Incidence and risk factors of delirium in ICU patients

Chuanqin WU; Yanping ZHU; Guohong LI

doi:10.16016/j.1000-5404.201801018

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Incidence and risk factors of delirium in ICU patients

更新时间：2026-01-09

- Incidence and risk factors of delirium in ICU patients
- Journal of Third Military Medical University Vol. 40, Issue 11, Pages: 1038-1043(2018)
- 作者机构：
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201801018
  CLC：
- Received：03 January 2018，
  
  Published：15 June 2018
- 稿件说明：
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Chuanqin WU, Yanping ZHU, Guohong LI. Incidence and risk factors of delirium in ICU patients[J]. Journal of Third Military Medical University, 2018, 40(11): 1038-1043.
DOI：

Chuanqin WU, Yanping ZHU, Guohong LI. Incidence and risk factors of delirium in ICU patients[J]. Journal of Third Military Medical University, 2018, 40(11): 1038-1043. DOI： 10.16016/j.1000-5404.201801018.

摘要

Abstract

Objective

To explore the incidence and related risk factors of delirium in ICU patients.

Methods

A total of 318 patients hospitalized in comprehensive ICU from Zhongda Hospital during March and September 2016 were enrolled in this study. Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) was used to evaluate whether a delirium occurred in the ICU patients every 8 h. Logistic regression analysis was employed to screen the related risk factors for delirium.

Results

There were 86 patients not being evaluated with CAM-ICU due to coma. In the remaining 232 ICU patients

95 cases experienced delirium

with an incidence rate of 40.9%

and 48 cases (50.5%) patients had delirium for the first time within 3 days after admission. There were 24 cases having excited type of delirium (25.5%)

25 cases with depression type (26.6%)

and 45 cases with mixed type (47.9%). Logistic regression analysis showed that older than 65 years

higher APACHE Ⅱ score

ICU admission due to trauma

drinking history

history of hypertension

metabolic acidosis

respiratory diseases

use of midazolam and mechanical ventilation were independent risk factors for delirium (

0.05).

Conclusion

The incidence of delirium in ICU is quite high. Patients older than 65 years

with high APACHEⅡ score

ICU admission for trauma

history of alcohol and hypertension

metabolic acidosis

and respiratory disease

may be prone to delirium after receiving midazolam and mechanical ventilation treatment.

关键词

Keywords

references

SHEHABI Y RIKER R R BOKESCH P M Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients Crit Care Med 2010 38 12 2311 2318 10.1097/CCM.0b013e3181f85759 http://cn.bing.com/academic/profile?id=b688d8f8b5910b464a6b281bb675498b&encoded=0&v=paper_preview&mkt=zh-cn SHEHABI Y, RIKER R R, BOKESCH P M, et al . Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients[J ] . Crit Care Med, 2010, 38(12):2311-2318. DOI:10.1097/CCM.0b013e3181f85759.

BARR J FRASER G L PUNTILLO K Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit Crit Care Med 2013 41 1 263 306 10.1097/CCM.0b013e3182783b72 http://www.learnicu.org/SiteCollectionDocuments/Pain,%20Agitation,%20Delirium.pdf BARR J, FRASER G L, PUNTILLO K, et al . Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit[J ] .Crit Care Med, 2013, 41(1): 263-306. DOI:10.1097/CCM.0b013e318 2783b72.

YOUNG J MURTHY L WESTBY M Diagnosis, prevention, and management of delirium: summary of NICE guidance BMJ 2010 341 c3704 10.1136/bmj.c3704 http://cn.bing.com/academic/profile?id=792270c6e52b57fb162991b050daee93&encoded=0&v=paper_preview&mkt=zh-cn YOUNG J, MURTHY L, WESTBY M, et al . Diagnosis, prevention, and management of delirium: summary of NICE guidance[J ] . BMJ, 2010, 341: c3704.DOI:10.1136/bmj.c3704.

郑春艳张欢欢杨玉金重症监护病房患者发生谵妄危险因素的Meta分析实用临床医学 2017 18 7 74 83 10.13764/j.cnki.lcsy.2017.07.028 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=lcsy201707028&dbname=CJFD&dbcode=CJFQ 郑春艳, 张欢欢, 杨玉金, 等.重症监护病房患者发生谵妄危险因素的Meta分析[J].实用临床医学, 2017, 18(7):74-83.DOI: 10.13764/j.cnki.lcsy.2017.07.028.

