Delirium and Weakness Acquired in the Intensive Care Unit: Individual and Combined Effects on 90-Day Mortality in Survivors of Critical Illness.

IF 3.2 3区医学 Q1 NURSING Journal of Clinical Nursing Pub Date : 2024-10-29 DOI:10.1111/jocn.17517

Shu-Fen Siao, Ya-Yun Zheng, Yu-Chung Wei, Leanne M Boehm, Cheryl Chia-Hui Chen

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Abstract

Aims: To compare the individual and combined effects on 90-day mortality among four critically ill survivor groups: normal (without ICU-acquired delirium or ICU-acquired weakness), delirium-only (with ICU-acquired delirium only), weakness-only (with ICU-acquired weakness only) and delirium-weakness (combined ICU-acquired delirium and weakness).

Methods: A prospective cohort study consecutively recruited delirium-free critically ill patients admitted to six medical ICUs at a university hospital. Delirium was assessed once daily for 14 days (or until death or ICU discharge) using the Confusion Assessment Method for the ICU. Participants who were discharged from the ICUs were assessed for weakness using the Medical Research Council scale. A summed score below 48 defines ICU-acquired weakness. These survivors were evaluated again for 90-day mortality. The study is reported using the STROBE checklist.

Results: Delirium developed in 107 (43.2%) participants during their first 14 days of ICU stay; 55 (22.2%) met criteria for weakness by ICU discharge. Participants with delirium were at increased risk for also developing ICU-acquired weakness, and the 90-day mortality was 18.2%. Independent of age and Acute Physiology and Chronic Health Evaluation II score at ICU admission, delirium-only and weakness-only were not associated with higher 90-day mortality, while participants in the delirium-weakness group had a 3.69-fold higher risk of death, compared to those who were normal during the ICU stay. A non-significant interaction was found, suggesting the joint effect of delirium and weakness on mortality is not higher than the sum of both effects individually.

Conclusions: Mortality is substantially high among critically ill survivors who experience both delirium and weakness, although no additive effect on mortality was observed when these conditions occur together. Our findings highlight the urgent need to optimise ICU care by prioritising the prevention, early identification and management of these two common ICU-acquired conditions.

Patient contribution: Study participation and completion of all assessments.

Trial registration: ClinicalTrials.gov identifier: NCT04206306.

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重症监护室中出现的谵妄和虚弱：危重病幸存者 90 天死亡率的个体和综合影响。

目的：比较四组危重病幸存者对90天死亡率的个体和综合影响：正常组（无ICU获得性谵妄或ICU获得性虚弱）、仅谵妄组（仅ICU获得性谵妄）、仅虚弱组（仅ICU获得性虚弱）和谵妄-虚弱组（ICU获得性谵妄和虚弱合并）：一项前瞻性队列研究连续招募了一家大学医院的六家内科重症监护室收治的无谵妄重症患者。在 14 天内（或直到死亡或重症监护室出院），每天使用重症监护室意识模糊评估法对谵妄进行一次评估。使用医学研究委员会量表对从重症监护室出院的参与者进行虚弱评估。总分低于 48 分即为重症监护室获得性虚弱。对这些幸存者再次进行了 90 天死亡率评估。研究采用 STROBE 检查表进行报告：107名参与者（43.2%）在入住重症监护室的前14天内出现谵妄；55名参与者（22.2%）在重症监护室出院时达到虚弱标准。患有谵妄的参试者同时患上重症监护室获得性虚弱的风险更高，90 天死亡率为 18.2%。与入ICU时的年龄和急性生理学和慢性健康评估II评分无关，单纯谵妄和单纯虚弱与较高的90天死亡率无关，而谵妄-虚弱组的参与者与在ICU住院期间正常的参与者相比，死亡风险高出3.69倍。研究发现，谵妄和虚弱的交互作用并不显著，这表明谵妄和虚弱对死亡率的共同影响并不高于两者单独影响的总和：结论：同时出现谵妄和虚弱的危重病幸存者的死亡率很高，但当这两种情况同时出现时，并没有观察到对死亡率的叠加效应。我们的研究结果凸显了通过优先预防、早期识别和管理这两种 ICU 常见疾病来优化 ICU 护理的紧迫性：参与研究并完成所有评估：试验注册：ClinicalTrials.gov identifier：NCT04206306。

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来源期刊

Journal of Clinical Nursing 医学-护理

CiteScore

6.40

自引率

2.40%

发文量

审稿时长

2 months

期刊介绍： The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice. JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice. We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.