Journal of Korean Academy of Fundamentals of Nursing (기본간호학회지)

Korean Academy of Fundamentals of Nursing (기본간호학회)
권호 표지

Risk Factors for Postoperative Delirium after Liver Transplantation in the Intensive Care Unit

간이식 후 중환자실에서의 섬망 발생 위험요인

  • Cha, Ok-Hee (Department of Nursing, Hyechon College) ;
  • Yoo, Yang-Sook (College of Nursing, The Catholic University of Korea) ;
  • Choi, Jung-Eun (Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Nam-Hee (Seoul St. Mary's Hospital, The Catholic University of Korea)
  • 조옥희 (혜천대학 간호과) ;
  • 유양숙 (가톨릭대학교 간호대학) ;
  • 최정은 (가톨릭대학교 서울성모병원) ;
  • 김남희 (가톨릭대학교 서울성모병원)
  • Published : 2009.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The objectives of this study were to determine the prevalence, incidence, duration and risk factors for delirium following liver transplantation while the patients were in the acute stage and admitted to the intensive care unit. Method: A retrospective chart review of 106 patients who had liver transplantation was conducted. A delirium risk factor checklist was used, to collect preoperative and postoperative data. Descriptive analysis, t-test, x2-test, and logistic regression analyses were used for data analysis. Results: The post-transplantation incidence of delirium was 29.3% (n=31). Multivariate analysis revealed that risk factors were preoperative conditions in the patients including spontaneous bacterial peritonitis, hepatorenal syndrome, and postoperative laboratory test results, such as hyperbilirubinemia. Conclusion: Therefore, a daily delirium risk factor assessment should be conducted before liver transplantation as a way to identify risk of delirium after the liver transplantation and to effectively manage delirium when it occurs.

