Estrup S, Kjer C K W, Poulsen L M, Gøgenur I, Mathiesen O
Department of Anesthesiology, Zealand University Hospital Koege, Koege, Denmark.
Department of Gastrointestinal Surgery, Center for Surgical Science, Zealand University Hospital Koege, Koege, Denmark.
Acta Anaesthesiol Scand. 2018 Mar;62(3):367-375. doi: 10.1111/aas.13037. Epub 2017 Nov 17.
Delirium is a serious condition often experienced by critically ill patients in intensive care units (ICUs). The role of circadian light for this condition is unclear. The aim of this study was to describe incidence of delirium, risk factors for delirium, and the association between delirium and circadian light for patients in the ICU.
This is a retrospective cohort study of all patients at a Danish ICU from 1 August 2015 to 31 January 2016. Exclusion criteria were heavy sedation, no Confusion Assessment Method for the ICU (CAM-ICU) scores, or inability to communicate in Danish. Delirium was defined as at least one positive CAM-ICU score or treatment with haloperidol. Three of nine beds at the ICU had a circadian light installation. Allocation to ICU beds with or without circadian light depended on availability at admission. Risk factors for development of delirium were analyzed by simple and multiple logistic regression.
We included 183 patients in the study. The incidence of delirium was 28% (95% CI 22, 35). Allocation to beds with or without circadian lighting was not associated with delirium incidence (OR 1.14; 95% CI 0.55, 2.37; P = 0.73). We found that Simplified Acute Physiology Score II (SAPS II) (OR 1.03; 95% CI 1.01, 1.06; P = 0.002), and dexmedetomidine was associated with delirium (OR 4.14; 95% CI 1.72, 10.03; P = 0.002).
In this population of patients admitted to an ICU during 6 months, the incidence of delirium was 28%. We did not find an association between circadian light and development of delirium.
谵妄是重症监护病房（ICU）中危重症患者常出现的一种严重情况。昼夜节律光照对这种情况的作用尚不清楚。本研究的目的是描述ICU患者谵妄的发生率、谵妄的危险因素以及谵妄与昼夜节律光照之间的关联。
这是一项对丹麦一家ICU在2015年8月1日至2016年1月31日期间所有患者的回顾性队列研究。排除标准为深度镇静、无ICU意识模糊评估方法（CAM-ICU）评分或无法用丹麦语交流。谵妄定义为至少一次CAM-ICU评分为阳性或接受氟哌啶醇治疗。该ICU九张床位中有三张安装了昼夜节律光照设备。入住有或没有昼夜节律光照的ICU床位取决于入院时的可用性。通过单因素和多因素逻辑回归分析谵妄发生的危险因素。
我们纳入了183例患者进行研究。谵妄的发生率为28%（95%可信区间22, 35）。分配到有或没有昼夜节律光照的床位与谵妄发生率无关（比值比1.14；95%可信区间0.55, 2.37；P = 0.73）。我们发现简化急性生理学评分II（SAPS II）（比值比1.03；95%可信区间1.01, 1.06；P = 0.002）以及右美托咪定与谵妄有关（比值比4.14；95%可信区间1.72, 10.03；P = 0.002）。
在这组6个月内入住ICU的患者中，谵妄的发生率为28%。我们未发现昼夜节律光照与谵妄发生之间存在关联。
