Study On Risk Factors Of Delirium In Critically Ill Patients Undergoing Mechanical Ventilation

Intensive Care Unit(ICU)is the most common place for patients with Severe Mechanical Ventilation.The most common complication is acute cerebral dysfunction with delirium as the main clinical manifestation,the main manifestations are the decrease of consciousness clarity,agitation,visual hallucination,thinking disorder,orientation and memory disorder.Delirium occurs in many ways,including potential factors or predisposing factors and predisposing factors,which interact and influence each other to promote the occurrence and development of delirium.After delirium occurs in ICU,patients will be unable to cooperate with treatment,unanticipated extubation,catheter loss,increased risk of adverse hospitalization events,increased disease severity,increased mortality rate,increased medical costs,and even prolonged hospitalization,it can also lead to long-term cognitive impairment.Therefore,the screening of risk factors of delirium in critically ill patients is conducive to early prevention,early intervention,improve the quality of life in critically ill patients and prognosis.Chronic obstructive pulmonary disease(COPD)and severe trauma are common types of critical illness in ICU.Chronic obstructive pulmonary disease(COPD)is a chronic inflammatory disease characterized by restricted airflow.Patients with COPD often have hypoxemia and carbon dioxide retention,disturbance of internal environment,resulting in impaired brain function and even various types of cognitive dysfunction,such as delirium.The study shows that COPD is the main risk factor of delirium,which often occurs in Acute exacerbation of COPD(AECOPD),and the occurrence of delirium can lead to the exacerbation of cognitive dysfunction in stable period of COPD,prolong the time of mechanical ventilation and ICU stay,and increase the mortality rate.However,there are few reports of analysis of risk factors for delirium in patients with AECOPD undergoing mechanical ventilation.Surgical delirium is typically studied postoperatively,and is influenced by the type and duration of surgery,the requirements and duration of postoperative intensive care management,age,and all preoperative conditions.In general,the more factors present or the longer the duration,the higher the risk of postoperative delirium.The older the patient,the longer the duration of surgery or ventilation,and the longer the history,the higher the likelihood of postoperative delirium.The incidence of delirium was higher in critically ill patients with trauma,ranging from 11.4 % to 55%.The incidence of postoperative delirium in elderly patients with trauma was significantly higher than that in young patients.Although there are many studies on postoperative delirium in critically ill patients with trauma,there are still many problems that need to be further explored due to the differences in population and research methods.The purpose of this study was to investigate the risk factors of delirium in critical patients with AECOPD and severe trauma after mechanical ventilation,and to identify,predict and intervene acute cerebral dysfunction in patients with mechanical ventilation in critical illness,to improve the quality of life,shorten the length of stay and improve the prognosis of critical illness patients with mechanical ventilation to provide clinical evidence and experience.Part One Study on risk factors of delirium in patients with AECOPD undergoing mechanical ventilationObjective: To observe the risk factors of delirium in AECOPD patients with mechanical ventilation.Methods: A total of 653 patients with AECOPD with mechanical ventilation in our hospital from March 1,2009 to December 1,2019 were selected for retrospective analysis.The criteria for admission were patients with AECOPD who were older than 18 years of age,had been in the ICU for less than 24 h and were successfully transferred from the ICU.The patients were divided into delirium group and non-delirium group according to the CAM-ICU score.General Information(including age,sex,underlying disease,smoking,alcohol history,etc.),Glasgow Coma scale(GCS),RASS score,Apache II score,type of sedative,use of vasoactive agents,blood gas analysis,and duration of mechanical ventilation were recorded for all patients.Univariate