Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute c...Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.展开更多
Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patie...Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patients, limited research exists on ICU nurses’ stress specifically related to delirium care. This study aims to investigate the stress experienced by ICU nurses in China when managing patients with delirium. Methods: This cross-sectional survey was conducted in China from January to February 2023. A total of 243 ICU nurses participated by completing an online survey that included the Personal Information Questionnaire and the Strain of Caring for Delirium Index (SCDI). Although 260 responses were initially collected, 29 invalid questionnaires were excluded, resulting in a final sample size of 243 valid responses. The SCDI scale demonstrated reliable internal consistency, with Cronbach’s α coefficients of 0.744, 0.812, 0.778, and 0.920 across its four subscales. Results: The survey results indicated that hypoactive delirium behaviors were perceived as the most significant stressors when caring for delirious patients. Among the behaviors, “noisy/yelling” was identified as the most challenging, whereas “pulling at tubes, dressings” was rated as the least challenging. No significant associations were found between demographic factors and stress levels. Conclusion: This study sheds light on the stress levels ICU nurses experience when caring for delirious patients, particularly in relation to hypoactive behaviors. Based on these findings, it is recommended that nurse managers implement stress management strategies and provide targeted delirium-related care training to better support ICU nurses and enhance the quality of delirium care.展开更多
Delirium is the most frequent manifestation of acute brain dysfunction in intensive care unit(ICU).Although antipsychotics are widely used to treat this serious complication,recent evidence has emphasized that these a...Delirium is the most frequent manifestation of acute brain dysfunction in intensive care unit(ICU).Although antipsychotics are widely used to treat this serious complication,recent evidence has emphasized that these agents did not reduce ICU delirium(ICU-D)prevalence and did not improve survival,length of ICU or hospital stay after its occurrence.Of note,no pharmacological strategy to prevent or treat delirium has been identified,so far.In this scenario,new scientific evidences are urgently needed.Investigations on specific ICU-D subgroups,or focused on different clinical settings,and studies on medications other than antipsychotics,such as dexmedetomidine or melatonin,may represent interesting fields of research.In the meantime,because there is some evidence that ICU-D can be effectively prevented,the literature suggests strengthening all the strategies aimed at prevention through no-pharmacological approaches mostly focused on the correction of risk factors.The more appropriate strategy useful to treat established delirium remains the use of antipsychotics managed by choosing the right doses after a careful case-by-case analysis.While the evidence regarding the use of dexmedetomidine is still conflicting and sparse,this drug offers interesting perspectives for both ICU-D prevention and treatment.This paper aims to provide an overview of current pharmacological approaches of evidence-based medicine practice.The state of the art of the on-going clinical research on the topic and perspectives for future research are also addressed.展开更多
<strong>Introduction: </strong>The delirium has received little attention from professionals working in the intensive care unit, mainly due to the fact that this is, rarely, the primary reason for patient ...<strong>Introduction: </strong>The delirium has received little attention from professionals working in the intensive care unit, mainly due to the fact that this is, rarely, the primary reason for patient admission. Given the high prevalence of delirium in an intensive care environment, the current guidelines recommend the daily assessment of delirium and a multidisciplinary approach. Delirium is a frequent and severe form of acute brain dysfunction, as well as an important source of concern in critical care. <strong>Objective:</strong> To assess the occurrence of delirium and time of stay in the intensive care unit. <strong>Method:</strong> This is a quantitative, descriptive study, with a cross-sectional design, which was carried out in a university hospital located in the interior of the State of Rio de Janeiro. The sample consisted of 89 patients, of both sexes, aged between 24 and 92 years. The RASS and CAM-ICU scales were used to assess delirium. The data were collected every 12 hours, for 3 months, 7 days a week and in an uninterrupted manner. <strong>Results:</strong> Were evaluated 89 patients, of which 16 were excluded according to the scale criteria, leaving 73 patients. After evaluation, 22 patients were diagnosed with delirium and 51 patients without delirium. Of the patients who presented delirium, 13 deaths and 9 had high to the nursery. Of the patients who did not have delirium, 40 had high to the nursery and 11 deaths. Patients with delirium had an average hospital stay of 23.25 days and patients who did not have delirium had an average of 4.5 days hospitalization.