Delirium in the oncology intensive care unit: Risk, recognition, and recovery strategies

Table 1 Risk factors, outcomes, and management strategies for delirium in oncology intensive care unit patients

Category	Specific factors	Risk/impact	Prevention/management strategy
Baseline predisposing factors	Age > 60 years	Higher incidence, OR = 1.01 per year (P = 0.038)	Enhanced screening, proactive monitoring
	Poor performance status	Strong predictor	Optimize functional status pre-admission
	Pre-existing cognitive impairment	Substantial contributor	Establish baseline cognitive assessment
	Hypertension, COPD	Increased vulnerability	Manage comorbidities, optimize oxygenation
	Advanced cancer cachexia	High-intensity risk	Nutritional support, symptom management
Cancer-specific factors	Pancreatic cancer	HR = 1.26 vs gastric cancer	Disease-specific risk stratification
	Leukemia	HR = 1.24 vs gastric cancer	Heightened vigilance during treatment
	Oropharyngeal cancer	HR = 1.30 vs gastric cancer	Enhanced monitoring protocols
	CNS malignancy	OR = 2.25	Neurological assessment, imaging
	Paraneoplastic syndromes	Variable	Consider the autoimmune encephalitis workup
Acute precipitating factors	High SAPS II, SOFA scores	Increased risk	Early intervention, severity mitigation
	Sepsis	Major independent risk	Prompt antimicrobial therapy
	Mechanical ventilation	OR = 2.67	Minimize duration, spontaneous breathing trials
	Benzodiazepine use	Particularly high risk	Avoid or minimize, prefer alternatives
Treatment-related	Chemotherapy (methotrexate, cytarabine, ifosfamide)	Direct neurotoxicity	Dose adjustment, nephroprotection
	Immunotherapy checkpoint inhibitors	Neurological immune-related adverse events	Early recognition, corticosteroids
	CAR-T cell therapy	ICANS in 20%-70%	Distinct protocol: Corticosteroids, tocilizumab
	CNS-active medications (≥ 3 classes)	OR = 11.15	Medication reconciliation, deprescribing
Prognostic impact	ICU delirium presence	ICU mortality OR = 10.75, hospital mortality OR = 5.84	Multicomponent prevention bundle
	Late-onset (> day 3), prolonged (≥ 3 days)	ICU mortality OR = 4.45, hospital mortality OR = 2.91	Early detection and intervention
	Delirium in COVID-19 cancer patients	Median ICU stay 19 days vs 8 days	Prevention prioritization
	Post-ICU delirium	Cancer treatment modification OR = 3.80	Rehabilitation, survivorship support
Prevention strategies	Early mobilization	47% risk reduction (OR = 0.53)	Structured mobility protocols
	Family involvement	54% incidence reduction (RR = 0.46)	Liberal visitation, care participation
	Sleep hygiene bundle	Effective reduction	Noise/Light reduction, circadian support
	ABCDEF bundle	Comprehensive risk reduction	Systematic implementation

OR: Odds ratio; COPD: Chronic obstructive pulmonary disease; HR: Hazard ratio; CNS: Central nervous system; SAPS: Simplified Acute Physiology Score; SOFA: Sequential Organ Failure Assessment; CAR-T: Chimeric antigen receptor T-cell; ICANS: Immune effector cell-associated neurotoxicity syndrome; ICU: Intensive care units; COVID-19: Coronavirus disease 2019; RR: Risk ratio.