirium Among Patients Admitted to ICUs in Oman,” was a component of Al Hoodar’s Master of Science in Nursing (MSN) thesis. It was supervised by Dr. Eilean Lazarus Rathinasamy, an Assistant Professor at the College of Nursing, Sultan Qaboos University, with co-supervision from Prof. Omar Al Omari, a Professor at the Department of Fundamentals and Administration, College of Nursing, Sultan Qaboos University.
This research marks the first in-depth exploration of delirium within Omani hospitals, offering essential insights into a condition known to prolong ICU stays, increase healthcare expenditures, and elevate mortality rates in the absence of treatment.
A Neglected but Serious Condition
“Delirium affects as many as 50% of older patients hospitalized worldwide and nearly 80% of those in ICUs,” Dr. Rathinasamy noted.
“Despite its significant impact on patient health and healthcare costs, delirium has received scant research attention in Oman.”
The study, spanning three months at two prominent hospitals—Sultan Qaboos University Hospital and Royal Hospital—involved 153 ICU patients.
The research's objectives were to ascertain the incidence of delirium, identify its predisposing and precipitating factors, and evaluate its influence on ICU length of stay and mortality rates.
Utilizing the validated Intensive Care Delirium Screening Checklist (ICDSC), the study identified that 26.1% of patients developed delirium, with several critical factors associated with its occurrence, including sepsis, mechanical ventilation, sedation, metabolic acidosis, and the insertion of nasogastric tubes.
Significant Findings and Recommendations
The results of the study were notably significant: patients diagnosed with delirium were observed to have significantly longer stays in the Intensive Care Unit (ICU) and experienced higher mortality rates compared to their counterparts without delirium. Furthermore, delirium was found to be positively correlated with the severity of illness, as measured by the APACHE II and SOFA scores, which are utilized to assess the severity of disease and organ failure in ICU patients.
Dr. Rathinasamy highlighted, "Sepsis, metabolic acidosis, and the insertion of nasogastric tubes were identified as strong predictors of delirium, underscoring the importance of these findings in understanding the prevention and management of this condition."
In light of these findings, the study proposes several strategies aimed at reducing the incidence and impact of delirium within ICUs in Oman.
A primary recommendation is the implementation of routine daily screening of ICU patients using validated tools, coupled with the adoption of the ABCDE Bundle. This comprehensive care approach encompasses awakening and breathing coordination, delirium monitoring, and early mobilization. Additionally, the study emphasizes the necessity for improved training programs in both Arabic and English for ICU staff, as well as the annual assessment of competencies.
In the realm of healthcare policy, the study's authors advocate for multidisciplinary collaboration within ICU care, focusing on the reduction of physical restraints, the promotion of early mobilization, and the facilitation of timely extubation from sedation. These measures are anticipated to not only enhance patient outcomes but also to significantly alleviate the financial strain on healthcare systems in Oman.
Dr. Rathinasamy concluded, "Delirium is a serious syndrome that warrants recognition as such by ICU teams. Shifting the culture within ICUs to prioritize delirium management could lead to improved patient care, reduced ICU stays, and decreased healthcare costs."
The study's findings have been disseminated in two esteemed journals, Anesthesiology Research and Practice and Critical Care Research and Practice. It received support from the Ministry of Higher Education, Research, and Innovation’s Publication Support Programme, which is dedicated to fostering high-quality research publication in Oman.