<strong> Conclusion: </strong>We can infer that the longer the patient spends in the intensive care unit, the greater the chance of delirium occurring. Therefore, preventive and interventional measures are necessary to decrease the mortality rate in patients with delirium and early detection is an excellent tool to improve this outcome.展开更多
We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their be...We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%;delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.展开更多
Purpose: The association between frailty and delirium has emerged as a research topic. Neurological symptoms have been reported among patients with coronavirus disease 2019 (COVID-19), but its effects on delirium rema...Purpose: The association between frailty and delirium has emerged as a research topic. Neurological symptoms have been reported among patients with coronavirus disease 2019 (COVID-19), but its effects on delirium remain unclear. This study aimed to compare the incidence of delirium between patients with COVID-19 and those without COVID-19, and to evaluate the impact of COVID-19 and frailty on delirium. Methods: This retrospective study included patients aged ≥ 20 years who were admitted to our intensive care unit (ICU) between January 2020 and February 2022. An inverse probability of treatment weighting using stabilized inverse propensity scores was adopted to minimize bias. After patient demographics were adjusted, the incidence of delirium, assessed using the Confusion Assessment Method for ICU, was compared between patients with COVID-19 and those without COVID-19. The effects of COVID-19 and the Clinical Frailty Scale score on delirium were analyzed by adjusting some covariates, including the sequential organ failure assessment (SOFA) score, using a generalized estimating equation. Results: Among 260 eligible patients, 226 patients were included. The weighted incidence of delirium was 56.9% and 61.9% in patients with and without COVID-19, respectively (p = 0.67). The generalized estimating equation revealed that the odds ratios (95% confidence interval) for COVID-19, the CFS score, and the SOFA score were 1.49 (0.62 - 3.57), 1.46 (1.11 - 1.91), and 1.22 (1.10 - 1.36), respectively. Conclusion: CFS and SOFA scores on ICU admission may be associated with delirium, with no significant difference between patients with COVID-19 and those without COVID-19.展开更多
Background: Critical patients in ICU have to experience pain, anxiety, and sleep deprivation which always cause delirium, which will prolong the hospital stay and come up with higher mortality. Analgesia based sedatio...Background: Critical patients in ICU have to experience pain, anxiety, and sleep deprivation which always cause delirium, which will prolong the hospital stay and come up with higher mortality. Analgesia based sedation can reduce the accumulation of sedative effects, and shorten ventilator time and ICU length of stay. Process management of analgesia and sedation can reduce the incidence of delirium. Objectives: To explore the clinical benefits of procedural analgesia and sedation for critical ill patients. Methods: This is a prospective, two-phase study that focuses on patients who required mechanical ventilation after surgery. Comparing patients’ pain and agitation scores, the species and dosage of sedative and analgesic, the incidence of delirium in the observation period and intervention period, data in two groups were collected and analyzed. Results: During the observational and interventional periods, we enrolled 213 patients before protocol implantation and 196 patients after protocol implantation. We found that there existed impropriate pain and sedation assessment in patients involved, and after training for procedural protocol, the average dosage of sedatives was decreased (p > 0.05). The percentage of reaching standard COPT score was 73.7% vs 84.1% (p > 0.05) and RASS score was 70.9% vs 79.6% (p > 0.05) in the observation period and intervention period, and the incidence of delirium was significantly reduced (31.9% vs 23.5%, p Conclusion: We concluded that protocol implantation of analgesia and sedation can reduce the incidence of delirium.展开更多
