BSN, RN, Senior Nurse, ICU, Tianjin Third Central Hospital, Tianjin, People Republic of China.
MSN, RN, Senior Nurse, ICU, Tianjin Third Central Hospital, Tianjin, People Republic of China.
J Nurs Res. 2022 Aug 1;30(4):e222. doi: 10.1097/jnr.0000000000000497.
Differences in short-term cognitive function between mechanically ventilated patients treated with multicomponent interventions and those receiving routine nursing care have not been established because of the lack of follow-up in previous studies.
This study was designed to evaluate the effects of the pain, agitation, and delirium (PAD) care bundle on delirium occurrence and clinical outcomes, specifically in terms of short-term cognitive function, in mechanically ventilated patients.
Data on 243 patients with mechanical ventilation were analyzed from January 2017 to February 2019. The eligible patients were divided randomly into two groups. The control group ( n = 120) received usual care, whereas the intervention group ( n = 123) received the PAD bundle, including pain monitoring and management, light sedation and daily awakening, early mobility, sleep promotion, and delirium monitoring. The incidence and duration of delirium, ventilator time, and intensive care unit (ICU) length of stay were compared between the two groups. Upon discharge from the ICU and at 3 and 6 months after discharge, cognitive function was assessed using the Montreal Cognitive Assessment scale and compared between the two groups.
The incidence of delirium was reduced significantly in the intervention group, and significant decreases in the duration of delirium, ventilator time, and ICU length of stay were found. Cognitive impairment in the intervention group was significantly lower at the 3-month follow-up assessment.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The PAD bundle was shown to be associated with a lower incidence of delirium and improved clinical outcomes. Short-term cognitive impairment occurred in fewer patients who were managed with the PAD bundle after ICU discharge. Our findings indicate that the PAD bundle has the potential to improve clinical outcomes. The administrative staff of ICUs should use strategies, such as interdisciplinary teamwork, to facilitate the buy-in and implementation of interventions.
由于之前的研究缺乏随访，因此尚未确定接受多组分干预的机械通气患者与接受常规护理的患者之间短期认知功能的差异。
本研究旨在评估疼痛、躁动和谵妄（PAD）护理包对机械通气患者谵妄发生和临床结局的影响，特别是在短期认知功能方面。
对 2017 年 1 月至 2019 年 2 月期间 243 名机械通气患者的数据进行了分析。将符合条件的患者随机分为两组。对照组（n=120）接受常规护理，而干预组（n=123）接受 PAD 包，包括疼痛监测和管理、轻度镇静和每日唤醒、早期活动、促进睡眠和谵妄监测。比较两组患者谵妄的发生率和持续时间、呼吸机使用时间和 ICU 住院时间。在 ICU 出院时和出院后 3 个月和 6 个月时，使用蒙特利尔认知评估量表评估认知功能，并比较两组之间的差异。
干预组谵妄发生率显著降低，谵妄持续时间、呼吸机使用时间和 ICU 住院时间均显著缩短。干预组在 3 个月随访评估时认知障碍明显较低。
结论/对实践的影响：PAD 包与降低谵妄发生率和改善临床结局相关。与接受 PAD 包管理的患者相比，在 ICU 出院后发生短期认知障碍的患者更少。我们的研究结果表明，PAD 包有可能改善临床结局。ICU 的行政人员应使用跨学科团队合作等策略，促进干预措施的实施。
