Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Intensive Care and UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium.
J Crit Care. 2021 Dec;66:132-137. doi: 10.1016/j.jcrc.2021.09.001. Epub 2021 Sep 20.
To explore differences between ICU patients with persistent delirium (PD), non-persistent delirium (NPD) and no delirium (ND), and to determine factors associated with PD.
Retrospective cohort study including all ICU adults admitted for ≥12 h (January 2015-February 2020), assessable for delirium and followed during their entire hospitalization. PD was defined as ≥14 days of delirium. Factors associated with PD were determined using multivariable logistic regression analysis.
Out of 10,295 patients, 3138 (30.5%) had delirium, and 284 (2.8%) had PD. As compared to NPD (n = 2854, 27.7%) and ND (n = 7157, 69.5%), PD patients were older, sicker, more physically restrained, longer comatose and mechanically ventilated, had a longer ICU and hospital stay, more ICU readmissions and a higher mortality rate. Factors associated with PD were age (adjusted odds ratio [aOR] 1.03; 95% confidence interval [CI] 1.02-1.04); emergency surgical (aOR 1.84; 95%CI 1.26-2.68) and medical (aOR 1.57; 95%CI 1.12-2.21) referral, mean Sequential Organ Failure Assessment (SOFA) score before delirium onset (aOR 1.18; 95%CI 1.13-1.24) and use of physical restraints (aOR 5.02; 95%CI 3.09-8.15).
Patients with persistent delirium differ in several characteristics and had worse short-term outcomes. Physical restraints were the most strongly associated with PD.
探讨 ICU 中持续性谵妄（PD）、非持续性谵妄（NPD）和无谵妄（ND）患者之间的差异，并确定与 PD 相关的因素。
这是一项回顾性队列研究，纳入了 2015 年 1 月至 2020 年 2 月期间 ICU 中所有入住时间≥12 小时的成年患者，对其进行谵妄评估，并在整个住院期间进行随访。PD 的定义为≥14 天的谵妄。采用多变量逻辑回归分析确定与 PD 相关的因素。
在 10295 名患者中，3138 名（30.5%）患有谵妄，284 名（2.8%）患有 PD。与 NPD（n=2854，27.7%）和 ND（n=7157，69.5%）相比，PD 患者年龄更大、病情更重、身体约束更多、昏迷和机械通气时间更长、ICU 和住院时间更长、ICU 再入院率更高、死亡率更高。与 PD 相关的因素包括年龄（调整后的优势比[aOR]1.03；95%置信区间[CI]1.02-1.04）；紧急手术（aOR 1.84；95%CI 1.26-2.68）和内科（aOR 1.57；95%CI 1.12-2.21）转诊、谵妄发作前平均序贯器官衰竭评估（SOFA）评分（aOR 1.18；95%CI 1.13-1.24）和身体约束的使用（aOR 5.02；95%CI 3.09-8.15）。
持续性谵妄患者在多个特征方面存在差异，且短期预后更差。身体约束与 PD 的相关性最强。