ZHENG C Y ZHANG H H YANG Y J Risk factors for delirium in intensive care unit patients:a Meta-analysis Pract Clin Med 2017 18 7 74 83 10.13764/j.cnki.lcsy.2017.07.028 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=lcsy201707028&dbname=CJFD&dbcode=CJFQ ZHENG C Y, ZHANG H H, YANG Y J, et al . Risk factors for delirium in intensive care unit patients:a Meta-analysis[J ] . Pract Clin Med, 2017, 18(7): 74-83. DOI: 10.13764/j.cnki.lcsy.2017.07.028.

冯传江姚琴琴欧丹丹危重患者谵妄发生的危险因素分析临床麻醉学杂志 2016 32 7 672 675 http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcmzxzz201607016 冯传江, 姚琴琴, 欧丹丹, 等.危重患者谵妄发生的危险因素分析[J].临床麻醉学杂志, 2016, 32(7):672-675.

FENG C J YAO Q Q OU D D Analysis of risk factors of delirium in critically ill patients J Clin Anesthesiol 2016 32 7 672 675 http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcmzxzz201607016 FENG C J, YAO Q Q, OU D D, et al . Analysis of risk factors of delirium in critically ill patients[J ] . J Clin Anesthesiol, 2016, 32(7): 672-675.

黄洁肖倩吴瑛 ICU谵妄危险因素的Meta分析中华护理杂志 2010 45 1 6 9 10.3761/j.issn.0254-1769.2010.01.002 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=zhhl201001004&dbname=CJFD&dbcode=CJFQ 黄洁, 肖倩, 吴瑛, 等.ICU谵妄危险因素的Meta分析[J].中华护理杂志, 2010, 45(1):6-9.DOI: 10.3761/j.issn.0254-1769.2010.01.002.

HUANG J XIAO Q WU Y A Meta-analysis of the risk factors of delirium in ICU Chin J Nurs 2010 45 1 6 9 10.3761/j.issn.0254-1769.2010.01.002 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=zhhl201001004&dbname=CJFD&dbcode=CJFQ HUANG J, XIAO Q, WU Y, et al . A Meta-analysis of the risk factors of delirium in ICU[J ] . Chin J Nurs, 2010, 45(1): 6-9. DOI: 10.3761/j.issn.0254-1769.2010.01.002.

WANG C WU Y YUE P et a1 Delirium assessment using confusion assessment method for the intensive care unit in Chinese critically ill patients J Crit Care 2013 28 3 223 229 10.1016/j.jcrc.2012.10.004 https://www.deepdyve.com/lp/elsevier/delirium-assessment-using-confusion-assessment-method-for-the-Xfh1i5R5Pd WANG C, WU Y, YUE P, et a1.Delirium assessment using confusion assessment method for the intensive care unit in Chinese critically ill patients[J]. J Crit Care, 2013, 28(3):223-229.DOI: 10.1016/j.jcrc.2012.10.004.

ZAAL I J DEVLIN J W PEELEN L M A systematic review of risk factors for delirium in the ICU Crit Care Med 2015 43 1 40 47 10.1097/CCM.0000000000000625 https://www.researchgate.net/publication/266085599_A_Systematic_Review_of_Risk_Factors_for_Delirium_in_the_ICU ZAAL I J, DEVLIN J W, PEELEN L M, et al .A systematic review of risk factors for delirium in the ICU[J ] .Crit Care Med, 2015, 43(1):40-47.

WASSENAAR A VAN DEN BOOGAARD M UNDERPIN-ICU STUDY GROUP Determination of the feasibility of a multicomponent intervention program to prevent delirium in the Intensive Care Unit: A modified RAND Delphi study Aust Crit Care 2017 30 6 321 327 10.1016/j.aucc.2016.12.004 http://cn.bing.com/academic/profile?id=2c3cc03a569f0d67201f7b0ad2b7d972&encoded=0&v=paper_preview&mkt=zh-cn WASSENAAR A, VAN DEN BOOGAARD M, UNDERPIN-ICU STUDY GROUP, et al . Determination of the feasibility of a multicompone nt intervention program to prevent delirium in the Intensive Care Unit: A modified RAND Delphi study[J ] . Aust Crit Care, 2017, 30(6):321-327.DOI:10.1016/j.aucc.2016.12.004.

WASSENAAR A VAN DEN BOOGAARD M VAN ACHTERBERG T Multinational development and validation of an early prediction model for delrium in ICU patients Intensive Care Med 2015 41 6 1048 1056 10.1007/s00134-015-3777-2 https://link.springer.com/article/10.1007%2Fs00134-015-3777-2 WASSENAAR A, VAN DEN BOOGAARD M, VAN ACHTERBERG T, et al . Multinational development and validation of an early prediction model for delrium in ICU patients[J ] . Intensive Care Med, 2015, 41(6):1048-1056. DOI:10.1007/s00134-015-3777-2.

