The Present Status And Influencing Factors Of ICU Delirium In Patients After Cardiac Surgery

ObjectivesTo describe the incidence of ICU delirium in patients after cardiac surgery and analyze the influencing factors to provide reference for clinical nurses to identify high-risk patients and formulate preventive measures.MethodsA cross-sectional descriptive design was used in this study.Two hundred and twenty-one patients transferred to ICU after cardiac surgery were recruited in a tertiary class A general hospital from May 2020 to April 2021.Delirium was assessed by Confusion Assessment Method for Intensive Care Unit(CAM-ICU),and other data were collected using self-designed general information questionnaire,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ),Critical-Care Pain Observation Tool(CPOT),Hospital Anxiety and Depression Scale(HADS),and Perceived Social Support Scale(PSSS).SPSS 22.0 software was used for data statistical analyses.The descriptive analysis was used to describe the present situation of ICU delirium in patients after cardiac surgery.Independent sample T test and Chi-square analysis were used to compare the incidence of ICU delirium in patients with different general information,physiological,psychological and social factors after cardiac surgery.Logistic regression analysis was conducted to explore the influencing factors of ICU delirium after cardiac surgery.ROC curve was used to calculate the area under the curve and the optimal cut-off value of each influencing factor.Results1.A total of 221 subjects were included in this study,ICU delirium occurred in 49 patients(22.17%).The cases of hypoactive type were 21(42.9%),hyperactive type were 11(22.4%),and mixed type were 17(34.7%).The duration of delirium ranged from 12 to 97 hours,with an average of(43.29±22.43)hours.2.Univariate analysis showed that patients with longer operation time(t=2.564,P<0.05),a higher lactic acid level(t=6.542,P<0.001)and using hypoglycemic drugs(χ2=10.983,P<0.01)had higher incidence of ICU delirium in general information.In physiological factors,patients with higher scores for APACHE Ⅱ(t=5.767,P<0.001)and pain(t=8.034,P<0.001)were more likely to develop ICU delirium.In psychological factors,patients with higher scores for anxiety(t=-7.049,P<0.001)and depression(t=-4.285,P<0.001)were more likely to develop ICU delirium.In social factors,patients with a lower score for social support had a higher incidence of ICU delirium(t=7.059,P<0.001).3.The results of Logistic regression analysis showed that postoperative lactic acid value(OR=3.128,P=0.001),the use of hypoglycemic drugs(OR=7.225,P=0.027)in general information,APACHE Ⅱ(OR=1.325,P=0.022),CPOT score(OR=3.898,P=0.000)in physiological factors,scores for anxiety(OR=1.671,P=0.004)and depression(OR=1.220,P=0.045)in psychological factors,and PSSS scores(OR=0.923,P=0.001)among social factors were influencing factors for ICU delirium after cardiac surgery.4.ROC curve analysis results showed that the area under the curve of the prediction model was 0.991,the sensitivity was 0.980,and the specificity was 0.895.The areas under the curve of postoperative lactic acid level,the use of hypoglycemic drugs,APACHE Ⅱ,pain score,anxiety score,depression score,and social support score were 0.807,0.623,0.752,0.827,0.813,0.698 and 0.780 respectively.The best truncation values of postoperative lactic acid level,APACHE Ⅱ,pain score,anxiety score,depression score and social support score were 4.05,23,3,7,8,37.Conclusions1.The incidence of ICU delirium in patients after cardiac surgery was high,and the manifestations of delirium are complex and varied.2.Elevated lactate level and use of hypoglycemic drugs are risk factors for ICU delirium in patients after cardiac surgery.3.The incidence of ICU delirium after cardiac surgery is related to the severity of the disease and the degree of pain.The more serious the disease and the pain are,the higher the incidence of ICU delirium.4.The incidence of ICU delirium in patients after cardiac surgery is related to the degree of anxiety and depression.The more severe of anxiety and depression,the higher the incidence of ICU delirium.5.The incidence of ICU delirium in patients after cardiac surgery is related to the level of social support of patients,which is a protective factor for the incidence of delirium.6.ICU delirium prediction model of patients after cardiac surgery have a certain predictive value,which can facilitate clinical staff to take targeted measures to reduce the incidence of delirium in patients after cardiac surgery.