Delirium transitions in the medical ICU: exploring the role of sleep quality and other factors.
Delirium transitions in the medical ICU: exploring the role of sleep quality and other factors.
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DOI：
10.1097/ccm.0000000000000610
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发表时间：
2015-01
影响因子：
8.8
通讯作者：
Needham DM
中科院分区：
文献类型：
--
作者：
Kamdar BB;Niessen T;Colantuoni E;King LM;Neufeld KJ;Bienvenu OJ;Rowden AM;Collop NA;Needham DM
睡眠中断是重症监护室（ICU）中谵妄的常见且可能可改变的风险因素。作为促进ICU睡眠质量改善（QI）项目的一部分，我们研究了感知睡眠质量评分和其他患者和ICU风险因素与每日过渡到谵妄的相关性。前瞻性观察性研究的次要分析。在201天的时间里，医疗ICU（MICU）。223例患者在连续两天谵妄评估期间在MICU过夜≥1次。使用理查兹坎贝尔睡眠问卷（RCSQ）测量每日感知睡眠质量评分。使用ICU的意识模糊评估方法（CAM-ICU）每天测量两次谵妄。评价的其他协变量包括：年龄、性别、种族、ICU入院诊断、夜间机械通气状态、前一天的谵妄状态和每日使用苯二氮卓类药物和阿片类药物（通过推注和持续输注）进行镇静。在ICU中，曾经与从未发生过谵妄的患者的感知睡眠质量相似（中位数[IQR]评分分别为58 [35-76] vs. 57 [33-78]，p=0.71），感知睡眠质量与谵妄过渡无关（校正OR 1.00，95% CI 0.99-1.00）。在机械通气患者中，接受持续苯二氮卓类药物和/或阿片类药物输注与谵妄转变相关（校正OR 4.02，95% CI 2.19-7.38，p<0.001），报告在家中使用药物助眠剂的患者不太可能转变为谵妄（校正OR 0.40，95% CI 0.20-0.80，p=0.01）。我们发现日常感知的睡眠质量等级和过渡到谵妄之间没有关联。输注苯二氮卓类和/或阿片类药物与机械通气患者在ICU中转变为谵妄密切相关，并且是危重患者谵妄的重要、可改变的风险因素。
Disrupted sleep is a common and potentially modifiable risk factor for delirium in the intensive care unit (ICU). As part of a quality improvement (QI) project to promote sleep in the ICU, we examined the association of perceived sleep quality ratings and other patient and ICU risk factors with daily transition to delirium. Secondary analysis of prospective observational study. Medical ICU (MICU) over a 201-day period. 223 patients with ≥1 night in the MICU in between two consecutive days of delirium assessment. None Daily perceived sleep quality ratings were measured using the Richards Campbell Sleep Questionnaire (RCSQ). Delirium was measured twice-daily using the Confusion Assessment Method for the ICU (CAM-ICU). Other covariates evaluated included: age, sex, race, ICU admission diagnosis, nighttime mechanical ventilation status, prior day’s delirium status, and daily sedation using benzodiazepines and opioids, via both bolus and continuous infusion. Perceived sleep quality was similar in patients who were ever versus never delirious in the ICU (median [IQR] ratings 58 [35-76] vs. 57 [33-78], respectively p=0.71), and perceived sleep quality was unrelated to delirium transition (adjusted OR 1.00, 95% CI 0.99-1.00). In mechanically ventilated patients, receipt of a continuous benzodiazepine and/or opioid infusion was associated with delirium transition (adjusted OR 4.02, 95% CI 2.19-7.38, p<0.001) and patients reporting use of pharmacological sleep aids at home were less likely to transition to delirium (adjusted OR 0.40, 95% CI 0.20-0.80, p=0.01). We found no association between daily perceived sleep quality ratings and transition to delirium. Infusion of benzodiazepine and/or opioid medications was strongly associated with transition to delirium in the ICU in mechanically ventilated patients and is an important, modifiable risk factor for delirium in critically ill patients.