Intensive Care Medicine
Published: 22 January 2025
Purpose
We performed a systematic review with meta-analysis
examining the relationship between pain or pain medications and delirium
occurence, duration, and severity.
Methods
We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central
Register of Controlled Trials from inception to May 15, 2023. We included
randomised or observational studies among critically ill adults, that reported
data on pain or exposure to analgesics, and reported delirium presence,
duration, or severity with no language or region restrictions. PROSPERO ID:
CRD42022367715. Two authors independently screened records and extracted data.
Risk of bias was evaluated using Risk of Bias 2 or the Risk of Bias In Non-randomized
Studies of Interventions. We pooled data using the Hartung-Knapp Sidik-Jonkmann
random effects model. PRISMA was followed.
Results
From 8,054 citations, 90 studies (119,230 patients)
published between 2001 and 2023 were included in the systematic review. 41
studies were included in the primary meta-analysis examining prevalent
delirium: seven studies evaluated pain; 12 studies evaluated fentanyl; and five
studies evaluated morphine. There was a trend to association between pain and
delirium occurrence (OR 2.49, 95% CI 0.98–6.30), and a significant association
between pain and incident delirium (OR 3.70, 95% CI 1.73–7.93). Fentanyl (OR 2.49,
95% CI 1.45–4.27) and morphine (OR 2.13, 95% CI 1.21–3.75) were associated with
delirium occurrence. Risk of bias was critical for many studies.
Conclusions
We observed an association between pain and incident
delirium among critically ill adults. Exposure to morphine or fentanyl (but no
other pain medications) was associated with increased risk of delirium
occurrence.
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