Rahimi-Bashar Farshid, Abolhasani Ghazal, Manouchehrian Nahid, Jiryaee Nasrin, Vahedian-Azimi Amir, Sahebkar Amirhossein
Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Department of Anesthesiology, Fatemi Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Biomed Res Int. 2021 Jan 8;2021:6219678. doi: 10.1155/2021/6219678. eCollection 2021.
The purpose of this study was to determine the incidence, risk factors, and impact of delirium on outcomes in ICU patients. In addition, the scoring systems were measured consecutively to characterize how these scores changed with time in patients with and without delirium. . A prospective cohort study enrolling 400 consecutive patients admitted to the ICU between 2018 and 2019 due to trauma or surgery. Patients were followed up for the development of delirium over ICU days using the Confusion Assessment Method (CAM) for the ICU and Intensive Care Delirium Screening Checklist (ICDSC). Cox model logistic regression analysis was used to explore delirium risk factors.
Delirium occurred in 108 (27%) patients during their ICU stay, and the median onset of delirium was 4 (IQR 3-4) days after admission. According to multivariate cox regression, the expected hazard for delirium was 1.523 times higher in patients who used mechanical ventilator as compared to those who did not (HR: 1.523, 95% CI: 1.197-2.388, < 0.001).
Our findings suggest that an important opportunity for improving the care of critically ill patients may be the determination of modifiable risk factors for delirium in the ICU. In addition, the scoring systems (APACHE IV, SOFA, and RASS) are useful for the prediction of delirium in critically ill patients.
本研究旨在确定重症监护病房（ICU）患者谵妄的发生率、危险因素及其对预后的影响。此外，连续测量评分系统，以描述这些评分在有谵妄和无谵妄患者中随时间的变化情况。这是一项前瞻性队列研究，纳入了2018年至2019年间因创伤或手术连续入住ICU的400例患者。使用ICU意识模糊评估法（CAM-ICU）和重症监护谵妄筛查检查表（ICDSC）对患者在ICU住院期间谵妄的发生情况进行随访。采用Cox模型逻辑回归分析探讨谵妄的危险因素。
108例（27%）患者在ICU住院期间发生谵妄，谵妄的中位发病时间为入院后4天（四分位间距3 - 4天）。根据多因素Cox回归分析，使用机械通气的患者发生谵妄的预期风险比未使用机械通气的患者高1.523倍（风险比：1.523，95%置信区间：1.197 - 2.388，P < 0.001）。
我们的研究结果表明，确定ICU中谵妄的可改变危险因素可能是改善危重症患者护理的一个重要机会。此外，评分系统（急性生理与慢性健康状况评分系统IV（APACHE IV）、序贯器官衰竭评估（SOFA）和 Richmond躁动 - 镇静评分（RASS））有助于预测危重症患者的谵妄。
