Department of Anesthesiology, Intensive Care Unit Local Health Authority of Caserta, Caserta, Italy.
Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy.
Nurs Crit Care. 2021 May;26(3):156-165. doi: 10.1111/nicc.12526. Epub 2020 Jul 6.
Several risk factors, such as age, alcohol abuse, dementia, and severe illness, can contribute to the development of delirium. However, limited information is available in the literature regarding the risk of delirium among surgical, trauma, neurological, and medical intensive care patients.
To describe the prevalence of risk factors associated with delirium in intensive care units.
This study used an observational design.
We enrolled 165 patients hospitalized in two intensive care units in Italy. Patients were first evaluated using the Prediction of Delirium model and were subsequently evaluated using the Intensive Care Delirium Screening Checklist; evaluation lasted a maximum of 5 days for each admitted patient after sedation. A logistic regression model was used to identify the prevalence and risk factors of delirium.
The average age of the patients was 57.6 (SD = 18.3) years, and the patients were predominantly male (65.0%). The majority of patients had been subjected to trauma (38.8%); 37.6% had undergone general surgical interventions, and 23.6% had undergone medical interventions. Delirium occurred in 55.8% of the 165 patients. The risk of delirium was independently associated with coma (odds ratio = 10.6; 95% confidence interval, 3.08-39.9) and the Acute Physiology and Chronic Health Evaluation II score (odds ratio = 4.27; 95% confidence interval, 1.58-11.53).
This study confirmed that coma and the Acute Physiology and Chronic Health Evaluation II score were non-modifiable risk factors for delirium. Further studies could categorize the different types of coma. Proper delirium management could limit the impact on the recovery of these patients, their autonomy, and their reintegration into the social and professional world.
Delirium increases intensive care unit and hospital length of stay. Early identification and risk factor assessment by critical care nurses are considered the key factors in the treatment of delirium.
年龄、酗酒、痴呆和重病等多种风险因素可能导致谵妄的发生。然而，关于手术、创伤、神经和内科重症监护患者发生谵妄的风险，文献中提供的信息有限。
描述重症监护病房中与谵妄相关的风险因素的流行情况。
本研究采用观察性设计。
我们纳入了意大利 2 家重症监护病房的 165 名住院患者。患者首先使用谵妄预测模型进行评估，随后使用重症监护谵妄筛查检查表进行评估；每位接受镇静治疗的入院患者的评估时间最长为 5 天。使用逻辑回归模型来确定谵妄的患病率和风险因素。
患者的平均年龄为 57.6（SD=18.3）岁，患者主要为男性（65.0%）。大多数患者经历了创伤（38.8%）；37.6%接受了普通外科干预，23.6%接受了内科干预。165 名患者中有 55.8%发生了谵妄。谵妄的风险与昏迷（优势比=10.6；95%置信区间，3.08-39.9）和急性生理学和慢性健康评估 II 评分（优势比=4.27；95%置信区间，1.58-11.53）独立相关。
本研究证实，昏迷和急性生理学和慢性健康评估 II 评分是谵妄的不可改变的风险因素。进一步的研究可以对不同类型的昏迷进行分类。适当的谵妄管理可以限制其对这些患者康复、自主性和重新融入社会和职业生活的影响。
谵妄会增加重症监护病房和医院的住院时间。重症监护护士对谵妄的早期识别和风险因素评估被认为是治疗谵妄的关键因素。
