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精神状态是预测ICU病房中呼吸机支持患者死亡率
Laurie Barclay, MD
April 13, 2004 — Delirium is an independent predictor of mortality for patients on ventilators in the intensive care unit (ICU), according to the results of a prospective cohort study published in the April 14 issue of The Journal of the American Medical Association.
"In the ICU, delirium is a common yet underdiagnosed form of organ dysfunction, and its contribution to patient outcomes is unclear," write E. Wesley Ely, MD, MPH, from Vanderbilt University in Nashville, Tennessee, and colleagues. "There is a paucity of published trials of prevention or treatment of delirium showing altered outcomes and none in ICU patients."
Between February 2000 and May 2001, 275 mechanically ventilated patients were admitted to adult medical and coronary ICUs and followed for delirium during 2,158 ICU days using the Confusion Assessment Method for the ICU and the Richmond Agitation-Sedation Scale.
Of 275 patients, 51 (18.5%) had persistent coma and died in the hospital, and 183 (81.7%) of the remaining 224 patients became delirious during their ICU admission. Demographic variables and baseline markers of illness severity and dementia were similar in patients with and without delirium.
Compared with patients who did not develop delirium, the group that did develop delirium had a higher six-month mortality rate (34% vs. 15%; P =.03), and length of stay was 10 days longer (P < .001). Even after adjustment for presence or absence of coma, use of sedatives or analgesics, and other relevant variables, the development of delirium was associated with triple the risk of death within six months (adjusted hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.4 - 7.7; P = .008) and longer hospital stay (adjusted HR, 2.0; 95% CI, 1.4 - 3.0; P < .001).
Delirium also predicted longer post-ICU stay, reduced median number of days surviving and free of mechanical ventilation, and greater incidence of cognitive impairment when discharged from the hospital.
Study limitations include delirium coding only once daily, lack of data on psychoactive medications other than sedatives, and analgesics, patient population not encompassing trauma or surgical ICUs or patients with baseline neurologic disease, and inability to determine cause-and-effect relationship between delirium and clinical outcomes.
"Delirium was an independent predictor of higher six-month mortality and longer hospital stay even after adjusting for relevant covariates including coma, sedatives, and analgesics in patients receiving mechanical ventilation," the authors write. "Future studies are needed to determine whether prevention or treatment of delirium would change clinical outcomes including mortality, length of stay, cost of care, and long-term neuropsychological outcomes among survivors of critical illness."
The Alliance for Aging Research, the National Institutes of Health, and the National Institute on Aging helped support this study.
JAMA. 2004;291:1753-1762 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-05-07 17:14
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