Evaluation of the relationship between the weaning process and delirium

In our study, patients for whom the decision to extubate was made underwent delirium screening with CAM-ICU both before extubation and during the 48-hour period following extubation. The type of delirium, its relationship with sedation and unsuccessful extubation, as well as potential triggering and risk factors were investigated. We included 38 patients who were monitored on mechanical ventilation for at least 24 hours, aged 18 and older, with a RASS between +4 and -3 in our study. Patients were screened for delirium with CAM-ICU before extubation, after which they were weaned from mechanical ventilation. Age, gender, APACHE-II, SOFA and CCI scores, duration of hospitalization and intubation were compared between CAM-ICU negative and positive patients before extubation, and the relationship with the type of sedation was examined. Before extubation, in CAM-ICU positive patients; age was younger, and male gender was predominant. When comparing APACHE-II, SOFA, and CCI scores, no significant difference was found between the two patient groups. Additionally, although not statistically significant, hospitalization and intubation durations were found to be longer in CAM-ICU positive patients before extubation. The CAM-ICU positivity rate was lower in patients sedated with dexmedetomidine than in patients not sedated. After extubation, patients were observed for 48 hours, and delirium was screened with CAM-ICU. The PaO2 value and PaO2/FiO2 ratio in arterial blood gas analysis of patients who were negative for CAM-ICU before extubation and positive after extubation were determined, and the highest PCO2 and lactate levels were compared. The decrease in the PaO2/FiO2 ratio of patients was found to have a significant association with delirium. Delirium was observed in 69.23% of patients with PaO2/FiO2<200 and in all but one patient (87.5%) with PaO2/FiO2<150. There was no significant difference in PCO2 and lactate levels. Among all patients, we observed failed extubation in only 3 patients. More studies are needed to investigate the relationship between delirium and failed extubation. Key Words: Delirium, CAM-ICU, Extubation, PaO2/FiO2