ObjectivesTo systematically review the delirium risk prediction models in intensive care unit (ICU) patients.MethodsThe Cochrane Library, PubMed, Web of Science, Ovid, VIP, WanFang Date and CNKI databases were electronically searched to collect studies on delirium risk prediction models in intensive care unit patients from inception to December, 2018. Two reviewers independently screened literature, extracted data, evaluated the included studies according to the CHARMS checklist, and then systematic review was performed to evaluate the risk prediction models.ResultsA total of 9 studies were included, of which 7 were prospective studies. Six models were internally validated. All studies reported the area under receiver operating characteristic curve (AUROC) over 0.7 (0.739-0.926). The reduction of cognitive reserve and increased blood urea nitrogen were the most commonly reported predisposing and precipitating factors of delirium among all prediction models. Methodologically, the absence or unreported of the blind method, to a certain extent, partially increase the risk of bias.ConclusionsNine prediction models all have great power in early identifying and screening patients who are at high risk of developing ICU delirium. On the basis of judiciously selecting a practical prediction model for clinical practice or carrying out a large sample-size prospective cohort study to construct the localized prediction model, stratified prevention strategies should be formulated and implemented according to the risk stratification results to reduce the incidence of ICU delirium and accelerate the rational allocation of medical resources for delirium prevention.
ObjectiveTo analyze the predictive value of ensemble classification algorithm of random forest for delirium risk in ICU patients with cardiothoracic surgery. MethodsA total of 360 patients hospitalized in cardiothoracic ICU of our hospital from June 2019 to December 2020 were retrospectively analyzed. There were 193 males and 167 females, aged 18-80 (56.45±9.33) years. The patients were divided into a delirium group and a control group according to whether delirium occurred during hospitalization or not. The clinical data of the two groups were compared, and the related factors affecting the occurrence of delirium in cardiothoracic ICU patients were predicted by the multivariate logistic regression analysis and the ensemble classification algorithm of random forest respectively, and the difference of the prediction efficiency between the two groups was compared.ResultsOf the included patients, 19 patients fell out, 165 patients developed ICU delirium and were enrolled into the delirium group, with an incidence of 48.39% in ICU, and the remaining 176 patients without ICU delirium were enrolled into the control group. There was no statistical significance in gender, educational level, or other general data between the two groups (P>0.05). But compared with the control group, the patients of the delirium group were older, length of hospital stay was longer, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, proportion of mechanical assisted ventilation, physical constraints, sedative drug use in the delirium group were higher (P<0.05). Multivariate logistic regression analysis showed that age (OR=1.162), length of hospital stay (OR=1.238), APACHEⅡ score (OR=1.057), mechanical ventilation (OR=1.329), physical constraints (OR=1.345) and sedative drug use (OR=1.630) were independent risk factors for delirium of cardiothoracic ICU patients. The variables in the random forest model for sorting, on top of important predictor variable were: age, length of hospital stay, APACHEⅡ score, mechanical ventilation, physical constraints and sedative drug use. The diagnostic efficiency of ensemble classification algorithm of random forest was obviously higher than that of multivariate logistic regression analysis. The area under receiver operating characteristic curve of ensemble classification algorithm of random forest was 0.87, and the one of multivariate logistic regression analysis model was 0.79.ConclusionThe ensemble classification algorithm of random forest is more effective in predicting the occurrence of delirium in cardiothoracic ICU patients, which can be popularized and applied in clinical practice and contribute to early identification and strengthening nursing of high-risk patients.
Postoperative delirium (POD) is a common postoperative complication. Dysregulation of gut flora is involved in POD through mechanisms such as neuroinflammation, oxidative stress, deposition of β-amyloid, and aberrant production of metabolites of gut flora. Therefore, interventions to regulate gut flora, such as probiotics, prebiotics, and faecal microbiota transplantation, can alleviate cognitive dysfunction. This article reviews the mechanisms of gut flora in POD and its prevention and treatment strategies, with the aim of providing new ideas for the clinical prevention and treatment of POD.
Objective To analyze the risk factors for delirium of the Stanford A aortic dissection patients after surgery. Method We retrospectively analyzed the clinical data of 335 patients with type A aortic dissection in Guangdong Cardiac Institution from January 2012 through December 2014. There were 280 males and 55 females. The average of age was 48.5±10.3 years. Delirium status of the patients were evaluated based on confusion assessment method for intensive care unit (CAM-ICU). The patients were divided into two groups including a delirium group and a control group. We tried to find the risk factors for postoperative delirium. Results There were 169 patients of delirium with a incident rate of 50.4%. One-way analysis of variance and multivariate analysis indicated that pre-operative D-dimer level (OR=2.480, 95% CI 1.347-4.564, P<0.01), the minimum mean arterial pressure during operation (OR=0.667, 95% CI 0.612-0.727, P<0.01), the postoperative ventilation time (OR=2.771, 95% CI 1.506-5.101, P<0.01) and the postoperative acute kidney failure (OR=1.911, 95% CI 1.065-3.430, P<0.05) were the independent risk factors for delirium of the Stanford A aortic dissection patient after surgery. Conclusion The incident rate of postoperative delirium of the Standford A aortic dissection patient is relatively high. Patients in this study with elevated pre-operative D-dimer level, lower intraoperative mean arterial pressure, longer postoperative ventilation and combination of acute kidney failure have a higher rate of postoperative delirium. Better understanding and intervention of these factors are meaningful to reduce the occurrence of postoperative delirium.
