Time trends of delirium rates in the intensive care unit
Time trends of delirium rates in the intensive care unit
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DOI：
10.1016/j.hrtlng.2020.03.006
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发表时间：
2020-09-01
期刊：
影响因子：
2.8
通讯作者：
Khan, Babar A.
中科院分区：
文献类型：
--
作者：
Khan, Sikandar H.;Lindroth, Heidi;Khan, Babar A.
背景：临床实践变化对 ICU 谵妄的影响尚不清楚。目标：随着时间的推移确定 ICU 谵妄发生率。方法：分析了先前描述的谵妄药理学管理试验筛选队列的数据。每天两次评估 Richmond 躁动-镇静量表 (RASS) 和 ICU 意识混乱评估方法 (CAM-ICU)。我们定义：任何谵妄（在 ICU 住院期间任何时候 CAM-ICU 呈阳性）和 ICU 获得性谵妄（第一次 CAM-ICU 阴性，随后 CAM-ICU 阳性）。使用混合效应逻辑回归模型来检验差异。结果：纳入了 2742 名入院患者。谵妄发生率为 16.5%，任何谵妄减少 [22.7% 至 10.2% (p < 0.01)]，ICU 获得性谵妄减少 [8.4% 至 4.4% (p = 0.01)]。昏迷率从 24% 下降至 17.4% (p = 0.04)。入住 ICU 时间越晚，平均 RASS 评分越高，谵妄发生率较低。结论：测量变量无法解释谵妄发生率，需要进一步的前瞻性研究。 (C) 2020 Elsevier Inc. 保留所有权利。
Background: Effects of clinical practice changes on ICU delirium are not well understood.Objectives: Determine ICU delirium rates over time.Methods: Data from a previously described screening cohort of the Pharmacological Management of Delirium trial was analyzed. Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU) were assessed twice daily. We defined: Any delirium (positive CAM-ICU at any time during ICU stay) and ICU-acquired delirium (1st CAM-ICU negative with a subsequent positive CAM-ICU). Mixed-effects logistic regression models were used to test for differences.Results: 2742 patient admissions were included. Delirium occurred in 16.5%, any delirium decreased [22.7% to 10.2% (p < 0.01)], and ICU-acquired delirium decreased [8.4% to 4.4% (p = 0.01)]. Coma decreased from 24% to 17.4% (p = 0.04). Later ICU years and higher mean RASS scores were associated with lower odds of delirium.Conclusions: Delirium rates were not explained by the measured variables and further prospective research is needed. (C) 2020 Elsevier Inc. All rights reserved.