Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania.
Pediatr Crit Care Med. 2024 Oct 1;25(10):880-888. doi: 10.1097/PCC.0000000000003555. Epub 2024 Jun 4.
To determine the patient-level factors associated with performing daily delirium screening in PICUs with established delirium screening practices.
A secondary analysis of 2019-2020 prospective data from the baseline phase of the PICU Up! pilot stepped-wedge multicenter trial (NCT03860168).
Six PICUs in the United States.
One thousand sixty-four patients who were admitted to a PICU for 3 or more days.
None.
Of 1064 patients, 74% (95% CI, 71-76%) underwent delirium screening at least once during their PICU stay. On 57% of the 8965 eligible patient days, screening was conducted. The overall prevalence of delirium was 46% across all screened days, and 64% of screened patients experienced delirium at some point during their PICU stay. Factors associated with greater adjusted odds ratio (aOR) of increased daily delirium screening included PICU stay longer than 15 days compared with 1-3 days (aOR 3.36 [95% CI, 2.62-4.30]), invasive mechanical ventilation as opposed to room air (aOR 1.67 [95% CI, 1.32-2.12]), dexmedetomidine infusions (aOR 1.23 [95% CI, 1.04-1.44]) and propofol infusions (aOR 1.55 [95% CI, 1.08-2.23]). Conversely, decreased aOR of daily delirium screening was associated with female gender (aOR 0.78 [95% CI, 0.63-0.96]), and the administration of continuous infusions of opioids (aOR 0.75 [95% CI, 0.63-0.90]) or ketamine (aOR 0.48 [95% CI, 0.29-0.79]). Neither patient age, the presence of family or physical restraints, or benzodiazepine infusions were associated with daily delirium screening rates.
In the 2019-2020 PICU UP! cohort, across six PICUs, delirium screening occurred on only 57% of days, despite the presence of established practices. Female gender, patients in the early stages of their PICU stay, and patients not receiving mechanical ventilation were associated with lower odds of daily delirium screening. Our results highlight the need for structured quality improvement processes to both standardize and increase the frequency of delirium screening.
确定与在已建立的谵妄筛查实践的儿科重症监护病房（PICU）中进行每日谵妄筛查相关的患者水平因素。
对 PICU Up！试点阶段前瞻性数据的二次分析（NCT03860168）。
美国六家儿科重症监护病房。
入住 PICU 3 天或以上的 1064 名患者。
无。
在 1064 名患者中，74%（95%CI，71-76%）在 PICU 住院期间至少进行了一次谵妄筛查。在 8965 个符合条件的患者日中，有 57%进行了筛查。所有筛查日的总体谵妄发生率为 46%，64%的筛查患者在 PICU 住院期间的某个时间点出现谵妄。与每日谵妄筛查几率增加相关的调整后比值比（aOR）较高的因素包括与 1-3 天相比 PICU 住院时间超过 15 天（aOR 3.36 [95%CI，2.62-4.30]）、使用有创机械通气而不是室内空气（aOR 1.67 [95%CI，1.32-2.12]）、使用右美托咪定输注（aOR 1.23 [95%CI，1.04-1.44]）和使用异丙酚输注（aOR 1.55 [95%CI，1.08-2.23]）。相反，每日谵妄筛查几率降低的因素包括女性（aOR 0.78 [95%CI，0.63-0.96]）和连续输注阿片类药物（aOR 0.75 [95%CI，0.63-0.90]）或氯胺酮（aOR 0.48 [95%CI，0.29-0.79]）。患者年龄、是否存在家庭或身体约束、或苯二氮䓬类药物输注均与每日谵妄筛查率无关。
在 2019-2020 年 PICU UP！队列中，在六家儿科重症监护病房中，尽管已经建立了实践，但谵妄筛查仅在 57%的天数进行。女性、处于 PICU 住院早期的患者和未接受机械通气的患者，每日发生谵妄筛查的几率较低。我们的结果强调需要进行结构化的质量改进流程，以规范和增加谵妄筛查的频率。
