Masuyama Tomoyuki, Sanui Masamitsu, Yoshida Naoto, Iizuka Yusuke, Ogi Kunio, Yagihashi Satoko, Nagatomo Kanae, Sasabuchi Yusuke, Lefor Alan K
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Department of Nursing, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Psychogeriatrics. 2018 May;18(3):209-215. doi: 10.1111/psyg.12314. Epub 2018 Feb 8.
Benzodiazepine use is a risk factor for the development of delirium in adult intensive care unit (ICU) patients. Suvorexant is an alternative to benzodiazepines to induce sleep, but the incidence of delirium in critically ill patients is unknown. We undertook this retrospective study to investigate the incidence of delirium in patients who receive suvorexant in the ICU.
This retrospective cohort study was conducted in a closed 12-bed ICU at a tertiary teaching hospital. Patients admitted to the ICU for 72 h or longer between January and June 2015 were evaluated for delirium using the Confusion Assessment Method for the Intensive Care Unit tool. We evaluated the incidence of delirium in patients who received suvorexant and those who did not. To adjust for confounding factors, multivariable logistic regression analysis was conducted.
Study subjects included 118 patients, with a median age of 72 years and a median Acute Physiology and Chronic Health Evaluation II score of 18 points. Eighty-two patients (69.5%) were admitted after cardiovascular surgery. In the suvorexant group, there were fewer post-cardiovascular surgical patients and more medical patients. The duration of mechanical ventilation during ICU stay was longer in the suvorexant group, and sedatives and sleep inducers other than suvorexant were used more frequently in the suvorexant group. The incidence of delirium was 43.8% in the suvorexant group and 58.8% in the non-suvorexant group (P = 0.149). After adjustment for risk factors using multivariable logistic regression analysis, suvorexant was associated with a lower incidence of delirium (odds ratio = 0.23, 95% confidence interval: 0.07-0.73; P = 0.012).
Suvorexant was associated with decreased odds of transitioning to delirium in critically ill patients. The use of suvorexant may lower the incidence of delirium in ICU patients. Future prospective studies are warranted.
在成人重症监护病房（ICU）患者中，使用苯二氮䓬类药物是发生谵妄的一个危险因素。苏沃雷生是一种用于诱导睡眠的苯二氮䓬类药物替代品，但重症患者谵妄的发生率尚不清楚。我们进行了这项回顾性研究，以调查在ICU接受苏沃雷生治疗的患者中谵妄的发生率。
这项回顾性队列研究在一家三级教学医院的一个拥有12张床位的封闭式ICU中进行。对2015年1月至6月期间入住ICU达72小时或更长时间的患者，使用重症监护病房意识模糊评估方法工具评估谵妄情况。我们评估了接受苏沃雷生治疗的患者和未接受该治疗的患者中谵妄的发生率。为校正混杂因素，进行了多变量逻辑回归分析。
研究对象包括118例患者，中位年龄为72岁，急性生理与慢性健康状况评分II中位数为18分。82例患者（69.5%）在心血管手术后入院。在苏沃雷生组，心血管手术后患者较少，内科患者较多。苏沃雷生组在ICU住院期间机械通气时间更长，且该组使用除苏沃雷生之外的镇静剂和睡眠诱导剂更为频繁。苏沃雷生组谵妄发生率为43.8%，未使用苏沃雷生组为58.8%（P = 0.149）。在使用多变量逻辑回归分析校正危险因素后，苏沃雷生与较低的谵妄发生率相关（比值比 = 0.23，95%置信区间：0.07 - 0.73；P = 0.012）。
苏沃雷生与重症患者发生谵妄的几率降低相关。使用苏沃雷生可能会降低ICU患者谵妄的发生率。未来有必要进行前瞻性研究。
