Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients
Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients
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DOI：
10.1097/00000542-200601000-00005
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发表时间：
2006-01-01
期刊：
影响因子：
8.8
通讯作者：
Ely, EW
中科院分区：
文献类型：
--
作者：
Pandharipande, P;Shintani, A;Ely, EW
背景：谵妄最近被证明是死亡、费用增加和通气患者住院时间延长的预测因素。镇静和镇痛药物缓解焦虑和疼痛，但可能有助于患者的过渡到delirium.Methods：在这个队列研究中，作者设计了一个先验的调查，以确定是否镇静和镇痛药物独立增加的概率，每天过渡到谵妄。马尔可夫回归模型（调整11个协变量）被用于评估198例机械通气患者，以确定在过去24小时内镇静剂和镇痛剂剂量的函数，每日过渡到谵妄的概率。结果：劳拉西泮是每日过渡到谵妄的独立危险因素（比值比，1.2 [95%可信区间，1.1-1.4]; P = 0.003），而芬太尼、吗啡和丙泊酚与较高但无统计学显著性的比值比相关。增加年龄和急性生理学和慢性健康评估11评分也是转变为谵妄的独立预测因素（多变量P值< 0.05）。结论：即使在调整相关协变量后，劳拉西泮给药仍是转变为谵妄的重要且潜在可改变的风险因素。
Background: Delirium has recently been shown as a predictor of death, increased cost, and longer duration of stay in ventilated patients. Sedative and analgesic medications relieve anxiety and pain but may contribute to patients' transitioning into delirium.Methods: in this cohort study, the authors designed a priori an investigation to determine whether sedative and analgesic medications independently increased the probability of daily transition to delirium. Markov regression modeling (adjusting for 11 covariates) was used in the evaluation of 198 mechanically ventilated patients to determine the probability of daily transition to delirium as a function of sedative and analgesic dose administration during the previous 24 h.Results: Lorazepam was an independent risk factor for daily transition to delirium (odds ratio, 1.2 [95% confidence interval, 1.1-1.4]; P = 0.003), whereas fentanyl, morphine, and propofol were associated with higher but not statistically significant odds ratios. Increasing age and Acute Physiology and Chronic Health Evaluation 11 scores were also independent predictors of transitioning to delirium (multivariable P values < 0.05).Conclusions: Lorazepam administration is an important and potentially modifiable risk factor for transitioning into delirium even after adjusting for relevant covariates.