Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
J Clin Anesth. 2024 Nov;98:111566. doi: 10.1016/j.jclinane.2024.111566. Epub 2024 Jul 30.
Delirium is a common complication in intensive care unit (ICU) patients. It can lead to various adverse events. In this study, we investigated the effectiveness of combining the use of the PREdiction of DELIRium (PRE-DELIRIC) model for delirium risk assessment and the use of a multicomponent care bundle for delirium assessment, prevention, and care in terms of reductions in the incidence of delirium among surgical ICU patients.
This retrospective study included surgical ICU patients who had received PRE-DELIRIC-guided SMART/SmART care (SMART care: SmART bundle plus multidisciplinary team; SmART care: Sleep/sweet sense of home (creating a comforting and restful environment for patients), Assessment (regular and thorough evaluation of patient needs and conditions), Release (revised endotracheal tube care/removal, restraint device care, and immobility reduction for patient comfort), and Time (reorientation of time to optimize patient care schedules) in our hospital between May 2022 and March 2023 (intervention group) and individuals who had received usual care between January 2021 and April 2022 (historical control group). The SmART intervention involves providing care in the following domains: sleep/sweet sense of home, assessment, release, and time. Patients with a PRE-DELIRIC score of >30% received SMART care, which includes multidisciplinary (physicians, pharmacists, respiratory therapists, and physiotherapists) care in addition to SmART care. For the control group, usual care was provided following the guidelines for the prevention and management of pain, agitation, delirium, immobility, and sleep disruption. The primary outcome was delirium incidence during ICU stay, which was assessed using the Intensive Care Delirium Screening Checklist. The secondary outcomes were the duration of ICU stay, rate of unplanned self-extubation, and status of ICU discharge.
The intervention and control groups comprised 184 and 197 patients, respectively; their mean ages were 63.7 ± 18.4 years and 62.4 ± 19.5 years, respectively. The incidence of delirium was significantly lower (p = 0.001) in the intervention group (22.3%) than in the control group (47.7%).
Our findings suggest that the PRE-DELIRIC-guided SMART/SmART care intervention is effective in preventing and managing delirium among surgical ICU patients.
谵妄是重症监护病房（ICU）患者的常见并发症。它可导致各种不良事件。在这项研究中，我们调查了结合使用谵妄风险评估的 PREdiction of DELIRium（PRE-DELIRIC）模型和多组分护理包用于评估、预防和护理 ICU 患者谵妄，以降低手术 ICU 患者发生谵妄的效果。
这是一项回顾性研究，纳入了 2022 年 5 月至 2023 年 3 月期间在我院接受 PRE-DELIRIC 指导的 SMART/SmART 护理（SMART 护理：SmART 包+多学科团队；SmART 护理：睡眠/家的甜蜜感觉（为患者创造舒适和宁静的环境）、评估（定期和彻底评估患者的需求和状况）、释放（修订气管内导管护理/移除、约束装置护理和减少患者舒适度的活动受限）和时间（重新定向时间以优化患者护理计划）的手术 ICU 患者（干预组）和 2021 年 1 月至 2022 年 4 月期间接受常规护理的个体（历史对照组）。SmART 干预涉及在以下领域提供护理：睡眠/家的甜蜜感觉、评估、释放和时间。PRE-DELIRIC 评分为>30%的患者接受 SMART 护理，包括多学科（医生、药剂师、呼吸治疗师和物理治疗师）护理，以及 SmART 护理。对于对照组，按照疼痛、躁动、谵妄、活动受限和睡眠障碍预防和管理指南提供常规护理。主要结局是 ICU 住院期间的谵妄发生率，使用重症监护谵妄筛查检查表进行评估。次要结局是 ICU 住院时间、计划外自行拔管率和 ICU 出院情况。
干预组和对照组分别包括 184 例和 197 例患者，平均年龄分别为 63.7±18.4 岁和 62.4±19.5 岁。干预组的谵妄发生率明显较低（p=0.001）（22.3%），而对照组（47.7%）。
我们的研究结果表明，基于 PRE-DELIRIC 的 SMART/SmART 护理干预措施可有效预防和管理手术 ICU 患者的谵妄。
