중환자간호학회지 (Journal of Korean Critical Care Nursing)

  • 제16권1호
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  • Pages.71-86
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  • 2023
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  • 2005-212X(pISSN)
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  • 2671-8634(eISSN)
한국중환자간호학회 (Korean Society of Critical Care Nursing)
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일 종합병원 중환자실의 섬망 발생 및 중재 현황과 의료진의 섬망 인식 조사

Investigation of Delirium Occurrence and Intervention Status in Intensive Care Unit at a Hospital and Perception of Delirium by Medical Staff

  • 강이슬 (서울아산병원 외과계중환자실1) ;
  • 김순희 (서울아산병원 중환자간호팀 ) ;
  • 이민정 (서울아산병원 감염관리센터 중환자실) ;
  • 이효진 (서울아산병원 내과계중환자실1 ) ;
  • 임옥분 (서울아산병원 외과계중환자실1 ) ;
  • 홍상범 (서울아산병원 중환자실 ) ;
  • 최혜란 (울산대학교 의과대학 임상전문간호학전공 )
  • Kang, Yi-Seul (Surgical Intensive Care Unit 1, Asan Medical Center) ;
  • Kim, Soon-Hee (Intensive Care Unit, Asan Medical Center) ;
  • Lee, Min-Jeoung (Biocontainment Intensive Care Unit, Asan Medical Center) ;
  • Lee, Hyo-Jin (Medical Intensive Care Unit 1, Asan Medical Center) ;
  • Lim, Oak-Bun (Surgical Intensive Care Unit 1, Asan Medical Center) ;
  • Hong, Sang-Bum (Deparment of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Choi, Hye-Ran (Department of Clinical Nursing, University of Ulsan)
  • 투고 : 2022.09.05
  • 심사 : 2023.02.14
  • 발행 : 2023.02.28
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초록

Purpose : This study aims to investigate the status of delirium intervention in adult intensive care unit (ICU) patients and the perception of this delirium by medical staff. Methods : This retrospective study involves 185 patients, whereas, a descriptive survey is conducted with 197 medical staff members. Results : The delirium group includes 100 patients (54.1%). The incidence of delirium is 64.9% in the medical ICU, 65.9% in the surgical ICU, 42.4% in the neuro ICU, and 46.5% in the cardiac ICU. The percentages of delirium prevention intervention differs between the two groups: 65.0% in the delirium group and 95.3% in the non-delirium group. The medical staff recognize that delirium is a common problem in the ICU (100.0%) and requires active medical intervention (98.5%). Conclusion : The length of stay at the ICU is longer in the delirium group than in the non-delirium group. It is necessary to standardize delirium prevention and treatment protocols to be equally applicable to all ICU patients.

