Silva Márcia Pereira, Vala Joana, Sousa João, Teixeira Joana Ferreira, Henriques Helga Rafael
Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Lisbon, Portugal; Burn Unit, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal.
Burn Unit, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal.
Burns. 2025 Aug;51(6):107556. doi: 10.1016/j.burns.2025.107556. Epub 2025 May 21.
Delirium is a neurocognitive syndrome caused by systemic disturbances, leading to impaired attention, awareness, and/or cognition. It poses a significant risk of comorbidities, mortality, prolonged hospitalization, and increased healthcare costs. The challenges in delirium management, follow-up, and rehabilitation, arising from complex chronic conditions and long-term complications after severe burns, highlight the urgent need for more research in this area. Thus, this study aims to investigate the incidence of delirium and the risk factors specific to this population.
This analytical observational prospective cohort study was conducted between August 2022 and January 2024. Adults (18 years and older) admitted to a single burn unit with a confirmed burn injury were included, regardless of burn severity. Sociodemographic and clinical variables included age, sex, extent of burn, and prior health status. Delirium assessment was made using the CAM-ICU scale at least twice a day. The primary outcome was the incidence of delirium and its risk factors, with secondary outcomes including the onset and duration of delirium episodes.
RESULTS/DISCUSSION: The sample consisted of 50 patients, with a delirium incidence of 52 %. Burn patients admitted to the burn unit developed delirium an average of 11.81 days (95 % CI=7.09-16.52) after hospitalization, with an average duration of 11.5 days (95 % CI = 7.28-15.72). Age was the only predisposing risk factor that emerged (p = 0.0141). Five variables emerged as precipitating risk factors in bivariate analyses: total surface burn area (TSBA) (p = 0.026), surgery (p = 0.0438), mechanical ventilation (p < 0.001), opioid infusion use (p < 0.001), and infection (p < 0.001). However, in multivariate Cox regression analyses, only mechanical ventilation remained statistically significant as a risk factor for delirium (HR=8.017; 95 % CI = 1.926 - 33.368; p = 0.004).
This study highlights mechanical ventilation as a critical risk factor contributing to the high incidence of delirium among burn patients. Early identification and management of risk factors-mainly mechanical ventilation, but also TSBA, surgery, opioid infusion use, and infection-can guide targeted interventions to improve patient outcomes and mitigate the impact of delirium on recovery.
谵妄是一种由全身性功能紊乱引起的神经认知综合征，会导致注意力、意识和/或认知功能受损。它会带来显著的合并症、死亡风险、住院时间延长以及医疗费用增加。严重烧伤后的复杂慢性病和长期并发症给谵妄的管理、随访及康复带来了挑战，凸显了该领域急需更多研究。因此，本研究旨在调查谵妄的发生率以及该人群特有的风险因素。
本分析性观察性前瞻性队列研究于2022年8月至2024年1月进行。纳入了入住单一烧伤病房且确诊为烧伤的成年人（18岁及以上），无论烧伤严重程度如何。社会人口统计学和临床变量包括年龄、性别、烧伤程度和既往健康状况。每天至少使用CAM-ICU量表进行两次谵妄评估。主要结局是谵妄的发生率及其风险因素，次要结局包括谵妄发作的起始时间和持续时间。
结果/讨论：样本包括50名患者，谵妄发生率为52%。入住烧伤病房的烧伤患者在住院后平均11.81天（95%置信区间=7.09 - 16.52）发生谵妄，平均持续时间为11.5天（95%置信区间 = 7.28 - 15.72）。年龄是唯一出现的易患风险因素（p = 0.0141）。在双变量分析中出现了五个促发风险因素：烧伤总面积（TSBA）（p = 0.026）、手术（p = 0.0438）、机械通气（p < 0.001）、阿片类药物输注使用（p < 0.001）和感染（p < 0.001）。然而，在多变量Cox回归分析中，只有机械通气作为谵妄的风险因素仍具有统计学意义（风险比=8.017；95%置信区间 = 1.926 - 33.368；p = 0.004）。
本研究强调机械通气是导致烧伤患者谵妄高发的关键风险因素。早期识别和管理风险因素——主要是机械通气，还有TSBA、手术、阿片类药物输注使用和感染——可以指导有针对性的干预措施，以改善患者预后并减轻谵妄对康复的影响。
