Review Article

Factors Related to Delirium of Intensive Care Untints in Korea: A Systematic Review


Background: The delirium in Intensive Care Untints (ICU) patients is a major cause of unplanned extubation, increased length of hospital day. This study aimed to review systematically risk factors associated with the occurrence of delirium among ICU patients in South Korea.

Methods: Data collection was done with domestic literature search databases including KMbase, KoreaMed, KISS, and KisTi and also with hand searching, from February 17 to May 19, 2019. Two researchers independently selected research literatures, and three researchers summarized and identified related variables based on data extraction methods.

Results: Overall, 140 articles identified, 18 articles met the inclusion criteria for review. According to the results of the methodological quality, one article was found to have a high level of quality, while the remaining 17 articles belonged to the medium level. Those factors found to be highly associated with delirium by more than 9 out of the 18 selected studies were listed as follows; age, the application of ventilator, APACHE II score, comorbidity, the application of restraint, and educational level. In addition, catheter insertion and the application of artificial airway were also found to have significant relevance with the occurrence of delirium.

Conclusion: For management of delirium among ICU patients, it is necessary to eliminate and prevent delirium-associated risk factors, and also to detect and treat the delirium early through regular monitoring using an appropriate screening tool for delirium.

1. Lee HS, Kim SS (2013). Development of a delirium occurrence screening model for patients in medical intensive care units. J Korean Clin Nurs Res, 19(3): 357-68.
2. Zaal IJ, Devlin JW, Peelen LM, et al (2015). A systematic review of risk factors for delirium in the ICU. Crit Care Med, 43(1): 40-7.
3. Ahn JS, Oh J, Park J, et al (2019). Incidence and procedure-related risk factors of de-lirium in patients admitted to an intensive care unit. Korean J Psychosomatic Med, 27(1): 35-41.
4. Nam HLN. Development of Korean inten-sive care delirium screening tool (KICDST) [PhD thesis]. The Graduate School, Ajou University, Korea; 2015.
5. Vyveganathan L, Izaham A, Mat WRW, et al (2019). Delirium in critically ill patients: in-cidence, risk factors and outcomes. Crit Care Shock, 22(1): 25-40.
6. Yoon HJ, Cho JY (2017). A study to define the range of sample size for setting inten-sive care unit(ICU) facility guidelines-focused on analysis of guidelines and present of ICUs facilities by general hos-pitals size. Journal of Korea Institute of Healthcare Architecture, 23(3): 47-56.
7. Noh EY, Park YH (2019). Prevalence of de-lirium and risk factors in heart surgery patients in intensive care unit: A retro-spective study. Korean Journal of Adult Nurs-ing, 31(2): 146.
8. Lee YJ. Risk factor of delirium patient in the cardiac surgery intensive care unit. [Mas-ter’s thesis]. Graduate School, the Catho-lic University of Korea, Korea; 2018.
9. Lee HJ, Kim SR (2018). Factors influencing delirium in neurological intensive care unit patient. J Korean Acad Adult Nurs, 30(5): 470-481.
10. Estabrooks CA, Floyd JA, Scott-Findlay S, et al (2003). Individual determinants of research utilization: a systematic review. J Adv Nurs, 43(5): 506-20.
11. Cicolini G, Comparcini D, Simonetti V (2014). Workplace empowerment and nurses' job satisfaction: a systematic lit-erature review. J Nurs Manag, 22(7): 855-71.
12. Park DH. Prediction model on causing fac-tors delirium in intensive care unit pa-tients [PhD thesis]. The Graduate School, Chung-Ang University, Korea; 2013.
13. Allen J, Alexander E (2012). Prevention, recognition, and management of delirium in the intensive care unit. AACN Adv Crit Care, 23(1): 5-11.
