重症监护病房危重症患者谵妄作为预后独立预测因素的评估：一项前瞻性研究。
Assessment of Delirium as an Independent Predictor of Outcome among Critically Ill Patients in Intensive Care Unit: A Prospective Study.
作者信息
Junior Mahendran Marriapan, Kumar Ajay, Kumar Pravin, Gupta Poonam
机构信息
Department of Anaesthesia and Intensive Care, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India.
出版信息
Indian J Crit Care Med. 2022 Jun;26(6):676-681. doi: 10.5005/jp-journals-10071-23907.
BACKGROUND
Delirium is frequently observed among critically ill patients in the intensive care unit. Although a preventable and reversible process, it is associated with greater morbidity and mortality. Early recognition and interpreting the predisposing and precipitating risk factors for delirium can improve outcomes among these patients.
OBJECTIVE
A prospective observational study was conducted with the primary objective to evaluate the incidence of delirium in a mixed adult intensive care unit. The secondary objectives were the evaluation of risk factors and outcomes of delirium.
METHODS
All patients who were more than 18 years of age and with an ICU stay of more than 24 hours were included in the study. Patients with prior history of neurological disorders, psychosis, and who were deaf were excluded. Eligible patients were evaluated by the residents to detect delirium using confusion assessment method for the intensive care unit (CAM-ICU) as a tool.
RESULTS
A total of 110 patients were included, and delirium was detected in 41 patients (37.3%). Among the predisposing risk factors, only hypertension was significantly associated with delirium. Among precipitating factors, mechanical ventilation, use of physical restraints and presence of window/natural light exposure, high Acute Physiology and Chronic Health Evaluation II scores, use of opioids, and benzodiazepines were associated with delirium. In multivariate risk regression analysis, presence of window/natural light exposure [odds ratio (OR), 55.52; 95% CI (8.887-346.904)]; ( <0.001) and duration of stay in ICU OR (1.145); 95% CI (1.058-1.238) ( = 0.001) were independent risk factors of delirium. Also, high mortality (53.7%) was observed among the delirious group of patients.
CONCLUSION
Delirium is a common problem in the ICU and is associated with poor outcomes. Various risk factors are linked to ICU environment.
HOW TO CITE THIS ARTICLE
Junior MM, Kumar A, Kumar P, Gupta P. Assessment of Delirium as an Independent Predictor of Outcome among Critically Ill Patients in Intensive Care Unit: A Prospective Study. Indian J Crit Care Med 2022;26(6):676-681.
背景
谵妄在重症监护病房的危重症患者中很常见。尽管这是一个可预防且可逆的过程，但它与更高的发病率和死亡率相关。早期识别并解读谵妄的易感因素和促发因素可改善这些患者的预后。
目的
进行了一项前瞻性观察性研究，主要目的是评估综合性成人重症监护病房中谵妄的发生率。次要目的是评估谵妄的危险因素和预后。
方法
研究纳入所有年龄超过18岁且在重症监护病房住院超过24小时的患者。排除有神经系统疾病、精神病病史以及失聪的患者。符合条件的患者由住院医师使用重症监护病房意识模糊评估法（CAM-ICU）作为工具来检测谵妄。
结果
共纳入110例患者，其中41例（37.3%）检测出谵妄。在易感危险因素中，只有高血压与谵妄显著相关。在促发因素中，机械通气、使用身体约束、有窗户/自然光照、急性生理与慢性健康状况评分II（APACHE II）分数高、使用阿片类药物和苯二氮䓬类药物与谵妄相关。在多因素风险回归分析中，有窗户/自然光照（比值比[OR]，55.52；95%置信区间[CI][8.887 - 346.904]；P<0.001）和在重症监护病房的住院时间（OR，1.145；95% CI[1.058 - 1.238]；P = 0.001）是谵妄的独立危险因素。此外，谵妄患者组的死亡率较高（53.7%）。
结论
谵妄是重症监护病房中的常见问题，且与不良预后相关。多种危险因素与重症监护病房环境有关。
如何引用本文
Junior MM, Kumar A, Kumar P, Gupta P. Assessment of Delirium as an Independent Predictor of Outcome among Critically Ill Patients in Intensive Care Unit: A Prospective Study. Indian J Crit Care Med 2022;26(6):676 - 681.
Zotero 插件