Department of Anesthesiology and Pain Medicine, Tufts University School of Medicine, Newton, Massachusetts 02135, USA.
J Trauma Acute Care Surg. 2013 Mar;74(3):876-83. doi: 10.1097/TA.0b013e31827e1b69.
Delirium is prevalent in surgical and trauma intensive care units (ICUs) and carries substantial morbidity. This study tested the hypothesis that daily administration of a diagnostic instrument for delirium in a surgical/trauma ICU decreases the time of institution of pharmacologic therapy and improves related outcomes.
Controlled trial of two concurrent groups. The Confusion-Assessment Method for ICU was administered daily to all eligible patients admitted to our surgical/trauma ICU for 48 hours or longer. The result was communicated to one of the two preexisting ICU services (intervention service) and not the other (control service). Primary outcome was the time between diagnosis of delirium and pharmacologic treatment. Secondary outcomes included duration of delirium, mechanical ventilation, and ICU stay.
Delirium occurred in 98 (35%) of 283 consecutive patients. Time between diagnosis and therapy did not differ between intervention (35 [35] hours) and control (40 [41] hours) groups. There was a difference in the number of delirium days treated in the intervention (73%) versus control (64%) groups (p = 0.035). The intervention group had significantly lower odds to neglect treating delirium when delirium was present (odds ratio, 0.67; 95% confidence interval, 0.45-1.00; p = 0.05). In the subgroup of trauma patients, the odds ratio of negligence was 0.37 (95% confidence interval, 0.14-0.99; p = 0.048), indicating lower probability for trauma patients to be untreated. There was no difference in the average duration of delirium, mechanical ventilation, and ICU stay.
In our surgical/trauma ICU, daily screening for delirium did not affect the timing of pharmacologic therapy. Although the intervention resulted in a higher number of delirious ICU patients being treated, particularly trauma patients, there was no effect on related outcomes.
Therapeutic study, level IV.
谵妄在外科和创伤重症监护病房（ICU）中很常见，且会导致严重的发病率。本研究旨在验证一个假设，即在外科/创伤 ICU 中每天使用一种谵妄诊断工具可以减少开始药物治疗的时间，并改善相关结局。
采用两组平行对照的临床试验设计。对入住我们外科/创伤 ICU 48 小时或以上的所有合格患者，每天使用 ICU 意识模糊评估法（CAM-ICU）进行评估。评估结果会告知两个预先存在的 ICU 服务中的一个（干预服务），而不会告知另一个（对照服务）。主要结局是从诊断谵妄到开始药物治疗的时间。次要结局包括谵妄持续时间、机械通气时间和 ICU 住院时间。
在 283 例连续患者中，有 98 例（35%）发生谵妄。干预组（35 小时）和对照组（40 小时）之间从诊断到治疗的时间无差异。干预组（73%）与对照组（64%）接受治疗的谵妄天数存在差异（p=0.035）。当谵妄存在时，干预组忽略治疗谵妄的可能性显著降低（比值比，0.67；95%置信区间，0.45-1.00；p=0.05）。在创伤患者亚组中，忽略治疗的比值比为 0.37（95%置信区间，0.14-0.99；p=0.048），表明创伤患者未接受治疗的可能性较低。谵妄持续时间、机械通气时间和 ICU 住院时间无差异。
在我们的外科/创伤 ICU 中，每天筛查谵妄并不影响药物治疗的时机。尽管干预措施导致更多的 ICU 谵妄患者接受治疗，特别是创伤患者，但对相关结局没有影响。
治疗性研究，IV 级。
