The Duration Of ICU Delirium And Its Influencing Factors Analysis

Background: ICU delirium is an acute dysfunction of the central nervous system caused by a series of simulations in the intensive care unit.Although the influencing factors of the occurrence of delirium has been described by some researchers and some preventive measures have done,the incidence of ICU delirium is still about 35-80% and lead to a series of bad outcomes for the patients.The harms of delirium has a positive correlation with the duration of delirium.But only few researches describe the duration of delirium and its influencing factors is unknown both abroad and domestic.So we intended to describe the duration of delirium and its related factors in this research.Objective: To describe the actuality of ICU delirium duration and to analysis its influencing factors.Methods: We studied the patients who were delirium positive from April 2016 to December 2016 in the Intensive Care Unit in Peking Union Medical College Hospital.We collected the general information and the clinical information including mechanical ventilation,usage of sedation,analgesia and antipsychotics,hypoxia,infection,internal environment and the types of delirium after the patients occurred delirium for the first time.We also record the management of the delirium patients until the resolution of delirium or the patients discharge from ICU.We analysis the data by Kaplan-Meier single factor analysis and Cox multiple-factors analysis.Results:(1)We assessed 870 patients in total from April 2016 to December 2016 and screened 77 delirium patients.The incidence of delirium in intensive care unit of PUMC is 8.9%.The range of the ages of delirium patients is 32-83,the average is 61.81 ± 12,84.The average duration of ICU delirium is(5.06 ± 4.59)days.The median duration of ICU delirium is 4 days.The range of delirium in ICU is from(1-21)days.The overall delirium score is steady,from 4.06-4.46 in the first five days after the occurrence of delirium.(2)The single factors analysis shows that age,APACHE II score,type A of delirium(sedation-related delirium or persistent delirium),type B of delirium(hypoactive delirium,hyperactive delirium or mixed delirium),duration of mechanical ventilation,internal environment disturbance,hypoxia,infection,usage of antipsychotics and the complement of ABCDEF bundle have inter-group differences.(3)The COX analysis shows that APACHE II score(x2=4.670,P=0.031),persistent delirium or not(x2=5.801,P=0.016),the duration of hypoxia(x2=14.438,P<0.001),and the durationof the usage of antipsychotics(x2=13.360,P<0.001)are the influencing factors of delirium duration.Conclusions: The incidence is 8.9% of delirium in intensive care unit.The mean duration of delirium is(5.06 ± 4.09)days.Duration of delirium is related to APACHE ?score,type A of delirium,duration of hypoxia and using of psychotics.Medical workers should pay more attention to the patients who are seriously ill,have persistent delirium or hypoxia.We also should be in caution when using psychotics to decrease the duration of delirium and to improve outcomes of the patients.