Delirium Incidence, Duration, and Severity in Critically Ill Patients With Coronavirus Disease 2019.
Delirium Incidence, Duration, and Severity in Critically Ill Patients With Coronavirus Disease 2019.
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DOI：
10.1097/cce.0000000000000290
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发表时间：
2020-12
影响因子：
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通讯作者：
Khan BA
中科院分区：
文献类型：
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作者：
Khan SH;Lindroth H;Perkins AJ;Jamil Y;Wang S;Roberts S;Farber M;Rahman O;Gao S;Marcantonio ER;Boustani M;Machado R;Khan BA
补充数字内容可在文本中找到。目的了解2019冠状病毒病ICU住院患者谵妄的发生率、持续时间和严重程度。2020年3月1日至2020年6月7日的回顾性数据提取研究。谵妄结局在ICU前14天进行评估。两个为印第安纳州服务的大型学术中心。纳入2020年3月1日至2020年6月7日连续入住ICU的重症急性呼吸综合征冠状病毒2型鼻咽拭子聚合酶链反应试验阳性患者。年龄小于18岁，没有任何谵妄评估或没有出院处置的个体被排除在外。主要结局是谵妄率和持续时间，次要结局是谵妄严重程度。268例连续患者纳入分析，平均年龄为58.4岁（sd， 15.6岁），40.3%为女性，44.4%为非洲裔美国人，20.7%为西班牙裔，急性生理和慢性健康评估II评分中位数为18（四分位数范围为13-25）。无昏迷谵妄者占29.1%，昏迷前谵妄者占27.9%，昏迷后谵妄者占23.1%。第一次神志不清评估法用于ICU评估的谵妄阳性率为61.9%。低活动性谵妄是最常见的亚型（87.4%）。到第14天，谵妄/无昏迷的中位数为5天（四分位数范围，4-11天），ICU-7评分的中位数为6.5（四分位数范围，5 -7），表明谵妄严重。该队列中78.4%的患者使用苯二氮卓类药物。即使在调整镇静药物后，机械通气也与谵妄发生的几率增加相关（优势比5.0;95% CI, 1.1-22.2; p = 0.033）。两组之间的死亡率没有差异。29.1%的ICU患者出现谵妄无昏迷。谵妄中位数持续5天，病情严重。机械通气与谵妄发生率显著相关，即使在调整镇静剂后也是如此。2019冠状病毒病患者需要注意控制谵妄持续时间和严重程度，并更深入地了解病毒对神经系统的影响。
Supplemental Digital Content is available in the text. To determine delirium occurrence rate, duration, and severity in patients admitted to the ICU with coronavirus disease 2019. Retrospective data extraction study from March 1, 2020, to June 7, 2020. Delirium outcomes were assessed for up to the first 14 days in ICU. Two large, academic centers serving the state of Indiana. Consecutive patients admitted to the ICU with positive severe acute respiratory syndrome coronavirus 2 nasopharyngeal swab polymerase chain reaction test from March 1, 2020, to June 7, 2020, were included. Individuals younger than 18 years of age, without any delirium assessments, or without discharge disposition were excluded. Primary outcomes were delirium rates and duration, and the secondary outcome was delirium severity. Two-hundred sixty-eight consecutive patients were included in the analysis with a mean age of 58.4 years (sd, 15.6 yr), 40.3% were female, 44.4% African American, 20.7% Hispanic, and a median Acute Physiology and Chronic Health Evaluation II score of 18 (interquartile range, 13–25). Delirium without coma occurred in 29.1% of patients, delirium prior to coma in 27.9%, and delirium after coma in 23.1%. The first Confusion Assessment Method for the ICU assessment was positive for delirium in 61.9%. Hypoactive delirium was the most common subtype (87.4%). By day 14, the median number of delirium/coma-free were 5 days (interquartile range, 4–11 d), and median Confusion Assessment Method for the ICU-7 score was 6.5 (interquartile range, 5–7) indicating severe delirium. Benzodiazepines were ordered for 78.4% of patients in the cohort. Mechanical ventilation was associated with greater odds of developing delirium (odds ratio, 5.0; 95% CI, 1.1–22.2; p = 0.033) even after adjusting for sedative medications. There were no between-group differences in mortality. Delirium without coma occurred in 29.1% of patients admitted to the ICU. Delirium persisted for a median of 5 days and was severe. Mechanical ventilation was significantly associated with odds of delirium even after adjustment for sedatives. Clinical attention to manage delirium duration and severity, and deeper understanding of the virus’ neurologic effects is needed for patients with coronavirus disease 2019.