Protocol for an observational study of delirium in the post-anaesthesia care unit (PACU) as a potential predictor of subsequent postoperative delirium.
Protocol for an observational study of delirium in the post-anaesthesia care unit (PACU) as a potential predictor of subsequent postoperative delirium.
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DOI：
10.1136/bmjopen-2017-016402
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发表时间：
2017-07-10
期刊：
影响因子：
2.9
通讯作者：
Avidan MS
中科院分区：
文献类型：
--
作者：
Cui V;Tedeschi CM;Kronzer VL;McKinnon SL;Avidan MS
术后谵妄可能是大手术的严重后果，与更长的住院时间、再入院、认知和功能恶化以及死亡有关。谵妄是一种急性、可逆性疾病，其特征是病程波动、注意力不集中、思维混乱和意识水平改变。麻醉后数小时内发生的谵妄和术后 1-5 天发生的谵妄被描述为不同的临床症状。本协议描述了一项观察性研究，旨在确定拔除气管插管后第一小时内的谵妄是否是术后 5 天谵妄的预测因子。提高对术后谵妄发生发展的了解将改善患者护理并更有效地实施谵妄预防措施。参加缓解老年综合征麻醉脑电图指南 (ENGAGES) 随机对照试验的患者将有资格参加本次研究。经验证的谵妄评估方法、3 分钟诊断性混乱评估方法以及里士满激动和镇静量表将用于评估 100 名患者在气管插管拔除后 30 分钟和 60 分钟时的谵妄情况。还将使用三种经过验证的方法，即意识模糊评估方法 (CAM)、重症监护病房的 CAM 和结构化图表审查，对术后 1-5 天的患者进行谵妄评估。然后将进行逻辑回归分析，以测试术后立即谵妄是否独立预测随后的术后谵妄。 ENGAGES 的这项观察性子研究已获得华盛顿大学医学院伦理委员会的批准。招募于 2016 年 6 月开始，并将持续到 2017 年 6 月。传播计划包括在科学会议和科学出版物上的演讲。 NCT02241655。
Postoperative delirium can be a serious consequence of major surgery, associated with longer hospital stays, readmission, cognitive and functional deterioration and mortality. Delirium is an acute, reversible disorder characterised by fluctuating course, inattention, disorganised thinking and altered level of consciousness. Delirium occurring in the hours immediately following anaesthesia and delirium occurring in the postoperative period of 1–5 days have been described as distinct clinical entities. This protocol describes an observational study with the aim of determining if delirium in the first hour following tracheal tube removal is a predictor of delirium in the 5 subsequent postoperative days. Improved understanding regarding the development of postoperative delirium would improve patient care and allow more effective implementation of delirium prevention measures. Patients enrolled to the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) randomised controlled trial will be eligible for this substudy. A validated delirium assessment method, the 3-min Diagnostic Confusion Assessment Method and the Richmond Agitation and Sedation Scale will be used to assess 100 patients for delirium at 30 min and 60 min following tracheal tube removal. Patients will also be assessed for delirium over postoperative days 1–5 using three validated methods, the Confusion Assessment Method (CAM), CAM for the Intensive Care Unit and structured chart review. Logistic regression analysis will then be performed to test whether immediately postoperative delirium independently predicts subsequent postoperative delirium. This observational substudy of ENGAGES has been approved by the ethics board of Washington University School of Medicine. Enrolment began in June 2016 and will continue until June 2017. Dissemination plans include presentations at scientific conferences and scientific publications. NCT02241655.