Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients
Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients
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DOI：
10.1097/ccm.0b013e3181f85759
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发表时间：
2010-12-01
影响因子：
8.8
通讯作者：
Ely, Wesley
中科院分区：
文献类型：
--
作者：
Shehabi, Yahya;Riker, Richard R.;Ely, Wesley
目的：确定重症监护患者经历的谵妄天数与死亡率、通气时间和重症监护病房住院时间之间的关系。设计：前瞻性队列分析。设置：来自5个国家68个重症监护病房的患者。患者：354名内科和外科重症监护患者入组SEDCOM（右美托咪定与咪达唑仑相比的安全性和有效性）试验接受镇静研究药物并完成至少一次谵妄评估。干预措施：镇静药物中断和/或滴定，以维持轻度镇静，每日进行觉醒和谵妄评估，直至机械通气30天。主要结局为30天全因死亡率。多变量分析采用考克斯回归法，将谵妄持续时间作为时间依赖变量，并对8个相关基线协变量进行调整，以量化谵妄天数与3个主要结局之间的关系。总体而言，354例患者中有228例（64.4%）诊断为谵妄。无谵妄患者的死亡率显著低于有谵妄患者（126例中的15例[11.9%] vs. 228例中的69例[30.3%]; p =谵妄3天（风险比，3.37;置信区间，1.92-7.23; p <0.001）。谵妄持续时间和通气时间和重症监护住院时间之间观察到类似的独立关系。结论：在通气和轻度镇静重症监护病房患者，谵妄的持续时间是最强的独立预测死亡，通气时间，重症监护病房住院调整后的相关协变量。(Crit Care Med 2010; 38：2311-2318）
Objectives: To determine the relationship between the number of delirium days experienced by intensive care patients and mortality, ventilation time, and intensive care unit stay.Design: Prospective cohort analysis.Setting: Patients from 68 intensive care units in five countries.Patients: Three hundred fifty-four medical and surgical intensive care patients enrolled in the SEDCOM (Safety and Efficacy of Dexmedetomidine Compared with Midazolam) trial received a sedative study drug and completed at least one delirium assessment.Interventions: Sedative drug interruption and/or titration to maintain light sedation with daily arousal and delirium assessments up to 30 days of mechanical ventilation.Measurements and Main Results: The primary outcome was all-cause 30-day mortality. Multivariable analysis using Cox regression incorporating delirium duration as a time-dependent variable and adjusting for eight relevant baseline covariates was conducted to quantify the relationship between number of delirium days and the three main outcomes. Overall, delirium was diagnosed in 228 of 354 patients (64.4%). Mortality was significantly lower in patients without delirium compared to those with delirium (15 of 126 [11.9%] vs. 69 of 228 [30.3%]; p = 3 days of delirium (hazard ratio, 3.37; confidence interval, 1.92-7.23; p < .001). Similar independent relationships were observed between delirium duration and ventilation time and intensive care length of stay.Conclusions: In ventilated and lightly sedated intensive care unit patients, the duration of delirium was the strongest independent predictor of death, ventilation time, and intensive care unit stay after adjusting for relevant covariates. (Crit Care Med 2010; 38:2311-2318)