Panitchote Anupon, Tangvoraphonkchai Kawin, Suebsoh Naluttaporn, Eamma Wanaporn, Chanthonglarng Bunruam, Tiamkao Somsak, Limpawattana Panita
Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Aging Clin Exp Res. 2015 Oct;27(5):735-40. doi: 10.1007/s40520-015-0323-6. Epub 2015 Feb 12.
Nurses have the key roles to detect delirium in hospitalized older patients but under-recognition of delirium among nurses is prevalent. The objectives of this study were to identify the under-recognition rate of delirium by intensive care nurses (ICU) using Confusion Assessment Method for the ICU (CAM-ICU) and factors associated with under-recognition.
Participants were older patients aged ≥65 years who were admitted to the ICU of Srinagarind Medical School, Khon Kaen, Thailand from May 2013 to August 2014. Baseline characteristics were collected. Delirium was rated by a trained clinical researcher using the CAM-ICU. Demographic data were analyzed using descriptive statistics. Univariate and multiple logistic regressions were used to analyze the outcomes.
Delirium occurred in 44 of 99 patients (44.4 %). Nurses could not identify delirium in 29.6 % of patients compared with researchers. Pre-existing dementia and depression were found in 47.7 % of patients. Pneumonia or other causes of respiratory failure were the most common causes of admission to ICU (47.7 %). Independent factors associated with under-recognition by nurses were identified-heart failure [adjusted odds ratio (OR), 77.8; 95 % confidence interval (CI) 2.5-2,543, p = 0.01] and pre-existing taking treatment with benzodiazepines (adjusted OR, 22.6; 95 % CI 1.8-85, p = 0.01).
Under-recognition of delirium is a frequent issue. New independent factors associated with under-recognition were identified. Awareness of delirium in the patients with these factors is recommended.
This study supports the finding of high under-recognition rates of delirium among hospitalized older adults in ICU. Patients with heart failure and receiving benzodiazepines were identified as barriers of recognition of delirium.
护士在识别住院老年患者的谵妄方面起着关键作用，但护士对谵妄的认识不足现象普遍存在。本研究的目的是确定重症监护护士（ICU）使用重症监护谵妄评估方法（CAM-ICU）对谵妄的识别不足率以及与识别不足相关的因素。
研究对象为2013年5月至2014年8月入住泰国孔敬诗里拉吉医学院ICU的65岁及以上老年患者。收集基线特征。由经过培训的临床研究人员使用CAM-ICU对谵妄进行评估。使用描述性统计分析人口统计学数据。采用单因素和多因素逻辑回归分析结果。
99例患者中有44例（44.4%）发生谵妄。与研究人员相比，护士无法识别29.6%患者的谵妄。47.7%的患者存在既往痴呆和抑郁。肺炎或其他呼吸衰竭原因是入住ICU最常见的原因（47.7%）。确定了与护士识别不足相关的独立因素——心力衰竭[调整后的优势比（OR），77.8；95%置信区间（CI）2.5 - 2543，p = 0.01]和既往使用苯二氮䓬类药物治疗（调整后的OR，22.6；95%CI 1.8 - 85，p = 0.01）。
谵妄识别不足是一个常见问题。确定了与识别不足相关的新的独立因素。建议对有这些因素的患者提高谵妄意识。
本研究支持了ICU住院老年患者谵妄识别不足率高的发现。心力衰竭患者和接受苯二氮䓬类药物治疗的患者被确定为谵妄识别的障碍。
