Analysis Of Risk Factors For Delirium In Adult General Intensive Care Unit Patients

Objective: 1.To investigate the current status of delirium in adult general ICU patients.2.To analyze the risk factors of delirium in adult general ICU patients,and to provide reference for the formulation of delirium prevention and treatment strategies.Methods:A descriptive study design was adopted to select 462 patients who met the inclusion and exclusion criteria in ICU of the First Hospital of China Medical University from November 2019 to June 2020 by continuous sampling method.The Self-designed delirium related factors questionnaire,Richmond agitation-sedation score,and the confusion assessment method for the ICU were used as research tools.To investigate the current status of delirium in adult general ICU patients.Using clinical indicators as independent variables and whether delirium occurred as dependent variable,univariate analysis and multivariate Logistic regression analysis were conducted to determine the independent risk factors for delirium in adult general ICU patients.Results: 1.Among the 462 patients in this study,156 patients developed delirium,and the incidence of delirium was 33.77%.Among the 156 patients with delirium,16 patients developed hyperactive delirium(10.26%),74 patients developed hypoactive delirium(47.44%),and 66 patients developed mixed delirium(42.30%).2.Unifactor analysis results showed that age 65 or above,APACHEⅡ score ≥15 points,emergency,use of vasopressors,sepsis,shock,acidosis,blood transfusion,hypernatremia,hyperkalaemia,hemoglobin≤90g/L,urea nitrogen ≥9mmol/L,creatinine ≥178 μmol/L,total bilirubin≥34.2 μmol/L,the duration length of mechanical ventilation,sedation with midazolam,and need for combined sedation were statistically significant different between the delirium group and the non-delirium group(P < 0.05).3.Multivariate Logistic regression showed that age 65 or above was a risk factor for delirium,(OR=3.667,95%CI[2.305～6.606]),shock was a risk factor for delirium(OR=2.284,95%CI[1.187～4.397]),hemoglobin ≤90g/L was a risk factor for delirium(OR=1.719,95%CI[1.070～2.761]),total bilirubin ≥34.2μmol/L was a risk factor for delirium(OR=1.911,95%CI[1.045～3.494]),the use of vasopressors was a risk factor for delirium(OR = 1.894,95%CI[1.136～3.158]),duration of mechanical ventilation was a risk factor for delirium(OR =1.011,95%CI[1.005～1.018]),sedation with midazolam was a risk factor for delirium(OR= 6.190,95%CI[1.359～28.186]),need for combined sedatives was a risk factor for delirium(OR = 1.862,95%CI[1.077～3.219]),and APACHEⅡ score ≥15 points was a risk factor for delirium,(OR= 2.328,95%CI[1.424 ～ 3.806]),According to the results of logistic regression analysis,the risk prediction model of delirium was established.The AUC of the prediction model was 83.3%(P < 0.001)which indicated that the prediction efficiency of the model was good.Conclusion: 1.The incidence of delirium in adult general ICU patients is high.2.Age 65 or above,shock,the use of vasopressors,hemoglobin≤90g/L,total bilirubin ≥34.2μmol/L,duration of mechanical ventilation,sedation with midazolam,the need for combined sedatives,and APACHEⅡ ≥15 points are risk factors for delirium.ICU medical staff should pay more attention to delirium to identify the high risk group of delirium,and take corresponding intervention measures to prevent the occurrence of delirium,shorten the duration of delirium and improve the prognosis of patients with delirium.