The Study Of The PAD Care Bundle For Preventing Delirium In Mechanically Ventilated Patients

1、Applying the PAD care bundle to critical nursing care to reduce the incidence of delirium and shorten the duration of delirium in patients with mechanical ventilation;2、By lowering the incidence of delirium and shortening the duration of delirium,to improve the clinical outcomes of patients with mechanical ventilation, such as shortening the mechanical ventilation time, shortening ICU length of stay and reducing the mortality within 28-day ICU stay.MethodsThe study was a randomized controlled trial. From March 2013 to June 2014,one hundred and eighty patients with mechanical ventilation who were admitted in intensive care unit in our hospital were randomly divided into two groups. The result was made by the computer. The control group received usual care. The intervention group received the PAD bundle, including pain monitoring and management, daily awakening and lightly sedation, early mobility, sleep promoting and delirium monitoring and management. The data of this study were collected by Numeric Rating Scale, Critical-Care Pain Observation Tool, Richmond Agitation and Sedation Scale, Confusion Assessment Method for the ICU, Richards Campbell Sleep Questionnaire. The incidence and duration of delirium, the dose of sedatives, the dose of analgesic drugs, ventilator time, ICU LOS and the 28-day ICU mortality were compared between the two groups. Statistical analysis was used the SPSS17.0.Clinical outcomes were presented as means(SD) for continuous variables and frequencies and percentages for categorical variables. Independent sample t test or nonparametric Mann-Whitney test was used to compare continuous variables between groups. For categorical variables, Chi-square test or Fisher exact test was used.ResultsCompared with the control group(n=72), we detected that the incidence of delirium in the intervention group(n=76) was significantly lower(47.2% vs. 28.9%;P=0.022). Compared with the control group, we found that the duration of delirium inthe intervention group was significantly shorter(2.68±1.21 vs 3.82±1.60, d). In the intervention group, the total dose of sedatives(244.67±122.39 vs 360.35±125.51, mg)and the mean dose of sedatives(0.048±0.015 vs 0.061±0.008, mg/kg.h) reduced markedly. The total dose of morphine(32.45 ± 17.91 vs 25.55 ±15.08, mg) and fentanyl(0.91±0.77 vs 0.71±0.64, mg) were more than the control group, but there was no significant difference between the two groups. Compared with the control group, we found that the scores of quality of sleep in the intervention group was significantly highter(55.78±18.51 vs 52.16±17.56). The ventilator time(155.22±53.88 vs 179.68±67.29, h) and ICU length of stay(8.50±3.35 vs 10.31±3.56, d) in the intervention group were significantly shorter than those of the control group.There was no significant difference in the 28-day ICU mortality between the two groups(19.7% vs 25.0%).Conclusions1 、 Mechanically ventilated patients managed with PAD bundle had lower incidence of delirium and shorter duration of delirium than those received usual care.2 、 Mechanically ventilated patients managed with PAD bundle had shorter ventilator time and ICU LOS than those received usual care.3、The PAD bundle was better than the usual nursing care and it was significant for improve the quality of nursing.