14. Kim NY, Kim YH, Kim EA, et al (2016). AACN essentials of critical care nursing. 3rd ed. Hyunmoomsa. Seoul. pp.182
15. Tilouche N, Hassen MF, Ali HBS, et al (2018). Delirium in the intensive care unit: incidence, risk factors, and impact on outcome. Indian J Crit Care Med, 22(3): 144-149.
16. Mattar I, Chan MF, Childs C (2019). Risk factors for acute delirium in critically ill adult patients: a systematic review. ISRN Crit Care, Article ID 910125:10 pages.
17. Page V, Katawala T (2011). Management of ICU delirium. ICU Director, 2(1-2): 31-5.
18. Sona CS, Sona JE, Zack ME, et al (2008). The impact of a simple, low-cost oral care protocol on ventilator-associated pneumonia rates in a surgical intensive care unit. J Intensive Care Med, 24(1): 54-62.
19. Lee SH. Path analysis for delirium on patient outcomes in intensive care units [PhD thesis]. Graduate School, the Catholic University, Korea; 2018.
20. Mori S, Takeda JRT, Carrara FSA, et al (2016). Incidence and factors related to delirium in an intensive care unit. Rev Esc Enferm USP, 50(4): 587-593.
21. Ebersoldt M, Sharshar T, Annane D (2007). Sepsis-associated delirium. Intensive Care Medicine, 33(6):941-950.
22. Young J, Murthy L, Westby M, et al (2010). Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ, 341:c3704.
23. Piao JS. Analysis of delirium risk factors in intensive care unit patients using electron-ic medical records [Master's thesis]. Graduate School, the Catholic University of Korea, Korea; 2013.
24. Park YH. Risk factors of delirium among the patients in the medical intensive care unit at a general hospital [Master's thesis]. The Graduate School of Industrial Tech-nology, Ulsan University, Korea; 2014.
25. Park EJ. Incidence and risk factors of deliri-um in older adults admitted to the inten-sive care unit [Master's thesis]. The Graduate School, Hanyang University, Korea; 2016.
26. Ahn YS. Operative and anesthetic factors influencing on delirium in the intensive care units: analysis of electronic health records [Master's thesis]. Graduate School, the Catholic University of Korea, Korea; 2016.
27. Kim AR (2010). Delirium among elderly pa-tients in the intensive care units. Health & Nursing, 22(1): 11-20.
28. Seo KS. Factors related to delirium occur-rence in medical intensive care unit pa-tients [Master's thesis]. The Graduate School, Seoul National University, Korea; 2008.
29. Yu MY, Park JW, Hyun MS, et al (2008). Factors related to delirium occurrence among the patients in the intensive care units. J of Korean Clin Nurs Res, 14(1): 151-60.
30. Lee EJ, Shim MY, Song SH, et al (2010). Risk factors related to delirium develop-ment in patients in surgical intensive care unit. J of Korean Crit Care Nurs, 3(2): 37-48.
31. Jin TX. Medications and risk of delirium in mechanically ventilated patients [Master's thesis]. Graduate School, The Catholic University of Korea, Korea;2016
32. Cho OH, Yoo YS, Choi JE, et al (2009). Risk factors for postoperative delirium after liver transplantation in the intensive care unit. J Korean Acad Fundam Nurs, 16(3): 290-99.
33. Chun YK, Park JY (2017). Risk factors of delirium among the patients at a surgical intensive care unit. J Korean Crit Care Nurs, 10(3): 31-40.
34. Choi SJ, Cho YA (2014). Prevalence and re-lated risk factors of delirium in intensive care units as detected by the CAM-ICU. J Korean Clin Nurs Res, 20(3): 406-16.
35. Kim YW. Risk factors and outcomes of sepsis-associated delirium in the intensive care unit [Master's thesis]. The Graduate School, the Catholic University of Korea, Korea; 2017.
IssueVol 50 No 8 (2021) QRcode
SectionReview Article(s)
Delirium Intensive care unit Systematic review

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How to Cite
Kim NY, Ryu SA, Kim YH. Factors Related to Delirium of Intensive Care Untints in Korea: A Systematic Review. Iran J Public Health. 2021;50(8):1526-1535.