Keywords

References

  1. Aldemir, M., Ozen, S., Kara, I. H., Sir, A., & Bac, B. (2001). Prediposing factors for delirium in the surgical intensive care unit. Critical Care, 5(5), 265-270. https://doi.org/10.1186/cc1044
  2. Beglinger, L. J., Duff, K., Van Der Heiden, S., Parrott, K.,Langbehn, D., & Gingrich, R. (2006). Incidence of delirium and associated mortality in hematopoietic stem cell transplantation patients. Biology of Blood and Marrow Transplantation, 12(9), 928-935 https://doi.org/10.1016/j.bbmt.2006.05.009
  3. Buis, C. I., Wiesner, R. H., Krom, R. A., Kremers, W. K., & Wijdicks, E. F. (2002). Acute confusional state following liver transplantation for alcoholic liver disease. Neurology, 59(4), 601-605. https://doi.org/10.1001/archneur.59.4.601
  4. Chang, Y. L., Tsai, Y. F., Lin, P. J., Chen, M. C., & Liu, C. Y. (2008). Prevalence and risk factors for postoperative delirium in a cardiovascular intensive care unit. American Journal of Critical Care, 17(6), 567-575.
  5. Dasgupta, M., & Dumbrell, A. C. (2006). Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. Journal of the American Geriatrics Society, 54(10), 1578-1589 https://doi.org/10.1111/j.1532-5415.2006.00893.x
  6. Devlin, J. W., Fong, J. J., Howard, E. P., Skrobik, Y., McCoy, N., Yasuda, C., & Marshall, J. (2008). Assessment of delirium in the intensive care unit: Nursing practices and perceptions. American Journal of Critical Care, 17(6),555-565.
  7. Dyrud, J. E. (2004). Posttransplantation delirium: A review. Organ Transplantation, 9(4), 428-431. https://doi.org/10.1097/01.mot.0000142728.91330.94
  8. Ely, E. W., Margolin, R., Francis, J., May, L., Truman, B., Dittus, R., et al. (2001). Evaluation of delirium in critically ill patients: Validation of the confusion assessment method for the intensive care Unit (CAM-ICU). Critical Care Medicine, 29(7), 1370-1379. https://doi.org/10.1097/00003246-200107000-00012
  9. Fann, J. R., Roth-Roemer, S., Burington, B. E., Katon, W. J., & Syrjala, K. L. (2002). Delirium in patients undergoing hematopoietic stem cell transplantation. Cancer, 95(9),1971-1981. https://doi.org/10.1002/cncr.10889
  10. Guarino, M., Stracciari, A., Pazzaglia, P., Sterzi, R., Santilli, I., Donato, F., et al. (1996). Neurological complications of liver transplantation. Journal of Neurology, 243(2), 137-142. https://doi.org/10.1007/BF02444004
  11. Hwang, J. S. (2007). Predisposing factors of complications in the treatment of hepatocellular carcinoma. The Korean Journal of Hepatology, 13(2s), 63-69
  12. Kim, W., Choi, S. W., Lee, H., & Kim, C. Y. (1990). The role of ascitic fluid protein concentration in the development of spontaneous bacterial peritonitis. The Korean Journal of Gastroenterology, 22(2), 362-367.
  13. Korean Network for Organ Sharing (2007). Statics of transplantation in Korea.
  14. Korean Network for Organ Sharing (2009). Statics of transplantation in Korea.. Retrieved May 30, 2009, from the Korean Network for Organ Sharing Web site http://www.konos.go.kr/
  15. Kwon, S. Y. (2004). Hepatorenal syndrome. The Korean Journal of Hepatology, 10(2s), 57-66.
  16. Lee, E. H. (2009). Cost-benefit analysis of an ICU psychosis prevention strategy using decision tree model. Unpublished master’s thesis, Seoul National University, Seoul
  17. Lee, J. (2008). A study for the diagnosis, severity and subtypes of delirium using the Korean Version of Delirium Rating Scale-revised-98 (K-DRS-98). Unpublished master's thesis, Chungnam National University, Daejeon.
  18. Lee, N. J. (2007). Current status of liver transplantation in Korea. The Korean Journal of Gastroenterology, 49(4suppl), 185-193.
  19. Misra, S., & Ganzini, L. (2003). Delirium, depression, and anxiety. Critical Care Clinics, 19(4), 771-787. https://doi.org/10.1016/S0749-0704(03)00048-4
  20. Pandharipande, P., Cotton, B. A., Shintani, A., Thompson, J., Pun, B. T., Morris, J. A., et al. (2008). Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. The Journal of Trauma Injury, Infection, and Critical Care, 65(1), 34-41. https://doi.org/10.1097/TA.0b013e31814b2c4d
  21. Park, I. S., Kim, N. S., Lim, H. J., & Jang, S. H. (1998). Comparison of the frequency of postoperative delirium in elderiy between general anesthesia and regional anesthesia. Korean Journal of Anesthesiology, 34(3), 623-629.
  22. Robinson, T. N., Raeburn, C. D., Tran, Z. V., Angles, E. M., Brenner, L. A., & Moss, M. (2009). Postoperative delirium in the elderiy: Risk factors and outcomes. Annals of Surgely, 249(1), 173-178. https://doi.org/10.1097/SLA.0b013e31818e4776
  23. Rocca, P., Cocuzza, E., Rasetti, R., Rocca, G., Zanalda, E., & Bogetto, F. (2003). Predictors of psychiatric disorders in liver transplantation candidates: Logistic regression models. Liver Transplantation, 9(7), 721-726 https://doi.org/10.1053/jlts.2003.50133
  24. Van Rompaey, B., Schuurmans, M. J., Shortridge-Baggett, L. M., Truijen, S., & Bossaert, L. (2008). Risk factors for intensive care delirium: a systematic review. Intensive and Critical Care Nursing, 24(2), 98-107. https://doi.org/10.1016/j.iccn.2007.08.005
  25. Seo, K. S. (2008). Factors related to delirium occurrence of medical intensive care unit patients. Unpublished master's thesis, Seoul National University, Seoul.
  26. Seo, Y. S. (2009). Hepatorenal syndrome type l and II. The Korean Journal of Hepatology, 15(1s), 69-83.
  27. Suh, H. J. (2006). Intensive care unit nurse's knowledge, nursing performance, and stress about delirium. Unpublished master's thesis, The Catholic University of Korea, Seoul
  28. Van de Beek, D., Kermers, W., Daly, R, C., Edward, B. S., Clavell, A. L., McGregor, C. G., et al. (2008). Effect of neurologic complication of outcome after heart transplant. Archives of Neurology, 65(2), 226-231. https://doi.org/10.1001/archneurol.2007.52
  29. Yoshimura, Y., Kubo, S., Shirata, K., Hirohashi, K., Tanaka, H., Shuto, T., et al. (2004). Risk factors for postoperative delirium after liver resection for hepatocellular carcinoma. World Journal of Surgery, 28(10), 982-986. https://doi.org/10.1007/s00268-004-7344-1
  30. Yu, M. Y. (2007). Related factor of delirium occurrence in the intensive care unit patients. Unpublished master's thesis, Ajou University of Korea, Gyeonggido