Delirium in elderly critically ill patients: the value of cerebral regulation.
4 affiliations
- 1Department of Critical Care Medicine, Hunan Provincial Clinical Research Center for Critical Care Medicine, National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, No. 87 Xiang-ya Road, Changsha, Hunan, 410008, China.
- 2Department of Critical Care Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, 410005, China.
- 3Department of Critical Care Medicine, Hunan Provincial Clinical Research Center for Critical Care Medicine, National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, No. 87 Xiang-ya Road, Changsha, Hunan, 410008, China. [email protected].
- 4Department of Critical Care Medicine, Hunan Provincial Clinical Research Center for Critical Care Medicine, National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, No. 87 Xiang-ya Road, Changsha, Hunan, 410008, China. [email protected].
Abstract
Background
Delirium is a common neurological complication in elderly critically ill patients, and a uniform blood pressure target may not adequately address individual cerebral perfusion requirements. This study aimed to evaluate whether cerebral regulation-targeted optimal blood pressure management (OBPM) reduces the incidence of delirium and improve clinical outcomes in this population.Methods
This prospective, single-center, observational study was conducted at Xiangya Hospital, Central South University, from August 2023 to May 2025. A total of 119 elderly critically ill patients were enrolled, including 39 in the OBPM group and 80 in the standard of care (SOC) group. Using near-infrared spectroscopy (NIRS) and ICM+ software, the tissue oxygen reactivity index (TOx) was derived from the dynamic correlation between regional cerebral oxygen saturation (rSO₂) and mean arterial pressure (MAP) across steady-state measurements obtained during stepwise norepinephrine titration, with the optimal MAP (MAPopt) defined as the MAP value at which TOx was minimized. In the OBPM group, blood pressure was targeted within MAPopt ± 5 mmHg, while the SOC group received standard care with blood pressure maintained within the normal range and no signs of inadequate tissue perfusion. The primary outcome, delirium, was screened twice daily throughout the ICU stay using the Confusion Assessment Method for the ICU (CAM-ICU) and the incidence of delirium was determined if the patients experienced it at least once. Secondary outcomes included all-cause mortality at hospital discharge, duration of mechanical ventilation, ICU length of stay, and hospital length of stay.Results
The incidence of delirium was significantly lower in the OBPM group than in the SOC group (33.3% vs. 55.0%, p = 0.043), and ICU length of stay was significantly shorter [5.0 (3.0-9.0) d vs. 7.0 (4.0-11.0) d, p = 0.022]. Multivariable logistic regression showed that OBPM was independently associated with lower odds of delirium (OR = 0.409, 95% CI: 0.184-0.909, p = 0.028). Mechanical ventilation (OR = 3.500, P = 0.010), sepsis-related organ failure assessment (SOFA) score (OR = 1.139, p = 0.010), and ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO₂/FiO₂) (OR = 0.995, p = 0.014) were also independently associated with delirium. No significant differences were observed between groups in hospital length of stay or mortality. Independent risk factors for mortality included sepsis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, lactate level, and prothrombin time.Conclusions
Cerebral regulation-targeted optimal blood pressure management was associated with a reduced incidence of delirium and shorter ICU stay in elderly critically ill patients, without increasing mortality. Larger multicenter randomized controlled trials are needed to confirm these findings and guide clinical implementation.
Related
- Predicting delirium in critically Ill patients with cancer using interpretable machine learning
- Construction and validation of a nomogram prediction model for the risk of delirium after hip arthroplasty in elderly patients
- Serum NLRP3 levels are associated with postoperative delirium of elderly patients with lung cancer: an observational analytical study
- Development of machine learning models for predicting delirium in elderly patients after thoracic surgeries
- Remimazolam versus propofol for elderly patients undergoing laparoscopic gastrointestinal surgery: a randomized trial concentrating on delirium and hemodynamic stability
BibTeX
@article{ren2026delirium,
title = {{Delirium in elderly critically ill patients: the value of cerebral regulation.}},
author = {Xingshu Ren and Lanlan Zhong and Yunan Mo and Qianyi Peng and Lina Zhang},
journal = {BMC geriatrics},
year = {2026},
month = jul,
doi = {10.1186/s12877-026-08074-6},
url = {https://europepmc.org/article/MED/42958096},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Delirium in elderly critically ill patients: the value of cerebral regulation.
AU - Xingshu Ren
AU - Lanlan Zhong
AU - Yunan Mo
AU - Qianyi Peng
AU - Lina Zhang
PY - 2026
DA - 2026/07/01
JO - BMC geriatrics
DO - 10.1186/s12877-026-08074-6
UR - https://europepmc.org/article/MED/42958096
AB - Background Delirium is a common neurological complication in elderly critically ill patients, and a uniform blood pressure target may not adequately address individual cerebral perfusion requirements. This study aimed to evaluate whether cerebral regulation-targeted optimal blood pressure management (OBPM) reduces the incidence of delirium and improve clinical outcomes in this population.Methods This prospective, single-center, observational study was conducted at Xiangya Hospital, Central South University, from August 2023 to May 2025. A total of 119 elderly critically ill patients were enrolled, including 39 in the OBPM group and 80 in the standard of care (SOC) group. Using near-infrared spectroscopy (NIRS) and ICM+ software, the tissue oxygen reactivity index (TOx) was derived from the dynamic correlation between regional cerebral oxygen saturation (rSO₂) and mean arterial pressure (MAP) across steady-state measurements obtained during stepwise norepinephrine titration, with the optimal MAP (MAPopt) defined as the MAP value at which TOx was minimized. In the OBPM group, blood pressure was targeted within MAPopt ± 5 mmHg, while the SOC group received standard care with blood pressure maintained within the normal range and no signs of inadequate tissue perfusion. The primary outcome, delirium, was screened twice daily throughout the ICU stay using the Confusion Assessment Method for the ICU (CAM-ICU) and the incidence of delirium was determined if the patients experienced it at least once. Secondary outcomes included all-cause mortality at hospital discharge, duration of mechanical ventilation, ICU length of stay, and hospital length of stay.Results The incidence of delirium was significantly lower in the OBPM group than in the SOC group (33.3% vs. 55.0%, p = 0.043), and ICU length of stay was significantly shorter [5.0 (3.0-9.0) d vs. 7.0 (4.0-11.0) d, p = 0.022]. Multivariable logistic regression showed that OBPM was independently associated with lower odds of delirium (OR = 0.409, 95% CI: 0.184-0.909, p = 0.028). Mechanical ventilation (OR = 3.500, P = 0.010), sepsis-related organ failure assessment (SOFA) score (OR = 1.139, p = 0.010), and ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO₂/FiO₂) (OR = 0.995, p = 0.014) were also independently associated with delirium. No significant differences were observed between groups in hospital length of stay or mortality. Independent risk factors for mortality included sepsis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, lactate level, and prothrombin time.Conclusions Cerebral regulation-targeted optimal blood pressure management was associated with a reduced incidence of delirium and shorter ICU stay in elderly critically ill patients, without increasing mortality. Larger multicenter randomized controlled trials are needed to confirm these findings and guide clinical implementation.
SN - 1471-2318
ER -