Clinical Features of Delirium among Patients in the Intensive Care Unit According to Motor Subtype Classification: A Retrospective Longitudinal Study
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Delirium in the intensive care unit (ICU) poses a significant safety and socioeconomic burden to patients and caregivers. However, invasive interventions for managing delirium have severe drawbacks. To reduce unnecessary interventions during ICU hospitalization, we aimed to investigate the features of delirium among ICU patients according to the occurrence of hypoactive symptoms, which are not expected to require invasive intervention. Materials and Methods: Psychiatrists assessed all patients with delirium in the ICU during hospitalization. Patients were grouped into two groups: a “non-hypoactive” group that experienced the non-hypoactive motor subtype once or more or a “hypoactive only” group that only experienced the hypoactive motor subtype. Clinical variables routinely gathered for clinical management were collected from electronic medical records. Group comparisons and logistic regression analyses were conducted. Results: The non-hypoactive group had longer and more severe delirium episodes than the hypoactive only group. Although the non-hypoactive group was prescribed more antipsychotics and required restraints longer, the hypoactive only group also re ceived both interventions. In multivariable logistic regression analysis, BUN [odds ratio (OR): 0.993, pH OR: 0.202], sodium (OR: 1.022), RASS score (OR: 1.308) and whether restraints were applied [OR: 1.579 (95% confidence interval 1.194–2.089), p<0.001] were significant predictors of hypoactive only group classification. Conclusion: Managing and predicting delirium patients based on whether patients experienced non-hypoactive delirium may be clinically important. Variables obtained during the initial 48 hours can be used to determine which patients are likely to re quire invasive interventions.
Abstract
Purpose: Delirium in the intensive care unit (ICU) poses a significant safety and socioeconomic burden to patients and caregivers. However, invasive interventions for managing delirium have severe drawbacks. To reduce unnecessary interventions during ICU hospitalization, we aimed to investigate the features of delirium among ICU patients according to the occurrence of hypoactive symptoms, which are not expected to require invasive intervention. Materials and Methods: Psychiatrists assessed all patients with delirium in the ICU during hospitalization. Patients were grouped into two groups: a “non-hypoactive” group that experienced the non-hypoactive motor subtype once or more or a “hypoactive only” group that only experienced the hypoactive motor subtype. Clinical variables routinely gathered for clinical management were collected from electronic medical records. Group comparisons and logistic regression analyses were conducted. Results: The non-hypoactive group had longer and more severe delirium episodes than the hypoactive only group. Although the non-hypoactive group was prescribed more antipsychotics and required restraints longer, the hypoactive only group also re ceived both interventions. In multivariable logistic regression analysis, BUN [odds ratio (OR): 0.993, pH OR: 0.202], sodium (OR: 1.022), RASS score (OR: 1.308) and whether restraints were applied [OR: 1.579 (95% confidence interval 1.194–2.089), p<0.001] were significant predictors of hypoactive only group classification. Conclusion: Managing and predicting delirium patients based on whether patients experienced non-hypoactive delirium may be clinically important. Variables obtained during the initial 48 hours can be used to determine which patients are likely to re quire invasive interventions.
