儿科重症监护病房床边家属陪伴与小儿患者谵妄：2014 - 2017年单中心队列回顾性分析
Family Presence at the PICU Bedside and Pediatric Patient Delirium: Retrospective Analysis of a Single-Center Cohort, 2014-2017.
作者信息
Smith Mallory B, Killien Elizabeth Y, Watson R Scott, Dervan Leslie A
机构信息
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
出版信息
Pediatr Crit Care Med. 2025 Apr 1;26(4):e482-e491. doi: 10.1097/PCC.0000000000003678. Epub 2024 Dec 20.
OBJECTIVES
To examine the association between family presence at the PICU bedside and daily positive delirium screening scores.
DESIGN
Retrospective cohort study.
SETTING
Tertiary children's hospital PICU.
SUBJECTS
Children younger than 18 years old with PICU length of stay greater than 36 hours enrolled in the Seattle Children's Hospital Outcomes Assessment Program from 2014 to 2017.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
In the dataset, delirium screening had been performed bid using the Cornell Assessment of Pediatric Delirium, with scores greater than or equal to 9 classified as positive. Family presence was documented every 2 hours. Among 224 patients, 55% ( n = 124/224) had positive delirium screening on 44% ( n = 408/930) of PICU days. Family presence at the bedside during PICU stay (< 90% compared with ≥ 90%) was associated with higher proportion of ever (as opposed to never) being screened positive for delirium (26/37 vs. 98/187; difference, 17.9% [95% CI, 0.4-32.1%]; p = 0.046). On univariate analysis, each additional decile of increasing family presence was associated with lower odds of positive delirium screening on the same day (odds ratio [OR], 0.87 [95% CI, 0.77-0.97]) and subsequent day (OR, 0.84 [95% CI, 0.75-0.94]). On multivariable analysis after adjustments, including baseline Pediatric Cerebral Performance Category (PCPC), higher family presence was associated with lower odds of subsequent-day positive delirium screening (OR, 0.89 [95% CI, 0.81-0.98]). Among patients with PCPC less than or equal to 2, each additional decile of increasing family presence was independently associated with lower odds of both same-day (OR, 0.90 [95% CI, 0.81-0.99]) and subsequent-day (OR, 0.85 [95% CI, 0.76-0.95]) positive delirium screening.
CONCLUSIONS
In our 2014-2017 retrospective cohort, greater family presence was associated with lower odds of delirium in PICU patients. Family presence is a modifiable factor that may mitigate the burden of pediatric delirium, and future studies should explore barriers and facilitators of family presence in the PICU.
目的
探讨儿科重症监护病房（PICU）床边家属陪伴与每日谵妄阳性筛查评分之间的关联。
设计
回顾性队列研究。
地点
三级儿童医院的PICU。
研究对象
2014年至2017年纳入西雅图儿童医院结局评估项目的18岁以下、PICU住院时间超过36小时的儿童。
干预措施
无。
测量指标及主要结果
在数据集中，使用康奈尔儿科谵妄评估量表每12小时进行一次谵妄筛查，评分大于或等于9分为阳性。每2小时记录一次家属陪伴情况。在224例患者中，55%（n = 124/224）在44%（n = 408/930）的PICU住院日有谵妄阳性筛查结果。PICU住院期间床边家属陪伴时间少于90%与多于或等于90%相比，谵妄筛查曾为阳性（而非从未阳性）的比例更高（26/37 vs. 98/187；差异为17.9% [95% CI，0.4 - 32.1%]；p = 0.046）。单因素分析显示，家属陪伴时间每增加十分位数，当日谵妄阳性筛查的几率降低（比值比[OR]，0.87 [95% CI，0.77 - 0.97]），次日也是如此（OR，0.84 [95% CI，0.75 - 0.94]）。在进行包括基线儿科脑功能表现类别（PCPC）等调整后的多因素分析中，更高的家属陪伴率与次日谵妄阳性筛查几率降低相关（OR，0.89 [95% CI，0.81 - 0.98]）。在PCPC小于或等于2的患者中，家属陪伴时间每增加十分位数，当日（OR，0.90 [95% CI，0.81 - 0.99]）和次日（OR，0.85 [MISSING SEPARATOR95% CI，0.76 - 0.95]）谵妄阳性筛查几率独立降低。
结论
在我们2014 - 2017年的回顾性队列研究中，更多的家属陪伴与PICU患者谵妄几率降低相关。家属陪伴是一个可改变的因素，可能减轻儿科谵妄的负担，未来研究应探索PICU中家属陪伴的障碍和促进因素。
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