The Present Status And Influencing Factors Of Subsyndromal Delirium In ICU

Objective:1 A scoping review of the influencing factors of subsyndromal delirium in ICU was conducted,supplemented by the influencing factors of subsyndromal delirium in non-ICU populations and the influencing factors of delirium in ICU,provides a reference basis for the selection of influencing factor indicators in this study.2 To describe the incidence,characteristics and clinical outcome of subsyndromal delirium during the assessment of CAMICU and ICDSC,and to analyze the risk factors of ICU subsyndromal delirium and its further development into delirium,and provide a reference for the identification and preventive measures of high-risk patients with ICU subsyndromal delirium and subsyndromal delirium progressing to delirium.Method:1 The proposed indicators of influencing factors of subsyndromal delirium in ICU1.1 Scoping reviews of influencing factors of subsyndromal delirium in ICUBased on the scope review methodology proposed by Arksey and O’Malley,a comprehensive and systematic search is conducted on the influence factors of ICU subsyndromal delirium,so as to provide a scientific reference for the development of research indicators on the influencing factors of ICU subsyndromal delirium.1.2 Supplement of influencing factors of subsyndromal delirium in non ICU population and influencing factors of delirium in ICUIn order to avoid the situation that too few research indicators caused by insufficient investigation of subsyndromal delirium in ICU,this study also searched the influencing factors of non ICU subsyndromal delirium and ICU delirium,and then increase the screening indicators after group discussion to the influence factors in the questionnaire,in order to explore whether these indicators will also promote the occurrence of subsyndromal delirium in ICU.2 The present status and influencing factors of subsyndromal delirium and its progression to delirium in ICUThis cross sectional study enrolled patient who had admitted to General Intensive Care Unit and Cardiothoracic Intensive Care Unit of a tertiary hospital in Nanchong,Sichuan from March to November 2021 by Continuous sampling.The research tool used Confusion Assessment Method for the Intensive Care Unit(CAMICU)and Intensive Care Delirium Screening Checklist(ICDSC)to evaluate subsyndromal delirium,and used a self-designed sociodemographic data collection table,clinical disease data collection table and laboratory index collection table gathers relevant information.Taking the collected research indexes as independent variables,the outcome of subsyndromal delirium and its further development into delirium as the dependent variable,univariate analysis and multivariate logistic regression analysis were used to determine the risk factors of subsyndromal delirium in ICU and the risk factors of further development from subsyndromal delirium to delirium.Results:1 The proposed indicators of influencing factors of subsyndromal delirium in ICU1.1 Scoping review of influencing factors of subsyndromal delirium in ICU166 literatures was searched preliminarily by computer,and 12 studies related to the influencing factors of ICU subsyndromal delirium were finally included,and a total of 26 research indicators were extracted.1.2 Supplement of influencing factors of subsyndromal delirium in non ICU population and influencing factors of delirium in ICUIn this part,a total of 21 research indicators are supplemented by the search,collation and discussion of the influencing factors of subsyndromal delirium in non ICU population and delirium in ICU.Finally,four indicators were deleted after pre-experimental investigation,and two indicators with missing values≥20%were excluded in statistical analysis.Finally,a total of 41 research indicators were included in the statistical analysis.2 Present status of subsyndromal delirium in ICU2.1 The incidence of ICU subsyndromal delirium(1)When used CAMICU scale assessment,the incidence of subsyndromal delirium was 55.6%.(2)When used ICDSC scale assessment,the incidence of subsyndromal delirium was 55.0%.(3)This study combined CAMICU and ICDSC assessment,the incidence of subsyndromal delirium was 61.1%.2.2 Characteristics of subsyndromal delirium in ICU(1)The starting time and duration of subsyndromal delirium in ICU80.9%of subsyndromal delirium occurred within 1 to 3 days of the patient transfer to the ICU,and the median duration of subsyndromal delirium was 3(2,5)days,lasting up to 38 days.(2)Symptoms of subsyndromal delirium in ICUWhen assessed with CAMICU,the symptoms of subsyndromal delirium were:feature 1,acute mental status change was 48.5%;feature 2,inattention was 86.4%;feature 3,altered level of consciousness was 57.4%;feature 4,disorganized thinking was 81.6%.When assessed with ICDSC,the main manifestations of patients with subsyndromal delirium were:feature 1,altered level of consciousness was 41.6%;feature 2,inattention was 59.5%;feature 5,psychomotor agitation or retardation was 55.4%;feature 7,sleep/wake cycle disturbance was 61.3%;feature 8,symptom fluctuation was 53.5%.(3)The development of subsyndromal delirium into deliriumIn this study,489 cases of the subject investigated,a total of 79 cases of delirium occured,of which 50 cases progressed from subsyndromal delirium to delirium,3 cases progressed from SSD1 to delirium and 47 cases progressed from SSD2 to delirium.3 Influencing factors of subsyndromal delirium in ICU(1)Univariate analysis showed that there were statistically significant differences in age,educational level,diabetes,sepsis,cerebral infarction,classification of disease,APACHE II,CPOT,length of stay in ICU,length of mechanical ventilation,number of catheter,blood transfusion,restraint,hypotension,anemia,infection,electrolyte disturbance,metabolic acidosis,analgesia,sedative,albumin,plasma fibrinogen concentration,choline esterase,total bile acid between non-subsyndromal delirium and subsyndromal delirium group(P<0.05).(2)Logistic regression analysis showed that age(P=0.001,OR=1.058),APACHE Ⅱ(P=0.002,OR=1.188),CPOT(P=0.000,OR=3.822),number of catheter(P=0.006,OR=1.533),blood transfusion(P=0.01,OR=3.260),infection(P=0.025,OR=3.366),electrolyte disturbance(P=0.001,OR=6.654)were independent risk factors for ICU subsyndromal delirium.4 Influencing factors of subsyndromal delirium progressed to delirium in ICU(1)Univariate analysis showed that there were statistically significant differences in age,marital status,surgery history in latest week,cerebral infarction,type of admission,classification of disease,APACHE II,CPOT,length of stay in ICU,length of mechanical ventilation,number of catheter,blood transfusion,restraint,analgesia,sedative,blood chloride,albumin and choline esterase between subsyndromal delirium and subsyndromal delirium progressed to delirium group(P<0.05).(2)Logistic regression analysis showed that CPOT(P=0.006,OR=1.645)and number of catheter(P=0.034,OR=1.294)were independent risk factors of subsyndromal delirium progressed to delirium in ICU.Conclusion:1 The incidence of ICU subsyndromal delirium is high.When combined use of CAMICU and ICDSC to evaluate and increase the frequency of investigations can improve the recognition of subsyndromal delirium.2 Subsyndromal delirium occurs mainly within the 1 to 3 days of a patient’s admission to the ICU.3 Subsyndromal delirium in ICU can progress to delirium,especially in SSD2.4 Elderly,high APACHE Ⅱ score,high CPOT score,large number of catheter,blood transfusion,infection,electrolyte disturbance are high risk factors of subsyndromal delirium in ICU.5 High CPOT score and large number of catheter are high risk factors of subsyndromal delirium progressed to delirium in ICU.