참고문헌 (53)
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" (2013), American Psychiatric Association
- Krewulak KD, "Risk factors and outcomes among delirium subtypes in adult ICUs : a systematic review", J Crit Care, 56, pp.257~264 (2020)
- Andrews PS, "Relationship between intensive care unit delirium severity and 2-year mortality and health care utilization", Am J Crit Care, 29, pp.311~317 (2020)
- Thomason JW, "Intensive care unit delirium is an independent predictor of longer hospital stay : a prospective analysis of 261 non-ventilated patients", Crit Care, 9, pp.R375~R381 (2005)
- Mitchell ML, "Long-term cognitive impairment and delirium in intensive care : a prospective cohort study", Aust Crit Care, 31, pp.204~211 (2018)
- Krewulak KD, "Incidence and prevalence of delirium subtypes in an adult ICU : a systematic review and meta-analysis", Crit Care Med, 46, pp.2029~2035 (2018)
- Sauvigny T, "Rate and risk factors for a hyperactivity delirium in patients with aneurysmal subarachnoid haemorrhage", Neurosurg Rev, 42, pp.481~488 (2019)
- Simons KS, "Temporal biomarker profiles and their association with ICU acquired delirium : a cohort study", Crit Care, 22, pp.137~ (2018)
- Ospina JP, "Epidemiology, mechanisms, diagnosis, and treatment of delirium : a narrative review", Clin Med Ther, 1, pp.3~ (2018)
- Pan Y, "Influence of physical restraint on delirium of adult patients in ICU : a nested case-control study", J Clin Nurs, 27, pp.1950~1957 (2018)
- O’Keeffe ST, "Clinical significance of delirium subtypes in older people", Age Ageing, 28, pp.115~119 (1999)
- Saravay SM, "How do delirium and dementia increase length of stay of elderly general medical inpatients?", Psychosomatics, 45, pp.235~242 (2004)
- Robinson TN, "Motor subtypes of postoperative delirium in older adults", Arch Surg, 146, pp.295~300 (2011)
- Meagher DJ, "The use of environmental strategies and psychotropic medication in the management of delirium", Br J Psychiatry, 168, pp.512~515 (1996)
- la Cour KN, "Distribution of delirium motor subtypes in the intensive care unit : a systematic scoping review", Crit Care, 26, pp.53~ (2022)
- Boncyk CS, "Pharmacologic management of intensive care unit delirium : clinical prescribing practices and outcomes in more than 8500 patient encounters", Anesth Analg, 133, pp.713~722 (2021)
- Evans D, "Patient injury and physical restraint devices : a systematic review", J Adv Nurs, 41, pp.274~282 (2003)
- Meagher DJ, "A longitudinal study of motor subtypes in delirium : frequency and stability during episodes", J Psychosom Res, 72, pp.236~241 (2012)
- Albrecht JS, "Stability of postoperative delirium psychomotor subtypes in individuals with hip fracture", J Am Geriatr Soc, 63, pp.970~976 (2015)
- Oh J, "Mutual relationship between anxiety and pain in the intensive care unit and its effect on medications", J Crit Care, 30, pp.1043~1048 (2015)
- Wang HF, "Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital : a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era", Ther Clin Risk Manag, 11, pp.393~406 (2015)
- Barr J, "Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit", Crit Care Med, 41, pp.263~306 (2013)
- Yanghyun Lee, "Korean Version of the Delirium Rating Scale-Revised-98: Reliability and Validity", PSYCHIATRY INVESTIGATION, 8(1), pp.30~38 (2011), 대한신경정신의학회
- Meagher D, "A new data-based motor subtype schema for delirium", J Neuropsychiatry Clin Neurosci, 20, pp.185~193 (2008)
- Sessler CN, "The Richmond Agitation-Sedation Scale : validity and reliability in adult intensive care unit patients", Am J Respir Crit Care Med, 166, pp.1338~1344 (2002)
- Knaus WA, "APACHE II : a severity of disease classification system", Crit Care Med, 13, pp.818~829 (1985)
- Andreasen NC, "Antipsychotic dose equivalents and dose-years : a standardized method for comparing exposure to different drugs", Biol Psychiatry, 67, pp.255~262 (2010)
- Park WR, "Potential usefulness of blood urea nitrogen to creatinine ratio in the prediction and early detection of delirium motor subtype in the intensive care unit", J Clin Med, 11, pp.5073~ (2022)