目的 探讨三级谵妄护理管理流程在神经内科重症监护室(neurology intensive care unit,NICU)急性脑卒中患者中的应用效果。方法 选择2021年5月至9月本院NICU收治的50例急性脑卒中患者作为研究对象并设为对照组,采取NICU预防谵妄的常规...目的 探讨三级谵妄护理管理流程在神经内科重症监护室(neurology intensive care unit,NICU)急性脑卒中患者中的应用效果。方法 选择2021年5月至9月本院NICU收治的50例急性脑卒中患者作为研究对象并设为对照组,采取NICU预防谵妄的常规护理措施;选择2021年12月至2022年4月收治NICU的50例急性脑卒中患者作为研究对象并设为试验组,试验组患者在对照组基础上实施三级谵妄护理管理流程,比较两组患者ICU谵妄(delirium in the intensive care unit,DICU)发生率、DICU持续时间、NICU住院时间、谵妄相关不良事件发生率;比较干预前后两组患者的谵妄水平和认知功能改善情况。结果 试验组患者DICU发生率较对照组低,两组比较,差异具有统计学意义(P<0.05)。试验组患者DICU持续时间、NICU住院时间较对照组短,谵妄相关不良事件发生率较对照组低;干预后试验组患者重症监护谵妄筛查量表(intensive care delirium screening checklist,ICDSC)评分低于对照组;试验组患者认知功能评分干预前后差值高于对照组,两组比较,差异有统计学意义(均P<0.05)。结论 在NICU急性脑卒中患者中实施三级谵妄护理管理流程可减少患者谵妄的发生,改善患者认知功能,缩短NICU住院时间,降低护理安全风险。展开更多
目的调查ICU谵妄的严重程度,分析其影响因素,探讨对患者预后的影响。方法纳入2022年9月一2023年9月入住山西省太原市某三级甲等医院综合ICU的患者410例,将其分为亚谵妄组、轻中度谵妄组和重度谵妄组,收集相关资料并于出院90d后随访。采...目的调查ICU谵妄的严重程度,分析其影响因素,探讨对患者预后的影响。方法纳入2022年9月一2023年9月入住山西省太原市某三级甲等医院综合ICU的患者410例,将其分为亚谵妄组、轻中度谵妄组和重度谵妄组,收集相关资料并于出院90d后随访。采用多因素Logistic回归分析谵妄严重程度的影响因素,采用Kaplan-Meier法绘制患者出院后90d的累积生存曲线并进行Log-rank检验。结果ICU谵妄发生率为36.77%;谵妄严重程度占比中,亚谵妄占32.20%,轻中度谵妄占47.32%,重度谵妄占20.48%。以亚妄为参照,年龄是轻中度谵妄的危险因素;机械通气时间是重度谵妄的危险因素;苯二氮草类药物使用、降钙素原、急性生理与慢性健康评分Ⅱ(Acute Physiology And Chronic Health EvaluationⅡ,APACHEⅡ)、胃肠功能分级是谵妄严重程度的危险因素(P<0.05);不同谵妄严重程度患者出院后90d病死率有影响。展开更多
目的评价灵活家庭探视制度对ICU患者谵妄的影响,为针对性干预提供参考。方法计算机检索PubMed、Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、万方数据等有关灵活家庭探视制度对ICU患者谵妄影响效果的研究,检...目的评价灵活家庭探视制度对ICU患者谵妄的影响,为针对性干预提供参考。方法计算机检索PubMed、Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、万方数据等有关灵活家庭探视制度对ICU患者谵妄影响效果的研究,检索时限从建库至2023年1月13日,由2名研究者独立筛选文献、提取资料、评价质量后进行Meta分析。结果共纳入17篇文献,Meta分析结果显示,与常规探视制度相比,灵活家庭探视制度能有效降低患者谵妄发生率[OR=0.41,95%CI(0.31,0.55),P<0.05]。结论灵活家庭探视制度可降低ICU患者谵妄发生率。展开更多
文摘Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.
文摘Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patients, limited research exists on ICU nurses’ stress specifically related to delirium care. This study aims to investigate the stress experienced by ICU nurses in China when managing patients with delirium. Methods: This cross-sectional survey was conducted in China from January to February 2023. A total of 243 ICU nurses participated by completing an online survey that included the Personal Information Questionnaire and the Strain of Caring for Delirium Index (SCDI). Although 260 responses were initially collected, 29 invalid questionnaires were excluded, resulting in a final sample size of 243 valid responses. The SCDI scale demonstrated reliable internal consistency, with Cronbach’s α coefficients of 0.744, 0.812, 0.778, and 0.920 across its four subscales. Results: The survey results indicated that hypoactive delirium behaviors were perceived as the most significant stressors when caring for delirious patients. Among the behaviors, “noisy/yelling” was identified as the most challenging, whereas “pulling at tubes, dressings” was rated as the least challenging. No significant associations were found between demographic factors and stress levels. Conclusion: This study sheds light on the stress levels ICU nurses experience when caring for delirious patients, particularly in relation to hypoactive behaviors. Based on these findings, it is recommended that nurse managers implement stress management strategies and provide targeted delirium-related care training to better support ICU nurses and enhance the quality of delirium care.
文摘Delirium is the most frequent manifestation of acute brain dysfunction in intensive care unit(ICU).Although antipsychotics are widely used to treat this serious complication,recent evidence has emphasized that these agents did not reduce ICU delirium(ICU-D)prevalence and did not improve survival,length of ICU or hospital stay after its occurrence.Of note,no pharmacological strategy to prevent or treat delirium has been identified,so far.In this scenario,new scientific evidences are urgently needed.Investigations on specific ICU-D subgroups,or focused on different clinical settings,and studies on medications other than antipsychotics,such as dexmedetomidine or melatonin,may represent interesting fields of research.In the meantime,because there is some evidence that ICU-D can be effectively prevented,the literature suggests strengthening all the strategies aimed at prevention through no-pharmacological approaches mostly focused on the correction of risk factors.The more appropriate strategy useful to treat established delirium remains the use of antipsychotics managed by choosing the right doses after a careful case-by-case analysis.While the evidence regarding the use of dexmedetomidine is still conflicting and sparse,this drug offers interesting perspectives for both ICU-D prevention and treatment.This paper aims to provide an overview of current pharmacological approaches of evidence-based medicine practice.The state of the art of the on-going clinical research on the topic and perspectives for future research are also addressed.
