DOI QR코드

DOI QR Code

Risk Factors of Delirium in ICU Patients with Acute Poisoning

중환자실 급성중독환자에서 섬망의 위험인자

  • Kim, Hee Yeon (Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cha, Kyung Man (Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • So, Byung Hak (Department of Emergency Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • 김희연 (가톨릭대학교 성빈센트병원 응급의학과) ;
  • 차경만 (가톨릭대학교 성빈센트병원 응급의학과) ;
  • 소병학 (가톨릭대학교 성빈센트병원 응급의학과)
  • Received : 2019.04.16
  • Accepted : 2019.05.29
  • Published : 2019.06.30

Abstract

Purpose: This study estimated the incidence of delirium and associated risk factors and outcomes in ICU patients with acute poisoning. Methods: Data were collected from ICU patients over 18 years of age that were admitted via the emergency center after presenting with poisoning from 2010 to 2015. Delirium was assessed retrospectively using the Intensive Care Delirium Screening Checklist (ICDSC). Risk factors were evaluated by univariate and multivariate analysis. Results: A total of 199 patients participated in this study and 68 (34.2%) were diagnosed with delirium based on the ICDSC score. The delirium group showed a significantly higher association with prolonged length of stay in the hospital and ICU in comparison with the non-delirium group. The delirium group was associated with greater use of physical restraint. A statistically greater number of patients with pharmaceutical substance poisoning developed delirium over a short period of time than those with non-pharmaceutical substance poisoning. There was no significant difference between the two groups with respect to age, sex, past history, GCS score, vital signs, application of ventilator care and renal replacement therapy. Conclusion: The finding that the delirium group had a greater length of stay in both the hospital and the ICU is consistent with the results of previous worldwide studies of the effects of delirium on the prognosis of patients who were admitted to the ICU, suggesting the possibility for domestic application. Additionally, use of physical restraint was positively related to the incidence of delirium. Thus, interventions for minimizing the use of physical restraints and considering alternatives are needed.

Keywords

References

  1. Muhlberg W, Becher K, Heppner HJ, et al. Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit. Z Gerontol Geriatr 2005;38:182-9. https://doi.org/10.1007/s00391-005-0309-7
  2. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004;291:1753-62. https://doi.org/10.1001/jama.291.14.1753
  3. European Delirium Association, American Delirium Society. The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Med 2014;12:141. https://doi.org/10.1186/s12916-014-0141-2
  4. Tilouche N, Hassen MF, Ali HBS, et al. Delirium in the Intensive Care Unit: Incidence, Risk Factors, and Impact on Outcome. Indian J Crit Care Med 2018;22:144-9. https://doi.org/10.4103/ijccm.IJCCM_244_17
  5. Devlin JW, Skrobik Y, Gelinas C, et al. Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2018;46:1532-48. https://doi.org/10.1097/CCM.0000000000003259
  6. Sohn JH, Na SH, Shin CS, et al. Impact of Delirium on Clinical Outcomes in Intensive Care Unit Patients: An Observational Study in a Korean General Hospital. J Korean Neuropsychiatr Assoc 2014;53:418-25. https://doi.org/10.4306/jknpa.2014.53.6.418
  7. McNicoll L, Pisani MA, Zhang Y, et al. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 2003;51:591-8. https://doi.org/10.1034/j.1600-0579.2003.00201.x
  8. Pisani MA, Murphy TE, Van Ness PH, et al. Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 2007;167:1629-34. https://doi.org/10.1001/archinte.167.15.1629
  9. Lee H, Oh SY, Yu JH, et al. Risk Factors of Postoperative Delirium in the Intensive Care Unit After Liver Transplantation. World J Surg 2018;42:2992-9. https://doi.org/10.1007/s00268-018-4563-4
  10. Noh EY, Park YH. Prevalence of Delirium and Risk Factors in Heart Surgery Patients in Intensive Care Unit: A Retrospective study. Korean J Adult Nurs 2019;31:146-55. https://doi.org/10.7475/kjan.2019.31.2.146
  11. Kim Y, Hong SJ. Intensive Care Unit Delirium. Korean J Crit Care Med 2015;30:63-72. https://doi.org/10.4266/kjccm.2015.30.2.63
  12. Hshieh TT, Fong TG, Marcantonio ER, et al. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci 2008;63:764-72. https://doi.org/10.1093/gerona/63.7.764
  13. Dawson AH, Buckley NA. Pharmacological management of anticholinergic delirium - theory, evidence and practice. Br J Clin Pharmacol 2016;81:516-24. https://doi.org/10.1111/bcp.12839
  14. Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, et al. Risk factors for intensive care delirium: a systematic review. Intensive Crit Care Nurs 2008;24:98-107. https://doi.org/10.1016/j.iccn.2007.08.005
  15. Benbenbishty J, Adam S, Endacott R. Physical restraint use in intensive care units across Europe: the PRICE study. Intensive Crit Care Nurs 2010;26:241-5. https://doi.org/10.1016/j.iccn.2010.08.003
  16. Van Rompaey B, Elseviers MM, Schuurmans MJ, et al. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care 2009;13:R77. https://doi.org/10.1186/cc7892
  17. Pan Y, Jiang Z, Yuan C, et al. Influence of physical restraint on delirium of adult patients in ICU: A nested case-control study. J Clin Nurs 2018;27:1950-7. https://doi.org/10.1111/jocn.14334
  18. Ouimet S, Kavanagh BP, Gottfried SB, et al. risk factors and consequences of ICU delirium. Intensive Care Med 2007;33:66-73. https://doi.org/10.1007/s00134-006-0399-8
  19. Jeon K. Management of Pain, Agitation and Delirium in the Intensive Care Units. Korean J Med 2014;86:546-56. https://doi.org/10.3904/kjm.2014.86.5.546
  20. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41:263-306. https://doi.org/10.1097/CCM.0b013e3182783b72
  21. Marra A, Frimpong K, Ely EW. The ABCDEF Implementation Bundle. Korean J Crit Care Med 2016;31:181-93. https://doi.org/10.4266/kjccm.2016.00682