KANOVA M SKLIENKA P ROMAN K Incidence and risk factors for delirium development in ICU patients-a prospective observational study Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017 161 2 187 196 10.5507/bp.2017.004 http://biomed.papers.upol.cz/pdfs/bio/2017/02/10.pdf KANOVA M, SKLIENKA P, ROMAN K, et al . Incidence and risk factors for delirium development in ICU patients-a prospective observational study[J ] .Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2017, 161(2):187-196. DOI:10.5507/bp.2017.004.

薛珲胡友斌李书清重症监护病房谵妄危险因素分析中国全科医学 2011 14 27 3094 3097 10.3969/j.issn.1007-9572.2011.27.011 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=qkyx201127016&dbname=CJFD&dbcode=CJFQ 薛珲, 胡友斌, 李书清, 等.重症监护病房谵妄危险因素分析[J].中国全科医学, 2011, 14(27):3094-3097.DOI: 10.3969/j.issn.1007-9572.2011.27.011.

XUE H HU Y B LI S Q Risk factors of delirium in ICU Chin Gen Pract 2011 14 27 3094 3097 10.3969/j.issn.1007-9572.2011.27.011 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=qkyx201127016&dbname=CJFD&dbcode=CJFQ XUE H, HU Y B, LI S Q, et al . Risk factors of delirium in ICU[J ] . Chin Gen Pract, 2011, 14(27):3094-3097. DOI: 10.3969/j.issn.1007-9572.2011.27.011.

VAN ROMPAEY B ELSEVIERS M M SCHUURMANS M J Risk factors for delirium in intensive care patients: a prospective cohort study Crit Care 2009 13 3 R77 10.1186/cc7892 http://cn.bing.com/academic/profile?id=6ba3be2927bf77ca39827c2c327c7eba&encoded=0&v=paper_preview&mkt=zh-cn VAN ROMPAEY B, ELSEVIERS M M, SCHUURMANS M J, et al . Risk factors for delirium in intensive care patients: a prospective cohort study[J ] . Crit Care, 2009, 13(3):R77.DOI:10.1186/cc7892.

黄洁骨科术后机械通气患者ICU谵妄发生率及危险因素调查护理学杂志 2015 30 18 32 34 10.3870/hlxzz.2015.18.032 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=hlxz201518011&dbname=CJFD&dbcode=CJFQ 黄洁.骨科术后机械通气患者ICU谵妄发生率及危险因素调查[J].护理学杂志, 2015, 30(18):32-34. DOI:10.3870/hlxzz.2015.18.032.

HUANG J Prevalence and risk factors of ICU delirium in mechanically ventilated orthopedic patients J Nurs Sci 2015 30 18 32 34 10.3870/hlxzz.2015.18.032 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=hlxz201518011&dbname=CJFD&dbcode=CJFQ HUANG J. Prevalence and risk factors of ICU delirium in mechanically ventilated orthopedic patients[J]. J Nurs Sci, 2015, 30(18): 32-34. DOI:10.3870/hlxzz.2015.18.032.

刘春峰姚炳荣徐爱明 APACHEⅡ评分预测ICU有创机械通气患者谵妄的应用研究中华临床医师杂志(电子版) 2015 9 8 1344 1347 10.3877/cma.j.issn.1674-0785.2015.08.015 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=zlyd201508015&dbname=CJFD&dbcode=CJFQ 刘春峰, 姚炳荣, 徐爱明, 等.APACHEⅡ评分预测ICU有创机械通气患者谵妄的应用研究[J].中华临床医师杂志(电子版), 2015, 9(8):1344-1347.DOI: 10.3877/cma.j.issn.1674-0785.2015.08.015.

LIU C F YAO B R XU A M Research on APACHE Ⅱ scores predicting delirium incidence of patients receiving invasive mechanical ventilation in ICU Chin J Clin (electronic edition) 2015 9 8 1344 1347 10.3877/cma.j.issn.1674-0785.2015.08.015 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=zlyd201508015&dbname=CJFD&dbcode=CJFQ LIU C F, YAO B R, XU A M, et al . Research on APACHE Ⅱ scores predicting delirium incidence of patients receiving invasive mechanical ventilation in ICU[J ] . Chin J Clin (electronic edition), 2015, 9(8):1344-1347.DOI:10.3877/cma.j.issn.1674-0785.2015.08.015.

