Escuela de Ciencias de la Salud, Facultad Enfermería, Universidad Pontificia Bolivariana, Grupo de Investigación en Cuidado de la Universidad Pontificia Bolivariana, Medellín, Colombia.
Escuela de Ciencias de la Salud, Facultad Enfermería, Universidad Pontificia Bolivariana, Grupo de Investigación en Cuidado de la Universidad Pontificia Bolivariana, Medellín, Colombia; Hospital Pablo Tobón Uribe, Medellín, Colombia.
Intensive Crit Care Nurs. 2018 Apr;45:37-43. doi: 10.1016/j.iccn.2017.12.010. Epub 2018 Feb 7.
To describe the prevalence and characteristics of delirium during the initial evaluation of critically ill patients aged 5-14 years.
METHOD/DESIGN: This is a cross-sectional descriptive study in a critical care unit. For six months, all patients were evaluated within the first 24-72 hours or when sedation permitted the use of the paediatric confusion assessment method for the intensive care unit (PCAM-ICU) and the Delirium Rating Scale-Revised-98 items #7 and #8 to determine motor type. We report the characteristics of PCAM-ICU delirium (at least three of the required items scored positive) and of subthreshold score cases (two positive items).
Of 77 admissions, 15 (19.5%) had delirium, and 11 (14.2%) were subthreshold. A total of 53.3% of delirium and 45.5% of subthreshold cases were hypoactive. The prevalence of delirium and subthreshold PCAM-ICU was 83.3% and 16.7% in mechanically ventilated children. The most frequent combination of PCAM-ICU alterations in subthreshold cases was acute onset-fluctuation with altered alertness. The main nursing diagnoses were related to reduced cellular respiration.
Delirium is common in critically ill children. It is necessary to assess whether certain nursing diagnoses imply an increase in delirium. Longitudinal studies of subthreshold PCAM-ICU cases are needed to understand their importance better.
描述 5-14 岁危重症患者初始评估期间谵妄的患病率和特征。
方法/设计：这是一项在重症监护病房进行的横断面描述性研究。在六个月的时间里，所有患者均在最初的 24-72 小时内进行评估，或在镇静允许使用儿科重症监护谵妄评估方法（PCAM-ICU）和修订后的 98 项 Delirium Rating Scale-Revised-#7 和 #8 项评估运动类型时进行评估。我们报告 PCAM-ICU 谵妄（至少有三个必需项目得分阳性）和亚阈值得分病例（两个阳性项目）的特征。
77 例入院患者中，15 例（19.5%）存在谵妄，11 例（14.2%）为亚阈值。谵妄和亚阈值 PCAM-ICU 分别有 53.3%和 45.5%为低活动度。机械通气患儿的谵妄和亚阈值 PCAM-ICU 患病率分别为 83.3%和 16.7%。亚阈值病例中 PCAM-ICU 改变最常见的组合是急性发作-波动伴警觉性改变。主要的护理诊断与细胞呼吸减少有关。
谵妄在危重症儿童中很常见。有必要评估某些护理诊断是否意味着谵妄的发生率增加。需要对亚阈值 PCAM-ICU 病例进行纵向研究，以更好地了解其重要性。