ObjectiveTo determine whether there was a clinical relevant association between anesthetic regimen (propofol or inhalational anesthetics) and the occurrence of postoperative delirium (POD) in patients undergoing cardiac surgery.MethodsThis retrospective study was conducted on patients with elective cardiac surgery under cardiopulmonary bypass (CPB) at West China Hospital of Sichuan University between October 2018 and March 2019. The patients were divided into a propofol group or an inhalational anesthetics group according to anesthetic regimen (including CPB). The primary outcome was the occurrence of POD during first 3 days after surgery. Logistic regression analysis was used to determine the relationship between anesthetic regimen and the occurrence of POD.ResultsA total of 197 patients who met the inclusion criteria were included, with an average age of 53 years, and 51.8% (102/197) were females. POD occurred in 21.3% (42/197) patients. The incidence of POD was 21.4% in the propofol group and 21.2% in the inhalational anesthetics group; there was no significant difference between the two groups (RR=1.01, 95%CI 0.51-2.00, P=0.970). Logistic regression analysis did not find that anesthetic regimen was a risk factor for delirium after cardiac surgery after adjusting risk factors (OR=1.05, 95%CI 0.48-2.32, P=0.900).ConclusionAnesthetic regimen (propofol or inhalational anesthetics) is not associated with an increased risk for POD in adult patients undergoing elective cardiac surgery under CPB.
Objective To evaluate the influence of early mobilization on delirium and respiratory dynamics in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The study prospectively recruited 107 AECOPD patients who admitted between January 2014 and June 2015 and underwent mechanical ventilation.On basis of same routine treatment,the patients were randomly divided into a treatment group (54 cases)receiving regime of early mobilization,and a control group (53 cases)receiving routine sedation and analgesia treatment.The incidence of delirium,duration of delirium,time of mechanical ventilation,and ICU mortality were compared between two groups.The respiratory mechanical parameters including endogenous positive end expiratory pressure (PEEPi),airway resistance(Raw),static compliance(Cs),and dynamic compliance(Cd)before treatment,3 days and 5 days after treatment were also compared between two groups. Results Compared with the control group,the incidence of delirium decreased (59.3% vs. 77.4%),the duration of delirium [(1.8±1.1)d vs. (2.6±1.3)d] and mechanical ventilation[(6.2±3.4)d vs. (7.9±4.2)d] reduced in the treatment group with significant difference(P<0.05).There was no significant difference in respiratory mechanical parameters before treatment between two groups(P>0.05).While at 3 days and 5 days after treatment,PEEPi decreased [(6.23±2.83)cm H2O vs. (7.42±2.62)cm H2O,(4.46±2.20)cm H2O vs. (5.92±2.51)cm H2O],Raw decreased [(20.35±7.15)cmH2O·L-1·s-1 vs. (23.23±6.64)cm H2O·L-1·s-1,(16.00±5.41)cm H2O·L-1·s-1 vs. (19.02±6.37)cm H2O·L-1·s-1],Cd increased [(25.20±9.37)mL/cm H2O vs (21.75±7.38)mL/cm H2O,(27.46±5.45)mL/cm H2O vs. (24.40±6.68)mL/cm H2O] in the treatment group compared with the control group(P<0.05),and the difference in Cs was not significant(P>0.05).No complications such as slippage,physical injury,or malignant arrhythmia occurred in two groups.The mortality slightly decreased in the treatment group compared with the control group (5.6% vs 11.3%),but the difference was not statistically significant(P>0.05). Conclusions The incidence of delirium is high in mechanically ventilated patients with AECOPD.Early mobilization can reduce the incidence and duration of delirium,decrease the airway resistance,increase the dynamic lung compliance,relieve dynamic pulmonary hyperinflation and reduce PEEPi,so as to improve the respiratory function and shorten the time of mechanical ventilation.Therefore,early mobilization is an effective and safe regime for AECOPD patients underwent mechanical ventilation.
