Respiratory Intensive Care Unit, Istituto Scientifico di Pavia, Fondazione S.Maugeri, IRCCS, Pavia, Italy.
J Crit Care. 2010 Mar;25(1):136-43. doi: 10.1016/j.jcrc.2009.07.004. Epub 2009 Sep 24.
Delirium is a rather common complication among patients admitted in intensive care units (ICUs), and rather than a single entity, it can be considered a spectrum of diseases where, besides overt cases, there are also many subsyndromal forms. Although there are many data about ICU delirium, there are few data concerning this complication in patients transferred from the ICU to a step-down unit (SDU) once clinically stable.
With the present study, we wanted to assess the incidence of and risk factors for delirium and subsyndromal forms and their impact on clinical outcome in a group of patients transferred from an ICU to an SDU.
All patients transferred from an ICU to our SDU over a 2-year period were screened for delirium and subsyndromal delirious forms using the Intensive Care Delirium Screening Checklist, a simple tool already validated in the ICU. The following data were also recorded: demographic data, severity score (SAPS II), reason for admission to the SDU, length of stay, death rate, use of sedatives, impact of delirium on weaning from mechanical ventilation (MV).
Among the 234 patients, the incidence of delirium and subsyndromal forms was 7.6% and 20%, respectively. Subsyndromal forms diagnosed at admission represented a risk factor for the subsequent development of delirium (odds ratio [OR], P < .0001). A previous episode of brain failure during ICU stay and older age were risks factors for the development of subsyndromal forms, whereas not needing MV was a protective factor. Delirium significantly prolonged the stay in the SDU but did not influence survival and the process of weaning from MV. Overall, the percentage of patients with an abnormal Intensive Care Delirium Screening Checklist score at discharge (5%) was reduced compared with that recorded at admission (18%).
Delirium may still occur after discharge from an ICU in patients who are transferred to an SDU. The strategy of care adopted in the SDU seems to positively affect the recovery from a delirious state. Patients with subsyndromal forms should be promptly recognized and treated because of the risk of developing delirium. Weaning from MV is not hindered by delirium.
谵妄是重症监护病房（ICU）患者中相当常见的并发症，而不是单一实体，它可以被视为一种疾病谱，除了明显的病例外，还有许多亚综合征形式。尽管有很多关于 ICU 谵妄的数据，但关于从 ICU 转入降阶梯病房（SDU）的患者中这种并发症的数据很少。
本研究旨在评估一组从 ICU 转入 SDU 的患者中谵妄和亚综合征形式的发生率和危险因素及其对临床结局的影响。
在 2 年期间，所有从 ICU 转入我们的 SDU 的患者均使用 ICU 谵妄筛查检查表筛查谵妄和亚综合征谵妄形式，这是一种已在 ICU 中验证的简单工具。还记录了以下数据：人口统计学数据、严重程度评分（SAPS II）、转入 SDU 的原因、住院时间、死亡率、镇静剂的使用、谵妄对机械通气（MV）脱机的影响。
在 234 名患者中，谵妄和亚综合征形式的发生率分别为 7.6%和 20%。入院时诊断的亚综合征形式是随后发生谵妄的危险因素（比值比[OR]，P<.0001）。在 ICU 住院期间发生的脑衰竭发作和年龄较大是亚综合征形式发生的危险因素，而不需要 MV 是保护因素。谵妄显著延长了在 SDU 的停留时间，但不影响生存和 MV 脱机过程。总体而言，与入院时记录的相比，出院时（5%）异常 ICU 谵妄筛查检查表评分的患者比例降低（18%）。
从 ICU 转入 SDU 的患者在出院后仍可能发生谵妄。SDU 中采用的护理策略似乎对从谵妄状态中恢复产生积极影响。由于发生谵妄的风险，应及时识别和治疗亚综合征形式的患者。谵妄不会阻碍 MV 的脱机。