키워드

참고문헌

  1. Maldonado JR. Delirium in the acute care setting: characteristics, diagnosis and treatment. Critical Care Clinics. 2008;24(4):657-722. http://dx.doi.org/10.1016/j.ccc.2008.05.008 
  2. Devlin JW, Skrobik Y, Gelinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine. 2018;46(9):e825-e73. http://dx.doi.org/10.1097/CCM.0000000000003299 
  3. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAMICU). Journal of the American Medical Association. 2001;286(21):2703-10. http://dx.doi.org/10.1001/jama.286.21.2703 
  4. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Critical Care Medicine. 2001;29(7):1370-9. http://dx.doi.org/10.1097/00003246-200107000-00012 
  5. Kang J, Choi MJ. A systematic review and meta-analysis on the effect of delirium prevention intervention in Korean intensive care units. Journal of Korean Critical Care Nursing. 2021;14(3):141-56. https://doi.org/10.34250/jkccn.2021.14.3.141 
  6. Choi SJ, Cho YA. Prevalence and related risk factors of delirium in intensive care units as detected by the CAM-ICU. Journal of Korean Clinical Nursing Research. 2014;20(3):406-16. http://dx.doi.org/10.22650/JKCNR.2014.20.3.406 
  7. Yu MY, Park JW, Hyun MS, Lee YJ. Factors related to delirium occurrence among the patients in the intensive care units. Journal of Korean Clinical Nursing Research. 2008;14(1):151-60. 
  8. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell Jr FE, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Journal of the American Medical Association. 2004;291(14):1753-62. http://dx.doi.org/10.1001/jama.291.14.1753 
  9. Andrews L, Silva SG, Kaplan S, Zimbro K. Delirium monitoring and patient outcomes in a general intensive care unit. American Journal of Critical Care. 2015;24(1):48-56. http://dx.doi.org/10.4037/ajcc2015740 
  10. Shim MY, Song SH, Lee M, Park MA, Yang EJ, Kim MS, et al. The effects of delirium prevention intervention on the delirium incidence among postoperative patients in a surgical intensive care unit. Journal of Korean Clinical Nursing Research. 2015;21(1):43-52. http://dx.doi.org/10.22650/JKCNR.2015.21.1.43 
  11. Barbateskovic M, Krauss SR, Collet MO, Larsen LK, Jakobsen JC, Perner A, et al. Pharmacological interventions for prevention and management of delirium in intensive care patients: a systematic overview of reviews and meta-analyses. British Medical Journal open. 2019;9(2):e024562. http://dx.doi.org/10.1136/bmjopen-2018-024562 
  12. Deng LX, Cao L, Zhang LN, Peng XB, Zhang L. Non-pharmacological interventions to reduce the incidence and duration of delirium in critically ill patients: a systematic review and network meta-analysis. Journal of Critical Care. 2020;60:241-8. https://doi.org/10.1016/j.jcrc.2020.08.019 
  13. Swan JT. Decreasing inappropriate unable-to-assess ratings for the confusion assessment method for the intensive care unit. American Journal of Critical Care. 2014;23(1):60-9. http://dx.doi.org/10.4037/ajcc2014567 
  14. Devlin JW, Fong JJ, Howard EP, Skrobik Y, McCoy N, Yasuda C, et al. Assessment of delirium in the intensive care unit: nursing practices and perceptions. American Journal of Critical Care. 2008;17(6):555-65. https://dx.doi.org/10.4037/ajcc2008.17.6.555 
  15. Gong KH, Ha YK, Gang IS. The perception of delirium, barriers, and importance of performing delirium assessment of ICU nurses utilizing the CAM-ICU. Journal of Korean Critical Care Nursing. 2015;8(2):33-42. 
  16. Park KO, Kim JK. A study on experience of transition from new clinical nurse to competent step. The Journal of Korean Academic Society of Nursing Education. 2013;19(4):594-605. https://doi.org/10.5977/jkasne.2013.19.4.594 
  17. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients. American Journal of Respiratory and Critical Care Medicine. 2002;166(10):1338-44. http://dx.doi.org/10.1164/rccm.2107138 
  18. Heo EY, Lee BJ, Hahm BJ, Song EH, Lee HA, Yoo CG, et al. Translation and validation of the Korean confusion assessment method for the intensive care unit. BioMed Central Psychiatry. 2011;11(1):94. http://dx.doi.org/10.1186/1471-244X-11-94 
  19. Kim J, Ahn JA. Risk factors for delirium in trauma intensive care unit patients. Korean Journal of Adult Nursing. 2020;32(6):623-31. http://dx.doi.org/kjan.2020.32.6.623  https://doi.org/10.7475/kjan.2020.32.6.623
  20. Noh EY, Park YH. Prevalence of delirium and risk factors in heart surgery patients in intensive care unit: a retrospective study. Korean Journal of Adult Nursing. 2019;31(2):146-55. http://dx.doi.org/10.7475/kjan.2019.31.2.146 
  21. Lee MJ, Yun SH, Choi KO, Seong SS, Lee SM, Kang JJ. Effects of delirium prevention interventions for neurocritical patients. Journal of Korean Academy of Fundamentals of Nursing. 2018;25(2):109-19. http://dx.doi.org/10.7739/jkafn.2018.25.2.109 
  22. Park SH, Kim HJ, Choi HY, You JE, Park JE, Kim EJ, et al. Factors related to motor subtypes of delirium patients in a surgical intensive care unit. Journal of Korean Clinical Nursing Research. 2020;26 (2):207-16. http://dx.doi.org/jkcnr.2020.26.2.207  https://doi.org/10.22650/JKCNR.2020.26.2.207
  23. Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility (ABCDE) bundle. Critical Care Medicine. 2014;42(5):1024-36. https://doi.org/10.1097/CCM.0000000000000129 
  24. Barnes-Daly MA, Phillips G, Fly EW. Improving hospital survival and reducing brain dysfunction at seven california community hospitals: implementing PAD guidelines via the ABCDEF bundle in 6,064 patients. Critical Care Medicine. 2017;45(2):171-8. https://doi.org/10.1097/CCM.0000000000002149 
  25. Kram SL, DiBartolo MC, Hinderer K, Jones RA. Implementation of the ABCDE bundle to improve patient outcomes in the intensive care unit in a rural community hospital. Dimensions of Critical Care Nursing. 2015;34(5):250-8. https://doi.org/110.1097/DCC.0000000000000129 
  26. Pun BT, Balas MC, Barnes-Daly MA, Thompson JL, Aldrich JM, Barr J, et al. Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults. Critical Care Medicine. 2019;47(1):3-14. https://doi.org/10.1097/CCM.0000000000003482 
  27. Song ES, Ahn S. Factors influencing discrepancy between objective and subjective delirium assessment in elderly patients in intensive care unit: patients and nurses' characteristics and delirium knowledge. Global Health and Nursing. 2018;8(2):70-81. https://doi.org/10.35144/ghn.2018.8.2.70 
  28. Collinsworth AW, Masica AL, Priest EL, Berryman CD, Kouznetsova M, Glorioso O, et al. Modifying the electronic health record to facilitate the implementation and evaluation of a bundled care program for intensive care unit delirium. The Journal for Electronic Health Data and Methods. 2014;2(1). https://doi.org/10.13063/2327-9214.1121