• Karla D Krewulak, Henry T Stelfox, LeighJeanna ParsonsJPDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.Critical Care Strategic Clinical Network (CC SCN), Alberta Health Services, Calgary, AB, Canada.O'Brien Institute for Public , E Wesley Ely, and Kirsten M Fiest.
• Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
• Crit. Care Med. 2018 Dec 1; 46 (12): 2029-2035.

ObjectivesUse systematic review and meta-analytic methodology to estimate the pooled incidence, prevalence, and proportion of delirium cases for each delirium subtype (hypoactive, hyperactive, and mixed) in an adult ICU population.Data SourcesWe conducted a search of the MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, and PsycINFO databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards from database inception until October 22, 2017, with no restrictions.Study SelectionWe included original research conducted in adults admitted to any medical, surgical, or speciality ICU that reported incidence or prevalence estimates of delirium according to delirium subtype.Data ExtractionData were extracted on sample size, population demographics, condition information, and reported delirium estimates.Data SynthesisForty-eight studies (27,342 patients; 4,550 with delirium) with an overall pooled prevalence of 31% (95% CI, 24-41; I = 99%) met inclusion criteria. The pooled incidence (n = 18 studies) of delirium subtypes were hyperactive (4% [95% CI, 2-6]; I = 92%]), hypoactive (11% [95% CI, 8-17; I = 97%]), and mixed (7% [95% CI, 4-11; I = 97%]). The pooled prevalence (n = 31 studies) of delirium subtypes were hyperactive (4% [95% CI, 3-6; I = 94%]), hypoactive (17% [95% CI, 13-22; I = 97%]), and mixed (10% [95% CI, 6-16; I = 99%]). The pooled prevalence of hypoactive delirium in study populations with a similarly high severity of illness or mechanically ventilated was higher (severity of illness: 29% [95% CI, 18-46%; I = 95%], 100% mechanically ventilated: 35% [95% CI, 23-55%; I = 93%]) compared with the pooled prevalence of hypoactive delirium.ConclusionsDespite significant heterogeneity between studies, these data show the majority of delirious ICU patients to have hypoactive delirium, a finding with potential monitoring, management, and prognostic implications. The prevalence of hypoactive delirium varies between-study populations and is higher in patients with greater severity of illness.

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