Delirium in the intensive care unit: Occurrence and clinical course in older patients
Delirium in the intensive care unit: Occurrence and clinical course in older patients
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DOI：
10.1034/j.1600-0579.2003.00201.x
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发表时间：
2003-05-01
影响因子：
6.3
通讯作者：
Inouye, SK
中科院分区：
文献类型：
--
作者：
McNicoll, L;Pisani, MA;Inouye, SK
目的：描述老年重症监护病房（ICU）患者中谵妄的发生率及其在医院的短期持续时间，并确定先前存在的痴呆与谵妄发生之间的关系。设计：前瞻性队列研究。118名年龄在65岁及以上的连续患者入住ICU.MEASUREMENTS：通过代理访谈和病历审查获得基线特征。使用两种经验证的替代评级工具确定痴呆。每天在ICU中使用ICU的意识模糊评估方法（CAM）（CAM-ICU）评估谵妄。出院后，从ICU，患者进行了为期7天的使用CAM。结果：谵妄存在于37 118例（31%）患者入院。只有45例患者入院时精神状态正常，其中14例（31%）在住院期间出现谵妄。在ICU后期，40%的患者发生谵妄。在ICU中几乎一半的谵妄患者在ICU后期有持续性谵妄。总体而言，118例患者中有83例（70%）在住院期间出现谵妄。44%的患者发生昏迷或昏迷，89%的昏迷/昏迷幸存者进展为谵妄。痴呆患者更有40%的可能性是谵妄（相对危险度= 1.4，95%置信区间= 1.1-1.7），即使在控制合并症，基线功能状态，疾病的严重程度，和侵入性programmes.CONCLUSION：谵妄是一种常见的并发症，在老年ICU患者，往往持续超过他们的ICU停留。老年ICU患者的谵妄是一个动态而复杂的过程。痴呆是该人群在ICU期间和之后发生谵妄的重要诱发风险因素。
OBJECTIVES: To describe the occurrence of delirium in a cohort of older medical intensive care unit (ICU) patients and its short-term duration in the hospital and to determine the association between preexisting dementia and the occurrence of delirium.DESIGN: Prospective cohort study.SETTING: Fourteen-bed medical ICU of an 800-bed university teaching hospital.PARTICIPANTS: One hundred eighteen consecutive patients aged 65 and older admitted to the ICU.MEASUREMENTS: Baseline characteristics were obtained through surrogate interviews and medical chart review. Dementia was determined using two validated surrogate-rated instruments. Delirium was assessed daily in the ICU using the Confusion Assessment Method (CAM) for the ICU (CAM-ICU). After discharge from the ICU, patients were followed for up to 7 days using the CAM.RESULTS: Delirium was present in 37 of 118 (31%) patients on admission. Only 45 patients had a normal mental status on admission, of whom 14 (31%) became delirious during their hospital stay. In the post-ICU period, delirium occurred in 40% of patients. Almost half of patients with delirium in the ICU had persistent delirium in the post-ICU period. Overall, 83 of 118 (70%) had delirium during hospitalization. Stupor or coma occurred in 44% of the patients overall, and 89% of survivors of stupor/coma progressed to delirium. Patients with dementia were 40% more likely to be delirious (relative risk = 1.4, 95% confidence interval = 1.1-1.7), even after controlling for comorbidity, baseline functional status, severity of illness, and invasive procedures.CONCLUSION: Delirium is a frequent complication in older ICU patients and often persists beyond their ICU stay. Delirium in older ICU persons is a dynamic and complex process. Dementia is an important predisposing risk factor for the development of delirium in this population during and after the ICU stay.