Delirium as detected by the CAM-ICU predicts restraint use among mechanically ventilated medical patients
Delirium as detected by the CAM-ICU predicts restraint use among mechanically ventilated medical patients
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DOI：
10.1097/01.ccm.0000164540.58515.bf
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发表时间：
2005-06-01
影响因子：
8.8
通讯作者：
Kollef, MH
中科院分区：
文献类型：
--
作者：
Micek, ST;Anand, NJ;Kollef, MH
目的：本次调查的首要目标是在呼吸衰竭的内科患者中识别重症监护病房 (CAM-ICU) 混乱评估方法所定义的谵妄个体。我们的第二个目标是比较临床干预措施，包括连续镇静输注的使用、不使用呼吸机的天数、ICU 住院时间、住院死亡率以及机械通气患者有和没有谵妄的身体约束的使用。设计：一项前瞻性、单中心、观察性队列研究。设置。城市教学医院的医疗重症监护病房（19张床位）。患者：成人、插管和机械通气患者。干预措施：使用 CAM-ICU 进行日常评估、结果评估和前瞻性数据收集。测量和主要结果：在使用 CAM-ICU 评估的 93 名患者中，44 名患者 (47%) 在重症监护室中出现谵妄 (CAM-ICU+) ≥ 1 天。 22 名患者 (24%) 没有记录谵妄发作 (CAM-ICU-)，27 名患者 (29%) 一直处于昏迷状态直至拔管或死亡。与无谵妄的患者 (CAM-ICU-) 相比，接受持续输注咪达唑仑 (59% vs. 32%，p < .05) 或芬太尼 (57% vs. 32%，p < .05) 和物理软肢约束 (77% vs. 50%，p < .05) 的谵妄患者 (CAM-ICU+) 的数量在统计上较多。结论：使用 CAM-ICU 的谵妄与更多地使用连续镇静输注和身体约束有关。需要进行更多研究来确定这些特定干预措施的使用如何影响危重患者谵妄的发生和自然史。
Objective: The first goal of this investigation was to identify individuals with delirium defined by the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) among medical patients with respiratory failure. Our second goal was to compare clinical interventions including use of continuous sedation infusions, the number of ventilator-free days, ICU length of stay, hospital mortality, and use of physical restraints in mechanically ventilated patients with and without delirium.Design: A prospective, single-center, observational cohort study.Setting. The medical intensive care unit (19 beds) of an urban teaching hospital.Patients: Adult, intubated, and mechanically ventilated patients.Interventions: Daily evaluation with the CAM-ICU, outcomes assessment, and prospective data collection.Measurements and Main Results: Among 93 patients evaluated using the CAM-ICU, 44 patients (47%) developed delirium (CAM-ICU+) for >= 1 day while in the intensive care unit. Twenty-two patients (24%) had no episodes of delirium recorded (CAM-ICU-), and 27 (29%) remained comatose until extubation or death. A statistically greater number of patients with delirium (CAM-ICU+) received continuous infusions of midazolam (59% vs. 32%, p < .05) or fentanyl (57% vs. 32%, p < .05) and physical soft-limb restraints (77% vs. 50%, p < .05) compared with patients without delirium (CAM-ICU-).Conclusions: The identification of delirium using the CAM-ICU was associated with greater use of continuous sedation infusions and physical restraints. Additional studies are required to determine how the use of these specific interventions influences the occurrence and the natural history of delirium among critically ill patients.