Pandharipande Pratik, Cotton Bryan A, Shintani Ayumi, Thompson Jennifer, Costabile Sean, Truman Pun Brenda, Dittus Robert, Ely E Wesley
Vanderbilt University School of Medicine [corrected] Department of Anesthesia/Critical Care Medicine, 1121 21st Ave So, Nashville MAB 526, TN [corrected] 37212, USA.
Intensive Care Med. 2007 Oct;33(10):1726-31. doi: 10.1007/s00134-007-0687-y. Epub 2007 Jun 5.
Acute brain dysfunction or delirium occurs in the majority of mechanically ventilated (MV) medical intensive care unit (ICU) patients and is associated with increased mortality. Unfortunately delirium often goes undiagnosed as health care providers fail to recognize in particular the hypoactive form that is characterized by depressed consciousness without the positive symptoms such as agitation. Recently, clinical tools have been developed that help to diagnose delirium and determine the subtypes. Their use, however, has not been reported in surgical and trauma patients. The objective of this study was to identify the prevalence of the motoric subtypes of delirium in surgical and trauma ICU patients.
Adult surgical and trauma ICU patients requiring MV longer than 24 h were prospectively evaluated for arousal and delirium using well validated instruments. Sedation and delirium were assessed using the Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method in the ICU (CAM-ICU), respectively. Patients were monitored for delirium for a maximum of 10[Symbol: see text]days or until ICU discharge.
A total of 100 ICU patients (46 surgical and 54 trauma) were enrolled in this study. Three patients were excluded from the final analysis because they stayed persistently comatose prior to their death.
Prevalence of delirium was 70% for the entire study population with 73% surgical and 67% trauma ICU patients having delirium. Evaluation of the subtypes of delirium revealed that in surgical and trauma patients, hypoactive delirium (64% and 60%, respectively) was significantly more prevalent than the mixed (9% and 6%) and the pure hyperactive delirium (0% and 1%).
The prevalence of the hypoactive or "quiet" subtype of delirium in surgical and trauma ICU patients appears similar to that of previously published data in medical ICU patients. In the absence of active monitoring with a validated clinical instrument (CAM-ICU), however, this subtype of delirium goes undiagnosed and the prevalence of delirium in surgical and trauma ICU patients remains greatly underestimated.
急性脑功能障碍或谵妄在大多数接受机械通气（MV）的医学重症监护病房（ICU）患者中都会出现，且与死亡率增加相关。遗憾的是，谵妄常常未被诊断出来，因为医护人员尤其难以识别以意识减退为特征且无激动等阳性症状的活动减退型谵妄。最近，已开发出有助于诊断谵妄并确定其亚型的临床工具。然而，尚未有关于其在外科和创伤患者中应用情况的报道。本研究的目的是确定外科和创伤ICU患者中谵妄运动亚型的患病率。
对需要机械通气超过24小时的成年外科和创伤ICU患者，使用经过充分验证的工具对其觉醒和谵妄情况进行前瞻性评估。分别使用里士满躁动镇静量表（RASS）和ICU中的意识模糊评估方法（CAM-ICU）评估镇静和谵妄情况。对患者进行谵妄监测，最长监测10天或直至ICU出院。
本研究共纳入100例ICU患者（46例外科患者和54例创伤患者）。3例患者因在死亡前一直处于昏迷状态而被排除在最终分析之外。
整个研究人群中谵妄的患病率为70%，外科ICU患者为73%，创伤ICU患者为67%。对谵妄亚型的评估显示，在外科和创伤患者中，活动减退型谵妄（分别为64%和60%）比混合型（9%和6%）和单纯活动亢进型谵妄（0%和1%）更为普遍。
外科和创伤ICU患者中活动减退型或“安静”型谵妄的患病率似乎与先前发表的医学ICU患者数据相似。然而，在缺乏使用经过验证的临床工具（CAM-ICU）进行主动监测的情况下，这种谵妄亚型未被诊断出来，外科和创伤ICU患者中谵妄的患病率仍被大大低估。
