PREVALENCE OF ICU DELIRIUM AMONG PATIENTS ADMITTED TO GASTROENTEROLOGY AND MEDICAL ICUS OF A TERTIARY CARE TRUST HOSPITAL: A CROSS-SECTIONAL STUDY IN RAJASTHAN, INDIA

Abstract

Background: Intensive Care Unit (ICU) delirium is an acute, fluctuating disturbance of attention and cognition associated with prolonged hospitalisation, increased mortality and long-term cognitive impairment. Indian data on nonventilated ICU cohorts and on gastroenterology critical care are limited. Objective: To determine the prevalence of ICU delirium among patients admitted to the Gastroenterology and Medical ICUs of a tertiary care trust hospital in Rajasthan, India, and to describe the demographic and clinical profile of deliriumpositive patients. Materials and Methods: A single-centre, cross-sectional observational study was carried out over six months (April 2023 – September 2023). Fifty adult patients (≥18 years) with an ICU stay of at least 24 hours were consecutively assessed once each using the Confusion Assessment Method for the ICU (CAM-ICU). Patients with pre-existing delirium, dementia or severe sensory impairment were excluded. Categorical variables are summarised as frequencies and percentages, and prevalence is reported for the whole sample and stratified by gender and ICU subgroup. Results: The overall prevalence of ICU delirium was 22.0% (11/50). All deliriumpositive cases were of the hyperactive subtype; no patient in the cohort was mechanically ventilated. Overall, 76.0% of patients were male, 56.0% had chronic illness, 36.0% reported alcohol use and 46.0% had a history of liver disease. Within the delirious sub-group (n = 11), 90.9% were male, 63.6% were aged ≤60 years, 72.7% had chronic illness, 54.5% reported alcohol use, 63.6% had liver disease, 36.4% had sepsis and 81.8% were admitted to the Medical ICU. Prevalence differed markedly by setting (Medical ICU 31.0% vs Gastroenterology ICU 9.5%) and by gender (males 26.3% vs females 8.3%). On CAM-ICU screening, acute onset / fluctuating course, inattention and altered level of consciousness were present in 100% of delirious patients, while disorganized thinking was present in 27.3%. Conclusion: One in five patients admitted to the studied ICUs screened positive for delirium, with a male, non-ventilated, medically complex profile and an exclusively hyperactive presentation. The findings support routine CAM-ICU screening, targeted attention to Medical ICU patients with liver disease and alcohol use, and the adoption of multi-component, non-pharmacological strategies to reduce delirium burden. Larger, multi-centre studies are needed to confirm these observations and to inform Indian ICU delirium care pathways.