Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients.
Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients.
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DOI：
10.1097/ta.0b013e31814b2c4d
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发表时间：
2008-07
期刊：
影响因子：
--
通讯作者：
Ely EW
中科院分区：
文献类型：
--
作者：
Pandharipande P;Cotton BA;Shintani A;Thompson J;Pun BT;Morris JA Jr;Dittus R;Ely EW
谵妄或急性脑功能障碍在重症监护病房（ICU）患者中非常普遍，但关于其在外科（SICU）和创伤ICU（TICU）患者中的患病率和风险因素的数据有限。本研究的目的是确定外科和创伤ICU患者谵妄的患病率和危险因素。使用里士满躁动镇静量表（RASS）和ICU混乱评估方法（CAM-ICU）前瞻性评估需要机械通气（MV）>24小时的SICU和TICU患者的谵妄。排除了基线痴呆、颅内损伤或缺血性/出血性卒中可能混淆谵妄评价的患者。使用马尔科夫模型来确定每日转变为谵妄的预测因素。入组了100例患者（46例SICU和54例TICU）。SICU和TICU的谵妄患病率分别为73%和67%。多变量分析确定咪达唑仑[OR 2.75（CI 1.43-5.26，p = 0.002）]暴露是转变为谵妄的最强独立风险因素。阿片类药物暴露显示出不一致的信息，例如芬太尼是SICU中谵妄的风险因素（p = 0.007），但不是TICU中的风险因素（p = 0.936），而吗啡暴露与谵妄风险较低相关（SICU，p = 0.069; TICU p = 0.024）。大约每10名SICU和TICU患者中就有7名出现谵妄。与苯二氮卓类药物的其他最新数据一致，咪达唑仑暴露是转变为谵妄的独立且可能可改变的风险因素。
Delirium or acute brain dysfunction is extremely prevalent in medical intensive care unit (ICU) patients, but limited data exist regarding its prevalence and risk factors among surgical (SICU) and trauma ICU (TICU) patients. The purpose of this study was to determine the prevalence and risk factors for delirium in surgical and trauma ICU patients. SICU and TICU patients requiring mechanical ventilation (MV) >24 hours were prospectively evaluated for delirium using the Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU). Those with baseline dementia, intracranial injury, or ischemic/hemorrhagic strokes that would confound the evaluation of delirium were excluded. Markov models were used to determine predictors for daily transition to delirium. One-hundred patients (46 SICU and 54 TICU) were enrolled. Prevalence of delirium was 73% in the SICU and 67% in the TICU. Multivariable analyses identified midazolam [OR 2.75 (CI 1.43–5.26, p = 0.002)] exposure as the strongest independent risk factor for transitioning to delirium. Opiate exposure showed an inconsistent message such that fentanyl was a risk factor for delirium in the SICU (p = 0.007) but not in the TICU (p = 0.936), while morphine exposure was associated with a lower risk of delirium (SICU, p = 0.069; TICU p = 0.024). Approximately 7 out of 10 SICU and TICU patients experience delirium. In keeping with other recent data on benzodiazepines, exposure to midazolam is an independent and potentially modifiable risk factor for the transitioning to delirium.