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重症监护患者谵妄危险因素的评估

Evaluation of Delirium Risk Factors in Intensive Care Patients.

作者信息

Erel Selin, Macit Aydın Eda, Nazlıel Bijen, Karabıyık Lale

机构信息

Gazi University Faculty of Medicine, Department of Anaesthesiology and Reanimation, Ankara, Turkey.

Gazi University Faculty of Medicine, Department of Anaesthesiology and Reanimation, Division of Intensive Care, Ankara, Turkey.

出版信息

Turk J Anaesthesiol Reanim. 2024 Dec 16;52(6):213-222. doi: 10.4274/TJAR.2024.241526.

Abstract

OBJECTIVE

The negative effects of delirium in intensive care unit (ICU) patients necessitate the identification and management of risk factors. This study aimed to determine the incidence of delirium and its associated modifiable and non-modifiable factors in the ICU setting to provide valuable insights for better patient care and outcomes.

METHODS

Patients admitted to the ICU underwent delirium screening twice daily. Comprehensive records of modifiable and non-modifiable risk factors were maintained throughout the ICU stay.

RESULTS

The incidence of delirium was 32.5%. Age [odds ratio (OR) 1.04, confidence interval (CI) 1.02-1.06, < 0.001)]. Illiteracy (OR 4, CI 1.19-13.35, =0.02), hearing impairment (OR 3.37, CI 1.71-7.01, =0.001), visual impairment (OR 3.90, CI 2.13-7.15, < 0.001), hypertension (OR 2.56, CI 1.42-4.62, =0.002), Sequential Organ Failure Assessment score (OR 1.21, CI 1.08-1.36, =0.001), Acute Physiology and Chronic Health Evaluation II score (OR 1.20, CI 1.12-1.28, < 0.001), presence of a nasogastric catheter/drain (OR 2.15, CI 1.18-3. 90, =0.01), tracheal aspiration (OR 3.63, CI 1.91-6.90, < 0.001), enteral nutrition (OR 2.54, CI 1.12-5.76, =0.02), constipation (OR 1.65, Cl 1.11-2.45, =0.02), oliguria (OR 1.56, Cl 1.06-2.28, =0.02), midazolam infusion (OR 3. 4, Cl 1.16-10.05, =0.02), propofol infusion (OR 2.91 Cl 1.03-8.19, =0.04), albumin use (OR 2.39, Cl 1.11-5.14 =0.02) and steroid use (OR 2.17, Cl 1.06-4.40, =0.03) were found to be independent risk factors for delirium.

CONCLUSION

This study highlights several risk factors contributing to delirium, such as age, sensory impairment, educational level, procedural interventions, and medications. Oral nutrition and mobilization are effective strategies for reducing delirium incidence in the ICU.

摘要

目的

谵妄对重症监护病房(ICU)患者有负面影响,因此有必要识别并管理风险因素。本研究旨在确定ICU环境中谵妄的发生率及其相关的可改变和不可改变因素,以便为改善患者护理和预后提供有价值的见解。

方法

入住ICU的患者每天接受两次谵妄筛查。在整个ICU住院期间,持续记录可改变和不可改变风险因素的综合信息。

结果

谵妄的发生率为32.5%。年龄[比值比(OR)1.04,置信区间(CI)1.02 - 1.06,<0.001]。文盲(OR 4,CI 1.19 - 13.35,=0.02)、听力障碍(OR 3.37,CI 1.71 - 7.01,=0.001)、视力障碍(OR 3.90,CI 2.13 - 7.15,<0.001)、高血压(OR 2.56,CI 1.42 - 4.62,=0.002)、序贯器官衰竭评估评分(OR 1.21,CI 1.08 - 1.36,=0.001)、急性生理与慢性健康状况评价II评分(OR 1.20,CI 1.12 - 1.28,<0.001)、存在鼻胃管/引流管(OR 2.15,CI 1.18 - 3.90,=0.01)、气管吸引(OR 3.63,CI 1.91 - 6.90,<0.001)、肠内营养(OR 2.54,CI 1.12 - 5.76,=0.02)、便秘(OR 1.65,Cl 1.11 - 2.45,=0.02)、少尿(OR 1.56,Cl 1.06 - 2.28,=0.02)、咪达唑仑输注(OR 3.4,Cl 1.16 - 10.05,=0.02)、丙泊酚输注(OR 2.91 Cl 1.03 - 8.19,=0.04)、白蛋白使用(OR 2.39,Cl 1.11 - 5.14 =0.02)和类固醇使用(OR 2.17,Cl 1.06 - 4.40,=0.03)被发现是谵妄的独立风险因素。

结论

本研究强调了导致谵妄的几个风险因素,如年龄、感觉障碍、教育水平、程序性干预和药物。肠内营养和活动是降低ICU中谵妄发生率的有效策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3649/11650099/b15bd3b4e626/TurkJAnaesthesiolReanim-52-213-figure-1.jpg

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