Wintermann Gloria-Beatrice, Weidner Kerstin, Strauss Bernhard, Rosendahl Jenny
Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Sachsen, Germany
Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Sachsen, Germany.
BMJ Open. 2020 Oct 8;10(10):e035733. doi: 10.1136/bmjopen-2019-035733.
To assess the delirium severity (DS), its risk factors and association with adverse patient outcomes in chronically critically ill (CCI) patients.
A prospective cohort study.
A tertiary care hospital with postacute intensive care units (ICUs) in Germany.
N=267 CCI patients with critical illness polyneuropathy and/or critical illness myopathy, aged 18-75 years, who had undergone elective tracheotomy for weaning failure.
None.
: DS was assessed using the Confusion Assessment Method for the Intensive Care Unit-7 delirium severity score, within 4 weeks (t1) after the transfer to a tertiary care hospital. In post hoc analyses, univariate linear regressions were employed, examining the relationship of DS with clinical, sociodemographic and psychological variables. : additionally, correlations of DS with fatigue (using the Multidimensional Fatigue Inventory-20), quality of life (using the Euro-Quality of Life) and institutionalisation/mortality at 3 (t2) and 6 (t3) months follow-up were computed.
Of the N=267 patients analysed, 9.4% showed severe or most severe delirium symptoms. 4.1% had a full-syndromal delirium. DS was significantly associated with the severity of illness (p=0.016, 95% CI -0.1 to -0.3), number of medical comorbidities (p<0.001, 95% CI .1 to .3) and sepsis (p<0.001, 95% CI .3 to 1.0). Patients with a higher DS at postacute ICU (t1), showed a higher mental fatigue at t2 (p=0.008, 95% CI .13 to .37) and an increased risk for institutionalisation/mortality (p=0.043, 95% CI 1.1 to 28.9/p=0.015, 95% CI 1.5 to 43.2).
Illness severity is positively associated with DS during postacute care in CCI patients. An adequate management of delirium is essential in order to mitigate functional and cognitive long-term sequelae following ICU.
DRKS00003386.
评估慢性危重症（CCI）患者的谵妄严重程度（DS）、其危险因素以及与不良患者结局的关联。
一项前瞻性队列研究。
德国一家设有急性后重症监护病房（ICU）的三级护理医院。
N = 267例患有危重症多神经病和/或危重症肌病的CCI患者，年龄在18 - 75岁之间，因撤机失败接受了择期气管切开术。
无。
在转至三级护理医院后的4周内（t1），使用重症监护病房谵妄严重程度评分的意识模糊评估方法评估DS。在事后分析中，采用单变量线性回归，研究DS与临床、社会人口统计学和心理变量之间 的关系。此外，计算DS与疲劳（使用多维疲劳量表 - 20）、生活质量（使用欧洲生活质量量表）以及3个月（t2）和6个月（t3）随访时的机构收容/死亡率之间的相关性。
在分析的N = 267例患者中，9.4%表现出严重或最严重的谵妄症状。有4.1%患有完全综合征性谵妄。DS与疾病严重程度（p = 0.016，95%CI - 0.1至 - 0.3）、内科合并症数量（p < 0.001，95%CI 0.1至0.3）和脓毒症（p < 0.001，95%CI 0.3至1.0）显著相关。急性后ICU（t1）时DS较高的患者，在t2时表现出更高的精神疲劳（p = 0.008，95%CI 0.13至0.37），机构收容/死亡风险增加（p = 0.043，95%CI 1.1至28.9/p = 0.015，95%CI 1.5至43.2）。
在CCI患者的急性后护理期间，疾病严重程度与DS呈正相关。为减轻ICU后的功能和认知长期后遗症，对谵妄进行适当管理至关重要。
DRKS00003386。