and multivariate Logistic stepwise regression analysis was used.Results: A total of 653 patients with AECOPD underwent mechanical ventilation.Delirium occurred in 103 of them.The incidence of delirium was15.8%.There were significant differences in age,History of drinking,renal function and cerebrovascular disease between delirium Group and Non-delirium Group(P<0.05).Univariate logistic regression analysis showed that Age [odds ratio(OR)3.14(1.89-5.21)],smoking,history of cardiovascular disease [OR1.63(1.04-2.54)],cerebrovascular disease history [OR8.13(5.14-12.84)],time of mechanical ventilation [OR6.77(1.63-28.09)],History of drinking [OR2.35(1.48-3.72)],stage 1 AKI [OR2.50(1.36-4I.60)],stage 2[OR3.39(1.81-6.37)and stage 3 [OR5.29(2.82-9.93)] were correlated with ICUD.Multivariate logistic regression analysis showed that old Age(>60 y)[OR5.27(2.79-9.96)],smoking [OR5.61(2.55-12.36)],History of drinking[OR2.25(1.23-4.11)],history of cerebrovascular disease [OR10.17(5.69-18.17)],stage 3 AKI [OR3.86(1.78-8.38)] were independent risk factors for delirium in AECOPD patients undergoing mechanical ventilation.Conclusions: The incidence of delirium in patients with AECOPD under mechanical ventilation was 15.8%.Old age(>60 y),smoking,drinking,cerebrovascular disease,stage 3 AKI were independent risk factors for delirium in AECOPD under mechanical ventilation.Part Two Study on risk factors of delirium in MV patients after severe trauma surgeryObjective: To explore the risk factors of postoperative delirium in critical patients undergoing emergency surgery for severe trauma.Methods: 120 critical trauma patients who were admitted to ICU from October 2016 to October 2020 and needed mechanical ventilation were selected.A retrospective study was conducted to analyze the incidence and risk factors of postoperative delirium.INCLUSION CRITERIA: Age >18Years Old,duration of stay in ICU? 24 h,patients successfully transferred out of ICU,all patients were mechanically ventilated upon admission to ICU,all patients underwent emergency surgery.The patients were divided into delirium group and non-delirium group according to the CAM-ICU evaluation,the general data(Age,sex,basic disease,smoking history,drinking history),operation time,intraoperative blood loss,intraoperative fluid transfusion and volume of transfusion,blood transfusion,intraoperative urine volume/hour,types of analgesics,application of vasoactive drugs in ICU,vital signs(pulse,blood pressure,aspiration,body temperature),Apache II score,liver and renal function,electrolytes,c-reactive protein,blood gas analysis,blood lactic acid,duration of mechanical ventilation,duration of stay in ICU and duration of delirium in ICU were collected.The application of single-factor and multi-factor Logistics stepwise regression analysis.Results: A total of 120 cases were included,37 cases appeared delirium,the incidence rate of delirium was 30.83 %.Delirium occurred in 30 patients(81.08 %)within 3 days after admission to ICU,and in a few patients after 1week.Univariate Logistic regression analysis showed that MAP at admission(<70mm Hg)[OR4.29(1.83-10.08)],blood loss during operation[OR2.51(1.11-5.67)],blood transfusion(>1000ml)[OR2.50(1.09-5.76)],blood lactic acid(> 2mmol/L)[OR3.04(1.28-7.22)],hemoglobin at admission to ICU(<80g/L)[OR5.01(1.92-13.06)],MAP at admission to ICU(<70 mm Hg)[OR3.47(1.24-9.71)],duration of mechanical ventilation [OR4.03(1.65-9.89)] and stay in ICU [OR4.03(1.65-9.89)] were correlated with postoperative delirium.Multiple logistic regression analysis showed that the increase of blood lactic acid(>2 mmol/L)[OR 4.40(1.49-13.02)],decrease of hemoglobin(<80 g/L)[ OR6.04(1.78-20.55)],decrease of MAP(<70 mm Hg)on admission to ICU [OR5.97(1.47-24.24)],prolonged ICU stay(>5 d)[ OR3.46(1.25-9.59)] were independent risk factors for postoperative delirium in critical patients undergoing emergency surgery for Severe Trauma.Conclusion: The incidence of delirium in critically ill patients undergoing emergency surgery for severe trauma is relatively high(30.83 %).The increase of blood lactic acid(>2 mmol/L),decrease of hemoglobin(<80 g/L)and decrease of MAP(< 70 mm Hg)on admission to ICU,prolonged ICU stay(>5d)were independent risk factors for postoperative delirium in critical patients undergoing emergency surgery for severe trauma.