ObjectiveTo explore the relevant risk factors for postoperative delirium (POD) in elderly patients undergoing radical colon cancer surgery, and provide a basis for formulating postoperative prevention and treatment measures for POD. MethodsA total of 128 elderly patients diagnosed with colon cancer and underwent radical colon cancer surgery at Xindu District People’s Hospital in Chengdu from January 2018 to December 2021 were included as the study subjects. Patients were divided into two groups according to the score of Delirium Assessment Scale (4AT Scale). The basic data, main perioperative clinical data and laboratory indicators of the two groups were collected, and univariate and logistic regression analysis were carried out to determine the potential risk factors of POD in elderly patients with colon cancer after radical operation. ResultsAccording to the results of the 4AT scale score, a total score of ≥4 points was used as the threshold for determining patient POD. Among 128 patients, there were 29 patients (22.66%) with POD and 99 patients (77.34%) without POD. ① General data comparison: There was no significant difference between the two groups in gender, body mass index, years of education, hypertension, diabetes, smoking history and drinking history (P>0.05), but there was significant difference in age, preoperative mini-mental state examination (MMSE) score and American Society of Anesthesiologists (ASA) grade (P<0.05). ② Comparison of main clinical data during the perioperative period: There was no statistically significant difference between the two groups of patients in ICU treatment, nonsteroidal anti-inflammatory drug treatment, visual analogue scale, and intraoperative hypotension (P>0.05), but there was a statistically significant difference in operative time, anesthesia time, intraoperative blood loss, and dexmedetomidine treatment (P<0.05). ③ Comparison of preoperative laboratory indicators: There was no statistically significant difference between the two groups of patients in terms of hemoglobin, serum albumin, white blood cell count, prognostic nutritional index, neutrophil/lymphocyte ratio, D-dimer, and albumin to fibrinogen ratio (P>0.05). ④ The results of logistic regression analysis showed that low preoperative MMSE score [OR=0.397, 95%CI (0.234, 0.673)], long surgical time [OR=1.159, 95%CI (1.059, 1.267) ], and long anesthesia time [OR=1.138, 95%CI (1.057, 1.226) ] were independent risk factors for the occurrence of POD in elderly colon cancer patients undergoing radical surgery. ConclusionPreoperative MMSE score, operative time, and anesthesia time are closely related to the occurrence of POD in elderly colon cancer radical surgery, worth implementing key perioperative management in clinical practice to prevent and manage POD.
Postoperative delirium is one of the most common postoperative complications in elderly patients, affecting the outcome of approximately half of surgical patients. The pathogenesis of postoperative delirium is still unclear, but multivariate models of the etiology of postoperative delirium are well-validated and widely accepted, and 40% of postoperative delirium can be effectively prevented by targeting predisposing factors. Benzodiazepines have long been considered as predisposing factors for postoperative delirium. Although benzodiazepines are widely used in clinical practice, most relevant guidelines recommend avoiding the use of benzodiazepines in the perioperative period to reduce the incidence of postoperative delirium. Controversy exists regarding the association of benzodiazepine use with postoperative delirium. This article discusses the results of studies on perioperative benzodiazepines and postoperative delirium.
ObjectiveTo investigate the effect of omega-3 polyunsaturated fatty acids on delirium in elderly patients after taking gastric cancer surgery.MethodsA prospective study was conducted. Elderly patients with gastric cancer undergoing radical gastrectomy in West China Hospital of Sichuan University from June 2015 to June 2018 were divided into experimental group and control group for the purpose of research. All patients were operated by the same group of surgeons and anesthesiologists. Patients in the experimental group received intravenous infusion of 10% fish fat emulsion (Ewing) 100 mL daily from the first day after operation extra to routine treatment; patients in the control group received routine treatment after operation. The postoperative delirium, inflammation, complications, hospital stay, andre-admission on 30 days were compared between the two groups.ResultsA total of 205 patients were under research. The results were as follows. ① There were 47 delirium patients in the control group and 22 delirium patients in the experimental group. The difference between the two groups was statistically significant (P<0.001). There were 32 cases and 19 cases discovered with delirium in the control group and the experimental group during 1-3 days after operation; there were 19 cases and 6 cases were detected with delirium in the control group and the experimental group during 4-7 days after operation, respectively. The difference was considered statistically significant (P<0.05). ② Inflammation indexes of the experimental group were significantly lower than those of the control group on the 3rd and 7th day after operation, including count of WBC, C-reactive protein, interleukin-6, tumor necrosis factor-α, and platelet crit, and the difference were statistically significant (P<0.05). ③ Postoperative fever occurred in 46 patients in the experimental group, while 71 patients in the control group. The difference was statistically significant (P<0.01). ④ There were 2 cases of incision liquefaction in the control group and 1 case of mild chylous leakage in the experimental group. There was no significant difference in incision liquefaction rate and chylous leakage rate between the two groups (P>0.05). ⑤ The average hospitalization time of the experimental group was shorter than that of the control group ［(8±1) d vs. (9±2) d］. The difference was considered statistically significant (P<0.01).Conclusionω-3 polyunsaturated fatty acids can reduce postoperative delirium and improve short-term prognosis in elderly patients with gastric cancer by controlling inflammation and stress response.
目的：观察慢性酒精中毒所致震颤谵妄的临床特点及预后。方法：对32例慢性酒精中毒所致震颤谵妄患者的临床资料进行回顾性分析，探讨其临床特点及预后。结果：32例患者中，因应激方式不当饮酒者19例，平均饮酒年龄20.3±9.6年，平均每日摄入乙醇量276.4±21.9 g。因戒断而出现临床症状者15例。临床表现为多种精神症状和不同程度的意识障碍，伴有肢体震颤。头部CT扫描发现脑萎缩者30例。经治疗后症状痊愈者25人，好转者4人。结论：慢性酒精中毒所致震颤谵妄发作的病理生理机制尚不明了，但其发作与戒断关系密切，经积极干预可获得较满意的预后。