裴兴华于海明吴艳红 APACHEⅡ评分与老年重症肺炎需有创机械通气患者谵妄发生的关系中华危重病急救医学 2017 29 9 821 824 10.3760/cma.j.issn.2095-4352.2017.09.011 http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgwzbjjyx201709014 裴兴华, 于海明, 吴艳红, 等. APACHEⅡ评分与老年重症肺炎需有创机械通气患者谵妄发生的关系[J].中华危重病急救医学, 2017, 29(9):821-824.DOI: 10.3760/cma.j.issn.2095-4352.2017.09.011.

PEI X H YU H M WU Y H Correlation between APACHEⅡ scores and delirium probability of senile severe pneumonia patients undergoing invasive mechanical ventilation Chin Critical Care Med 2017 29 9 821 824 10.3760/cma.j.issn.2095-4352.2017.09.011 http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgwzbjjyx201709014 PEI X H, YU H M, WU Y H, et al . Correlation between APACHEⅡ scores and delirium probability of senile severe pneumonia patients undergoing invasive mechanical ventilation[J ] . Chin Critical Care Med, 2017, 29(9): 821-824. DOI: 10.3760/cma.j.issn.2095-4352.2017.09.011.

FONG T G JONES R N SHI P Delirium accelerates cognitive decline in Alzheimer disease Neurology 2009 72 18 1570 1575 10.1212/WNL.0b013e3181a4129a http://cn.bing.com/academic/profile?id=8dddeeac970461778a057f20c08b190b&encoded=0&v=paper_preview&mkt=zh-cn FONG T G, JONES R N, SHI P, et al .Delirium accelerates cognitive decline in Alzheimer disease[J ] . Neurology, 2009, 72(18): 1570-1575.DOI:10.1212/WNL.0b013e3181a4129a.

董志霞陆伦根酒精戒断综合征的机制、临床特点及治疗进展现代医药卫生 2017 33 1 12 14 10.3969/j.issn.1009-5519.2017.01.006 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=xyws201701007&dbname=CJFD&dbcode=CJFQ 董志霞, 陆伦根.酒精戒断综合征的机制、临床特点及治疗进展[J].现代医药卫生, 2017, 33(1):12-14.DOI: 10.3969/j.issn.1009-5519.2017.01.006.

DONG Z X LU L G Mechanism, clinical characteristics and treatment progress of alcohol withdrawal syndrome J Mod Med Health 2017 33 1 12 14 10.3969/j.issn.1009-5519.2017.01.006 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=xyws201701007&dbname=CJFD&dbcode=CJFQ DONG Z X, LU L G. Mechanism, clinical characteristics and treatment progress of alcohol withdrawal syndrome[J]. J Mod Med Health, 2017, 33(1): 12-14. DOI: 10.3969/j.issn.1009-5519.2017.01.006.

VAN GOOL W A VAN DE BEEK D EIKELENBOOM P Systemic infection and delirium:when cytokines and acetylcholine collide Lancet 2010 375 9716 773 775 10.1016/S0140-6736(09)61158-2 http://cn.bing.com/academic/profile?id=552869fa54f7f754fe5343ec5417a2ac&encoded=0&v=paper_preview&mkt=zh-cn VAN GOOL W A, VAN DE BEEK D, EIKELENBOOM P.Systemic infection and delirium:when cytokines and acetylcholine collide[J].Lancet, 2010, 375(9716):773-775.

袁晓丽江智霞宋凌霞我国老年患者术后谵妄危险因素的系统评价中国全科医学 2015 18 10 1197 1202 10.3969/j.issn.1007-9572.2015.10.024 http://d.old.wanfangdata.com.cn/Periodical/zgqkyx201510026 袁晓丽, 江智霞, 宋凌霞, 等.我国老年患者术后谵妄危险因素的系统评价[J].中国全科医学, 2015, 18(10):1197-1202.DOI: 10.3969/j.issn.1007-9572.2015.10.024.

YUAN X L JIANG Z X SONG L X Risk factors of postoperative delirium in elderly patients in China:a systematic review Chin Gen Pract 2015 18 10 1197 1202 10.3969/j.issn.1007-9572.2015.10.024 http://d.old.wanfangdata.com.cn/Periodical/zgqkyx201510026 YUAN X L, JIANG Z X, SONG L X, et al . Risk factors of postoperative delirium in elderly patients in China:a systematic review[J ] . Chin Gen Pract , 2015, 18(10):1197-1202.DOI: 10.3969/j.issn.1007-9572.2015.10.024.

