소아중환자실 입원 아동의 섬망 발생 관련 요인
Factors associated with Pediatric Delirium in the Pediatric Intensive Care Unit
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Purpose: This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors. Methods: The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, x2 test, t-test, and logistic regression analyses. Results: The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age (x2=14.10, p=.007), admission type (x2=7.40, p=.007), use of physical restraints (x2=26.11, p<.001), RASS score (x2=14.80, p=.001), need for oxygen (x2=5.31, p=.021), use of a mechanical device (x2=9.97, p=.041), feeding (x2=7.85, p=.005), and the presence of familiar objects (x2=29.21, p<.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.16~45.95, p<.001) and the presence of familiar objects (OR=0.09, 95% CI=0.03~0.30, p=.002). Conclusion: Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child.
Abstract
Purpose: This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors. Methods: The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, x2 test, t-test, and logistic regression analyses. Results: The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age (x2=14.10, p=.007), admission type (x2=7.40, p=.007), use of physical restraints (x2=26.11, p<.001), RASS score (x2=14.80, p=.001), need for oxygen (x2=5.31, p=.021), use of a mechanical device (x2=9.97, p=.041), feeding (x2=7.85, p=.005), and the presence of familiar objects (x2=29.21, p<.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.16~45.95, p<.001) and the presence of familiar objects (OR=0.09, 95% CI=0.03~0.30, p=.002). Conclusion: Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child.
참고문헌 (30)
- "Diagnostic and statistical manual of mental disorders: DSM-5" (2013)[URL]
- Sandeep Grover, "Symptom profile of delirium in children and adolescent—does it differ from adults and elderly?", General Hospital Psychiatry, 34(6), pp.626~632 (2012), Elsevier BV[DOI]
- Albert F.G. Leentjens, "A comparison of the phenomenology of pediatric, adult, and geriatric delirium", Journal of Psychosomatic Research, 64(2), pp.219~223 (2008), Elsevier BV[DOI]
- Creten C, "Pediatric delirium in the pediatric intensive care unit : A systematic review and an update on key issues and research questions", Minerva Anestesiologica, 77(11), pp.1099~1107 (2011)
- Chani Traube, "Delirium and Mortality in Critically Ill Children", Critical Care Medicine, 45(5), pp.891~898 (2017), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Nathan E. Brummel, "Implementing Delirium Screening in the ICU", Critical Care Medicine, 41(9), pp.2196~2208 (2013), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Salluh JI, "Outcome of delirium in critically ill patients : Systematic review and meta-analysis", BMJ, 350, pp.h2538~ (2015)[DOI]
- Juliana Barr, "Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit", Critical Care Medicine, 41(1), pp.263~306 (2013), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Milbrandt EB, "Costs associated with delirium in mechanically ventilated patients", Critical Care Medicine, 32(4), pp.955~962 (2004)[DOI]
- Dubois MJ, "Delirium in an intensive care unit : A study of risk factors", Intensive Care Medicine, 27(8), pp.1297~1304 (2001)
- Reade MC, "Sedation and delirium in the intensive care unit", The New England Journal of Medicine, 370(5), pp.444~454 (2014)[DOI]
- Silver G, "Pediatric delirium and associated risk factors : A single-center prospective observation study", Pediatric Critical Care Medicine, 16(4), pp.303~309 (2015)[DOI]
- Traube C, "Cornell Assessment of Pediatric Delirium : A valid, rapid observational tool for screening delirium in the PICU", Critical Care Medicine, 42(3), pp.656~663 (2014)[DOI]
- Vlajkovic GP, "Emergence delirium in children : Many questions, few answers", Anesthesia and Analgesia, 104(1), pp.84~91 (2007)[DOI]
- Grover S, "Delirium in children and adolescents", International Journal of Psychiatry in Medicine, 39(2), pp.179~187 (2009)[DOI]
- 유제복, "회복실에 대한 사전 정보제공과 보호자 상주 중재가 수술 직후 각성 시 소아 청소년 환아의 불안, 섬망 및 통증에 미치는 효과", Journal of Korean Academy of Nursing, 42(3), pp.333~341 (2012), 한국간호과학회
- Lim EY, "An exploratory study of staff nurse's knowledge and experience of delirium in the pediatric intensive care unit", master's, pp.2015
- James SR, "Nursing care of children", pp.5~442 (2009), Hyunmoon
- Sessler CN, "The Richmond Agitation-Sedation Scale : Validity and reliability in adult intensive care unit patients", American Journal of Respiratory and Critical Care Medicine, 166(10), pp.1338~1344 (2002)[DOI]
- 전경만, "중환자실 환자의 통증, 진정 및 섬망 관리", 대한내과학회지, 86(5), pp.546~556 (2014), 대한내과학회[DOI]
- Smith HA, "Diagnosing delirium in critically ill children : Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit", Critical Care Medicine, 39(1), pp.150~157 (2011)[DOI]
- Park EJ, "Incidence and risk factors of delirium in older adults admitted to the intensive care unit", master's, pp.2016
- 조옥희, "간이식 후 중환자실에서의 섬망 발생 위험요인", 기본간호학회지, 16(3), pp.290~299 (2009), 기본간호학회
- Van Rompaey B, "Risk factors for delirium in intensive care patients : A prospective cohort study", Critical Care, 13(3), pp.R77~ (2009)[DOI]
- Strom T, "A protocol of no sedation for critically ill patients receiving mechanical ventilation : A randomised trial", Lancet, 375(9713), pp.475~480 (2010)[DOI]
- Korean Child Neurology Society, "Pediatric neurology" (2013), Koonja
- Kain ZN, "Family-centered preparation for surgery improves perioperative outcomes in children : A randomized controlled trial", Anesthesiology, 106(1), pp.65~74 (2007)[DOI]
- Marilyn J, "Wong's essentials of pediatric nursing" (2014), Hyunmoon
- Ahn HS, "Pediatrics" (2016), Mirae N
- 유미영, "중환자실 환자의 섬망발생 관련요인에 관한 연구", 임상간호연구, 14(1), pp.151~160 (2008), 병원간호사회