Sosa Fernando Ariel, Roberti Javier, Franco Margarita Tovar, Kleinert María Mercedes, Patrón Agustina Risso, Osatnik Javier
Unidade de Terapia Intensiva, Hospital Alemán, Buenos Aires, Argentina.
Rev Bras Ter Intensiva. 2018 Mar;30(1):50-56. doi: 10.5935/0103-507x.20180010.
To describe the incidence of and risk factors for delirium in the intensive care unit of a tertiary care teaching hospital in Argentina and to conduct the first non-European study exploring the performance of the PREdiction of DELIRium in ICu patients (PRE-DELIRIC) model.
Prospective observational study in a 20-bed intensive care unit of a tertiary care teaching hospital in Buenos Aires, Argentina. The PRE-DELIRIC model was applied to 178 consecutive patients within 24 hours of admission to the intensive care unit; delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).
The mean age was 64.3 ± 17.9 years. The median time of stay in the intensive care unit was 6 (range, 2 - 56) days. Of the total number of patients, 49/178 (27.5%) developed delirium, defined as a positive CAM-ICU assessment, during their stay in the intensive care unit. Patients in the delirium group were significantly older and had a significantly higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The mortality rate in the intensive care unit was 14.6%; no significant difference was observed between the two groups. Predictive factors for the development of delirium were increased age, prolonged intensive care unit stay, and opioid use. The area under the curve for the PRE-DELIRIC model was 0.83 (95%CI; 0.77 - 0.90).
The observed incidence of delirium highlights the importance of this problem in the intensive care unit setting. In this first study conducted outside Europe, PRE-DELIRIC accurately predicted the development of delirium.
描述阿根廷一家三级护理教学医院重症监护病房中谵妄的发生率及危险因素，并开展首个非欧洲地区关于探索ICU患者谵妄预测（PRE-DELIRIC）模型性能的研究。
在阿根廷布宜诺斯艾利斯一家拥有20张床位的三级护理教学医院的重症监护病房进行前瞻性观察研究。将PRE-DELIRIC模型应用于178例入住重症监护病房24小时内的连续患者；采用重症监护病房意识模糊评估法（CAM-ICU）评估谵妄。
平均年龄为64.3±17.9岁。在重症监护病房的中位住院时间为6（范围2 - 56）天。在全部患者中，49/178（27.5%）在重症监护病房住院期间发生谵妄，定义为CAM-ICU评估呈阳性。谵妄组患者年龄显著更大，急性生理与慢性健康状况评分系统II（APACHE II）得分显著更高。重症监护病房的死亡率为14.6%；两组间未观察到显著差异。谵妄发生的预测因素为年龄增加、重症监护病房住院时间延长和使用阿片类药物。PRE-DELIRIC模型的曲线下面积为0.83（95%CI：0.77 - 0.90）。
观察到的谵妄发生率凸显了该问题在重症监护病房环境中的重要性。在欧洲以外开展的这项首次研究中，PRE-DELIRIC准确预测了谵妄的发生。