文摘<strong>Introduction: </strong>The delirium has received little attention from professionals working in the intensive care unit, mainly due to the fact that this is, rarely, the primary reason for patient admission. Given the high prevalence of delirium in an intensive care environment, the current guidelines recommend the daily assessment of delirium and a multidisciplinary approach. Delirium is a frequent and severe form of acute brain dysfunction, as well as an important source of concern in critical care. <strong>Objective:</strong> To assess the occurrence of delirium and time of stay in the intensive care unit. <strong>Method:</strong> This is a quantitative, descriptive study, with a cross-sectional design, which was carried out in a university hospital located in the interior of the State of Rio de Janeiro. The sample consisted of 89 patients, of both sexes, aged between 24 and 92 years. The RASS and CAM-ICU scales were used to assess delirium. The data were collected every 12 hours, for 3 months, 7 days a week and in an uninterrupted manner. <strong>Results:</strong> Were evaluated 89 patients, of which 16 were excluded according to the scale criteria, leaving 73 patients. After evaluation, 22 patients were diagnosed with delirium and 51 patients without delirium. Of the patients who presented delirium, 13 deaths and 9 had high to the nursery. Of the patients who did not have delirium, 40 had high to the nursery and 11 deaths. Patients with delirium had an average hospital stay of 23.25 days and patients who did not have delirium had an average of 4.5 days hospitalization.<strong> Conclusion: </strong>We can infer that the longer the patient spends in the intensive care unit, the greater the chance of delirium occurring. Therefore, preventive and interventional measures are necessary to decrease the mortality rate in patients with delirium and early detection is an excellent tool to improve this outcome.
文摘We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%;delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.
文摘Purpose: The association between frailty and delirium has emerged as a research topic. Neurological symptoms have been reported among patients with coronavirus disease 2019 (COVID-19), but its effects on delirium remain unclear. This study aimed to compare the incidence of delirium between patients with COVID-19 and those without COVID-19, and to evaluate the impact of COVID-19 and frailty on delirium. Methods: This retrospective study included patients aged ≥ 20 years who were admitted to our intensive care unit (ICU) between January 2020 and February 2022. An inverse probability of treatment weighting using stabilized inverse propensity scores was adopted to minimize bias. After patient demographics were adjusted, the incidence of delirium, assessed using the Confusion Assessment Method for ICU, was compared between patients with COVID-19 and those without COVID-19. The effects of COVID-19 and the Clinical Frailty Scale score on delirium were analyzed by adjusting some covariates, including the sequential organ failure assessment (SOFA) score, using a generalized estimating equation. Results: Among 260 eligible patients, 226 patients were included. The weighted incidence of delirium was 56.9% and 61.9% in patients with and without COVID-19, respectively (p = 0.67). The generalized estimating equation revealed that the odds ratios (95% confidence interval) for COVID-19, the CFS score, and the SOFA score were 1.49 (0.62 - 3.57), 1.46 (1.11 - 1.91), and 1.22 (1.10 - 1.36), respectively. Conclusion: CFS and SOFA scores on ICU admission may be associated with delirium, with no significant difference between patients with COVID-19 and those without COVID-19.
文摘Background: Critical patients in ICU have to experience pain, anxiety, and sleep deprivation which always cause delirium, which will prolong the hospital stay and come up with higher mortality. Analgesia based sedation can reduce the accumulation of sedative effects, and shorten ventilator time and ICU length of stay. Process management of analgesia and sedation can reduce the incidence of delirium. Objectives: To explore the clinical benefits of procedural analgesia and sedation for critical ill patients. Methods: This is a prospective, two-phase study that focuses on patients who required mechanical ventilation after surgery. Comparing patients’ pain and agitation scores, the species and dosage of sedative and analgesic, the incidence of delirium in the observation period and intervention period, data in two groups were collected and analyzed. Results: During the observational and interventional periods, we enrolled 213 patients before protocol implantation and 196 patients after protocol implantation. We found that there existed impropriate pain and sedation assessment in patients involved, and after training for procedural protocol, the average dosage of sedatives was decreased (p > 0.05). The percentage of reaching standard COPT score was 73.7% vs 84.1% (p > 0.05) and RASS score was 70.9% vs 79.6% (p > 0.05) in the observation period and intervention period, and the incidence of delirium was significantly reduced (31.9% vs 23.5%, p Conclusion: We concluded that protocol implantation of analgesia and sedation can reduce the incidence of delirium.