- Pang H, "Acute kidney injury-associated delirium : a review of clinical and pathophysiological mechanisms", Crit Care, 26, pp.258~ (2022)
- Cerejeira J, "The cholinergic system and inflammation : common pathways in delirium pathophysiology", J Am Geriatr Soc, 60, pp.669~675 (2012)
- Guo Y, "Prevalence and risk factors of postoperative delirium in elderly hip fracture patients", J Int Med Res, 44, pp.317~327 (2016)
- Renneboog B, "Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits", Am J Med, 119, pp.71~ (2006)
- Granberg Axèll AI, "Intensive care unit syndrome", delirium is associated with anemia, drug therapy and duration of ventilation treatment, 2002, pp.46, 726~731
- Maldonado JR, "Pathoetiological model of delirium : a comprehensive understanding of the neurobiology of delirium and an evidence-based approach to prevention and treatment", Crit Care Clin, 24, pp.789~856 (2008)
- Scholtens RM, "Variability of delirium motor subtype scale–defined delirium motor subtypes in elderly adults with hip fracture : a longitudinal study", J Am Geriatr Soc, 65, pp.e45~e50 (2017)
- Maldonado JR, "Delirium in the acute care setting : characteristics, diagnosis and treatment", Crit Care Clin, 24, pp.657~722 (2008)
- Glynn K, "How do delirium motor subtypes differ in phenomenology and contributory aetiology? A cross-sectional, multisite study of liaison psychiatry and palliative care patients", BMJ Open, 11, pp.e041214~ (2021)
- Evensen S, "Delirium motor subtypes and prognosis in hospitalized geriatric patients-A prospective observational study", J Psychosom Res, 122, pp.24~28 (2019)
- Hamano J, "Comparison of the prevalence and associated factors of hyperactive delirium in advanced cancer patients between inpatient palliative care and palliative home care", Cancer Med, 10, pp.1166~1179 (2021)
- Collet MO, "Prevalence and risk factors related to haloperidol use for delirium in adult intensive care patients : the multinational AIDICU inception cohort study", Intensive Care Med, 44, pp.1081~1089 (2018)
- Peterson JF, "Delirium and its motoric subtypes : a study of 614critically ill patients", J Am Geriatr Soc, 54, pp.479~484 (2006)
- Meagher D, "Development of an abbreviated version of the delirium motor subtyping scale(DMSS-4)", Int Psychogeriatr, 26, pp.693~702 (2014)
- Morandi A, "Clinical features associated with delirium motor subtypes in older inpatients : results of a multicenter study", Am J Geriatr Psychiatry, 25, pp.1064~1071 (2017)
- Bellelli G, ""Delirium day" : a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool", BMC Med, 14, pp.106~ (2016)
- Mufti HN, "Perioperative prediction of agitated(hyperactive)delirium after cardiac surgery in adults-The development of a practical scorecard", J Crit Care, 42, pp.192~199 (2017)
- Noimark D, "Predicting the onset of delirium in the post-operative patient", Age Ageing, 38, pp.368~373 (2009)
- Inouye SK, "A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics", Ann Intern Med, 119, pp.474~481 (1993)
- Wilson MM, "Impaired cognitive function and mental performance in mild dehydration", Eur J Clin Nutr, 57(Suppl 2), pp.S24~S29 (2003)
- Haines RW, "Elevated urea-to-creatinine ratio provides a biochemical signature of muscle catabolism and persistent critical illness after major trauma", Intensive Care Med, 45, pp.1718~1731 (2019)
- Gunst J, "The urea-creatinine ratio as a novel biomarker of critical illness-associated catabolism", Intensive Care Med, 45, pp.1813~1815 (2019)
- Makiguchi T, "Impact of skeletal muscle mass on postoperative delirium in patients undergoing free flap repair after oral cancer resection", J Plast Surg Hand Surg, 54, pp.161~166 (2020)
- Peterson JF, "The prevalence of delirium subtypes in medical ICU patients", J Am Geriatr Soc, 51, pp.S174~ (2003)
- Lahariya S, "Phenomenology of delirium among patients admitted to a coronary care unit", Nord J Psychiatry, 70, pp.626~632 (2016)