Prevalence and complications of agitation between intensive care unit admission and tracheal extubation in adult cardiac surgery patients: A single-centre observational study.

BACKGROUND

Some patients admitted to the intensive care unit (ICU) after adult cardiac surgery develop agitation prior to tracheal extubation. The prevalence and consequences of such agitation remain unknown.

OBJECTIVES

The objectives were to study the prevalence and complications of agitation that occurs between ICU admission and prior to tracheal extubation.

METHODS

A single-centre observational study was conducted from March 2021 to December 2023. Data were retrieved from the medical records of all adult patients with sedation ceased for tracheal extubation < 24 hours after ICU admission. Agitation prior to tracheal extubation was defined as a Richmond Agitation-Sedation Scale score ≥+2. Comparisons were made between agitated and nonagitated groups. All variables underwent descriptive analysis. For time-to-event outcomes, Cox regression was performed, while dichotomous outcomes were analysed using logistic regression.

RESULTS

Seven hundred patient records were analysed. Agitation was identified in 204 (29%) patients. Patients with agitation had prolonged mechanical ventilation (mean: 25.7 hours, standard deviation [SD]: 41.1) compared to non-agitated patients (mean: 11.6 hours, SD: 15.6, hazard ratio: 0.50, 95% confidence interval [CI]: 0.42-0.59), and prolonged ICU stay (72.9 hours, SD: 66.1 compared to nonagitated patients (52.4 hours, SD: 60.7, hazard ratio: 0.68, 95% CI: 0.58-0.80). Sixty-four (31.4%) patients with agitation were referred to specialist pain services compared to 92 (18.5%) nonagitated patients (odds ratio [OR]: 2.00, 95% CI: 1.38-2.91). Delirium in the ICU developed in 48 (23.5%) patients with agitation, compared to 61 (12.3%) nonagitated patients (OR: 2.19, 95% CI: 1.44-3.34). After transfer to the ward, 70 (34.5%) patients with agitation and 114 (23%) nonagitated patients were diagnosed with delirium (OR: 0.57, 95% CI: 0.40-0.82).

CONCLUSION

Patients frequently developed agitation before extubation. All patients received mechanical ventilation, but the duration was prolonged in agitated patients, who also stayed in the ICU for longer, received more specialist pain services, and had a higher likelihood of delirium.