文摘目的 探讨三级谵妄护理管理流程在神经内科重症监护室(neurology intensive care unit,NICU)急性脑卒中患者中的应用效果。方法 选择2021年5月至9月本院NICU收治的50例急性脑卒中患者作为研究对象并设为对照组,采取NICU预防谵妄的常规护理措施;选择2021年12月至2022年4月收治NICU的50例急性脑卒中患者作为研究对象并设为试验组,试验组患者在对照组基础上实施三级谵妄护理管理流程,比较两组患者ICU谵妄(delirium in the intensive care unit,DICU)发生率、DICU持续时间、NICU住院时间、谵妄相关不良事件发生率;比较干预前后两组患者的谵妄水平和认知功能改善情况。结果 试验组患者DICU发生率较对照组低,两组比较,差异具有统计学意义(P<0.05)。试验组患者DICU持续时间、NICU住院时间较对照组短,谵妄相关不良事件发生率较对照组低;干预后试验组患者重症监护谵妄筛查量表(intensive care delirium screening checklist,ICDSC)评分低于对照组;试验组患者认知功能评分干预前后差值高于对照组,两组比较,差异有统计学意义(均P<0.05)。结论 在NICU急性脑卒中患者中实施三级谵妄护理管理流程可减少患者谵妄的发生,改善患者认知功能,缩短NICU住院时间,降低护理安全风险。
文摘目的调查ICU谵妄的严重程度,分析其影响因素,探讨对患者预后的影响。方法纳入2022年9月一2023年9月入住山西省太原市某三级甲等医院综合ICU的患者410例,将其分为亚谵妄组、轻中度谵妄组和重度谵妄组,收集相关资料并于出院90d后随访。采用多因素Logistic回归分析谵妄严重程度的影响因素,采用Kaplan-Meier法绘制患者出院后90d的累积生存曲线并进行Log-rank检验。结果ICU谵妄发生率为36.77%;谵妄严重程度占比中,亚谵妄占32.20%,轻中度谵妄占47.32%,重度谵妄占20.48%。以亚妄为参照,年龄是轻中度谵妄的危险因素;机械通气时间是重度谵妄的危险因素;苯二氮草类药物使用、降钙素原、急性生理与慢性健康评分Ⅱ(Acute Physiology And Chronic Health EvaluationⅡ,APACHEⅡ)、胃肠功能分级是谵妄严重程度的危险因素(P<0.05);不同谵妄严重程度患者出院后90d病死率有影响。
文摘目的评价灵活家庭探视制度对ICU患者谵妄的影响,为针对性干预提供参考。方法计算机检索PubMed、Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、万方数据等有关灵活家庭探视制度对ICU患者谵妄影响效果的研究,检索时限从建库至2023年1月13日,由2名研究者独立筛选文献、提取资料、评价质量后进行Meta分析。结果共纳入17篇文献,Meta分析结果显示,与常规探视制度相比,灵活家庭探视制度能有效降低患者谵妄发生率[OR=0.41,95%CI(0.31,0.55),P<0.05]。结论灵活家庭探视制度可降低ICU患者谵妄发生率。
文摘目的 构建ICU患者活动减少型谵妄风险动态列线图预测模型,并验证其预测效果。方法 选取2022年10月—2023年11月重庆市某三级甲等医院ICU患者430例作为研究对象,采用ICU意识模糊评估表联合Richmond躁动-镇静评分进行谵妄评估和分型。通过单因素分析和多因素Logistic回归分析确定独立预测因子,构建动态列线图预测模型。采用受试者操作特征曲线下面积(area under the curve,AUC)和Hosmer-Lemeshow(H-L)拟合优度检验模型的区分度和校准度,并对模型进行内、外部验证。结果 纳入模型的预测因子为电解质紊乱(OR=2.350)、留置导管≥2根(OR=3.529)、使用利尿剂(OR=0.342)、格拉斯哥昏迷评分(OR=0.183)、C反应蛋白浓度(OR=1.006)、血尿素浓度(OR=1.063)。建模组AUC为0.941 (95%CI:0.916~0.966),灵敏度为87.9%,特异度为90.3%,H-L检验结果为P=0.415。验证组AUC为0.897 (95%CI:0.837~0.956),灵敏度为79.6%,特异度为86.5%,H-L检验结果为P=0.450。结论 该研究构建的动态列线图预测模型能有效预测ICU患者发生活动减少型谵妄的概率,为医护人员科学预测活动减少型谵妄的发生提供有效工具,且临床使用便捷。
