Gershengorn Hayley B, Patel Samira, Mallow Christopher M, Falise Joseph, Sosa Marie Anne, Parekh Dipen J, Ferreira Tanira
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 7th Avenue, Miami, FL, 33136, USA.
Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Intensive Care Med. 2023 Dec;49(12):1489-1498. doi: 10.1007/s00134-023-07243-0. Epub 2023 Oct 16.
Clinician-patient language concordance improves patient outcomes in non-intensive care unit (ICU) settings. We sought to assess the association of ICU nurse-patient language concordance with delirium-related outcomes.
We conducted a retrospective cohort study of adult English- or Spanish-speaking mechanically ventilated ICU patients admitted to ICUs at the University of Miami Hospital and Clinics (January 2021-September 2022). Our primary exposure was nurse-patient language concordance on each shift. We used mixed-effects multivariable regression to evaluate the association of language concordance with the primary outcome of restraint use, and secondary outcomes of agitation and identification of delirium, during each shift (with patient as a random effect).
Our cohort included 4326 shifts (3380 [78.1%] with language concordance) from 548 patients and 157 nurses. Spanish language was preferred by 269 (49.1%) of patients. English-speaking patients tended to be younger (65 [53, 75] vs 73 [61, 83], p < 0.001) and of non-Hispanic ethnicity (55.5% vs 7.1%, p < 0.001). English-speakers had restraints ordered on fewer of their included shifts (0 [0, 3] vs 1 [0, 3], p = 0.005). After adjustment, the odds of restraint use on shifts with language concordance was significantly lower (odds ratio [OR, 95% confidence interval [CI]]: 0.50 [0.39-0.63], p < 0.001). Agitation (18.6% vs 25.2%; OR [95% CI]: 0.71 [0.55-0.92], p = 0.009) and delirium identification (34.5% vs 41.3%; OR [95% CI]: 0.54 [0.34-0.88], p = 0.014) were also less common.
We identified a twofold reduction in the odds of restraint use among mechanically ventilated patients for language concordant nurse-patient dyads. Ensuring nurse-patient language concordance may improve ICU delirium, agitation, and restraint use.
在非重症监护病房（ICU）环境中，临床医生与患者语言匹配可改善患者预后。我们旨在评估ICU护士与患者语言匹配与谵妄相关预后之间的关联。
我们对迈阿密大学医院和诊所ICU收治的成年英语或西班牙语机械通气ICU患者进行了一项回顾性队列研究（2021年1月至2022年9月）。我们的主要暴露因素是每个班次护士与患者的语言匹配情况。我们使用混合效应多变量回归来评估语言匹配与每个班次约束使用的主要结局以及躁动和谵妄识别的次要结局之间的关联（将患者作为随机效应）。
我们的队列包括来自548名患者和157名护士的4326个班次（3380个班次[78.1%]语言匹配）。269名（49.1%）患者更喜欢西班牙语。说英语的患者往往更年轻（65岁[53,75]对73岁[61,83]，p<0.001）且非西班牙裔（55.5%对7.1%，p<0.001）。说英语的患者在纳入的班次中被下达约束医嘱的较少（0[0,3]对1[0,3]，p=0.005）。调整后，语言匹配班次使用约束的几率显著降低（优势比[OR，95%置信区间[CI]]：0.50[0.39 - 0.63]，p<0.001）。躁动（18.6%对25.2%；OR[95%CI]：0.71[0.55 - 0.92]，p=0.009）和谵妄识别（34.5%对41.3%；OR[95%CI]：0.54[0.34 - 0.88]，p=0.014）也较少见。
我们发现机械通气患者中，护士与患者语言匹配的二元组使用约束的几率降低了两倍。确保护士与患者语言匹配可能会改善ICU谵妄、躁动及约束使用情况。