RAPELI P KIVISAARI R AUTTI T Cognitive function during early abstinence from opioid dependence: a comparison to age, gender, and verbal intelligence matched controls BMC Psychiatry 2006 6 9 10.1186/1471-244X-6-9 http://cn.bing.com/academic/profile?id=63e7ba8d58d99ee9bb7080d5cd00cdaa&encoded=0&v=paper_preview&mkt=zh-cn RAPELI P, KIVISAARI R, AUTTI T, et al .Cognitive function during early abstinence from opioid dependence: a comparison to age, gender, and verbal intelligence matched controls[J ] .BMC Psychiatry, 2006, 6:9.DOI:10.1186/1471-244X-6-9.

PISANI M A MURPHY T E VAN NESS P H Characteristics associated with delirium in older patients in a medical intensive care unit Arch Intern Med 2007 167 15 1629 1634 10.1001/archinte.167.15.1629 https://archinte.jamanetwork.com/journals/INTEMED/articlepdf/769859/ioi70094_1629_1634.pdf PISANI M A, MURPHY T E, VAN NESS P H, et al . Characteristics associated with delirium in older patients in a medical intensive care unit[J ] . Arch Intern Med, 2007, 167(15):1629-1634.DOI:10.1001/archinte.167.15.1629.

ALDEMIR M ÖZEN S KARA I H Predisposing factors for delirium in the surgical intensive care unit Crit Care 2001 5 265 270 10.1186/cc1044 http://cn.bing.com/academic/profile?id=7a6f034163031fadd67ff5732e04eadc&encoded=0&v=paper_preview&mkt=zh-cn ALDEMIR M, ÖZEN S, KARA I H, et al . Predisposing factors for delirium in the surgical intensive care unit[J ] . Crit Care, 2001, 5:265-270.

李俊艳董晨明杨静 ICU患者谵妄与镇静重庆医学 2015 44 27 3865 3867, 3888 10.3969/j.issn.1671-8348.2015.27.043 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=cqyx201527045&dbname=CJFD&dbcode=CJFQ 李俊艳, 董晨明, 杨静. ICU患者谵妄与镇静[J].重庆医学, 2015, 44(27):3865-3867, 3888.DOI: 10.3969/j.issn.1671-8348.2015.27.043.

LI J Y DONG C M YANG J Delirium and sedation in patients with ICU Chongqing Med 2015 44 27 3865 3867, 3888 10.3969/j.issn.1671-8348.2015.27.043 http://kns.cnki.net/KCMS/detail/detail.aspx?filename=cqyx201527045&dbname=CJFD&dbcode=CJFQ LI J Y, DONG C M, YANG J. Delirium and sedation in patients with ICU[J]. Chongqing Med, 2015, 44(27): 3865- 3867, 3888. DOI: 10.3969/j.issn.1671-8348.2015.27.043.

SHEHABI Y BELLOMO R READE M C Early goal directed sedation versus standard sedation in mechanically ventilated critically ill patients:a pilot study Crit Care Med 2013 41 8 1983 1991 10.1097/CCM.0b013e31828a437d http://www.westicu.cn/UpFile/201406/2014062171854169.PDF SHEHABI Y, BELLOMO R, READE M C, et al .Early goal directed sedation versus standard sedation in mechanically ventilated critically ill patients:a pilot study[J ] . Crit Care Med, 2013, 41(8):1983-1991.D OI:10.1097/CCM.0b013e31828a437d.

HUGHES C G GIRARD T D PANDHARIPANDE P P Daily sedation interruption versus targeted light sedation strategies in ICU patients Crit Care Med 2013 41 9 Suppl 1 S39 S45 10.1097/CCM.0b013e3182a168c5 http://cn.bing.com/academic/profile?id=d58d383092f6ad2310907d5bc743a98b&encoded=0&v=paper_preview&mkt=zh-cn HUGHES C G, GIRARD T D, PANDHARIPANDE P P. Daily sedation interruption versus targeted light sedation strategies in ICU patients[J].Crit Care Med, 2013, 41(9 Suppl 1):S39-S45.DOI:10.1097/CCM.0b013e3182a168c5.

TREGGIARI M M ROMAND J A YANEZ N D Randomized trials of light versus deep sedation on mental health after critical illness Crit Care Med 2009 37 9 2527 2534 10.1097/CCM.0b013e3181a5689f http://cn.bing.com/academic/profile?id=78b64cd417227f0355576ee9668c5b66&encoded=0&v=paper_preview&mkt=zh-cn TREGGIARI M M, ROMAND J A, YANEZ N D, et al .Randomized trials of light versus deep sedation on mental health after critical illness[J ] . Crit Care Med, 2009, 37(9):2527-2534.

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