Finally, different meantime patterns of practice may play an important role in critical care outcomes [23]. Currently, a paucity of data exists regarding global prevalence and practice regarding delirium. In most published studies evaluating delirium, the enrolled patients are predominantly from North America and Europe, even though delirium in the ICU is a global challenge. In this regard, data from multicenter studies in different regions of the world are important to provide additional information and to allow better design of future clinical trials.Our study has some shortcomings that must be addressed. First, it is a 1-day point-prevalence study, and potential seasonal selection bias cannot be ruled out. Nonetheless, enrolling a large number of ICUs usually diminishes this aspect.

In addition, follow-up was restricted to 30 days; therefore, we were not able to address the impact of delirium on long-term morbidity and mortality of our population of critically ill patients. Even so, the present study provides solid data from a large number of ICUs in 11 countries demonstrating that delirium is not only prevalent but also independently associated with increased ICU LOS, mortality, and hospital mortality.In a point-prevalence study, one must deem possible that other factors may affect patients’ outcomes. One possible factor might be related to significant practice variation in delirium treatment [8,9,24]. Delirium is treated in various ways (that is, physical restraint, sedatives, antipsychotics), and such diverse approaches may have effects on the clinical outcomes evaluated in our study.

Furthermore, in the present study, delirium was considered a dichotomous variable, a yes/no event. Thus, it is reasonable to consider that our results could have varied if delirium severity and duration were measured [5,25-27]. Regarding the factors associated with delirium in our study, the current design does not allow us to establish a true “cause/effect” relation between delirium and the selected outcomes. However, our multicenter study involving numerous ICUs does provide evidence of the negative effect of delirium on major clinical outcomes in mixed critically ill patients.ConclusionsThis 1-day point-prevalence international Dacomitinib study confirms previous findings from single-center studies showing that delirium occurs frequently and is independently associated with adverse outcomes in general ICU patients. Among clinical characteristics associated with the diagnosis of delirium, the use of invasive devices and midazolam were identified and may be considered potentially modifiable risk factors.