Prevalence of Agitation and Its Associated Factors in Adult Intensive Care Unit: A Systematic Review and Meta-Analysis.

BACKGROUND: Agitation is a common and clinically significant phenomenon among patients admitted to intensive care units (ICUs), particularly those receiving mechanical ventilation or experiencing critical illness. Previous studies have shown inconsistent results regarding the prevalence and predictors of agitation in intensive care units. AIM: To assess the pooled prevalence and associated factors of agitation among adults in the intensive care unit. STUDY DESIGN: A systematic review and meta-analysis was conducted. The review protocol has been registered in the Prospero database under registration number CRD420251022240, following PRISMA guidelines. RESULTS: This systematic review and meta-analysis included 10 studies. The pooled prevalence of agitation in the intensive care unit was 55.65% (95% CI: 40.07, 71.24). The pooled analysis revealed a significant association between hyperthermia (≥ 37.5°C) and the prevalence of agitation in adult patients in the intensive care unit. The adjusted odds ratio (AOR) for hyperthermia was 3.24 (95% CI: 1.51-4.91, p < 0.0002). CONCLUSION: This meta-analysis highlights the significant burden of agitation among adult patients in intensive care units, revealing that over half of critically ill individuals experience agitation during their ICU stay. Among the various contributing factors examined, elevated body temperature emerged as the only one with a statistically significant association with agitation. RELEVANCE TO CLINICAL PRACTICE: This study underscores the importance of vigilant temperature monitoring and timely management of fever in ICU patients. Hyperthermia was found to be associated with a higher likelihood of agitation, although a direct causal relationship cannot be established from the available data. Maintaining normothermia remains a reasonable clinical goal that may contribute to overall patient stability. Implementing structured temperature control protocols as part of routine ICU care could help reduce agitation-related complications such as unplanned extubation, increased sedation needs and prolonged ICU stays, thereby supporting improved patient safety and outcomes.