Associated Temporal Factors in Critically Ill Adults

Background Agitation is a frequent complication in critically ill adults, can result in life-threatening events for patients or care providers, and extends the hospital length of stay, thereby increasing hospital costs. Objectives To describe the incidence, onset, and temporal factors related to agitation in critically ill adults. Methods Data were collected for the first 5 days of stay of all adult patients consecutively admitted to a medical respiratory intensive care unit and a surgical trauma intensive care unit during a 2-month period. Agitation was documented by using scores on the Richmond Agitation-Sedation Scale or notation of agitation in the medical record. The hour was used as the documentation epoch, and data were summarized by hour, 4-hour block, and day for each patient. Results Data were collected on 200 patients, 100 from each unit. Among the sample, 118 (59%) were agitated at some time during the 5 days. The overall agitation rate was 7.8% of the total hourly time. Mean onset of agitation was 11.6 hours from time of admission to the unit. Of the 118 patients who were agitated at some time, 102 (86%) had agitation on day 1. Compared with patients in the surgical trauma unit, patients in the medical respiratory unit had significantly more hours of agitation the first day and first hour of admission and significantly earlier onset of agitation. Conclusions Agitation was present in more than one-half of the patients in the sample, typically developed on the first day, and involved consecutive days. (American Journal of Critical Care. 2014;23:296-304) AGITATION ONSET, FREQUENCY, AND ASSOCIATED TEMPORAL FACTORS IN CRITICALLY ILL ADULTS