SUBSYNDROMAL DELIRIUM AND INSTITUTIONALIZATION AMONG PATIENTS WITH CRITICAL ILLNESS.
| Autor: | Brummel, Nathan E., Boehm, Leanne M. |
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| Předmět: |
ACADEMIC medical centers
APACHE (Disease classification system) CRITICAL care medicine CRITICALLY ill LENGTH of stay in hospitals HOSPITAL admission & discharge INSTITUTIONAL care INTENSIVE care units LIFE skills LONGITUDINAL method NEUROPSYCHOLOGICAL tests MEDICAL cooperation PATIENTS PROBABILITY theory QUESTIONNAIRES PSYCHOSES RESEARCH RESEARCH funding RESPIRATORY insufficiency SHOCK (Pathology) COMORBIDITY MULTIPLE regression analysis PSYCHOSOCIAL factors SOCIOECONOMIC factors SEVERITY of illness index DISEASE duration DIAGNOSIS PROGNOSIS PSYCHOLOGY |
| Zdroj: | American Journal of Critical Care; Nov2017, Vol. 26 Issue 6, p447-455, 9p, 1 Diagram, 3 Charts, 1 Graph |
| Abstrakt: | Background The prognostic importance of subsyndromal delirium is unknown. Objective To test whether duration of subsyndromal delirium is independently associated with institutionalization. Methods The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used twice daily to assess for subsyndromal delirium in patients with respiratory failure or shock. Delirium was considered present if the assessment was positive. Subsyndromal delirium was considered present if the assessment was negative but the patient exhibited any CAM-ICU features. Multivariable regression was used to determine the association between duration of subsyndromal delirium and institutionalization, adjusting for age, education, baseline cognition and disability, comorbidities, severity of illness, delirium, coma, sepsis, and doses of sedatives and opiates. Results Subsyndromal delirium, lasting a median of 3 days, developed in 702 of 821 patients (86%). After adjusting for covariates, duration of subsyndromal delirium was an independent predictor of increased odds of institutionalization (P = .007). This association was greatest in patients with less delirium (P for interaction = .01). Specifically, of patients who were never delirious, those with 5 days of subsyndromal delirium (upper interquartile range [IQR]) were 4.2 times more likely to be institutionalized than those with 1.5 days of subsyndromal delirium (lower IQR). Conclusions Subsyndromal delirium occurred in most critically ill patients, and its duration was an independent predictor of institutionalization. Routine monitoring of all delirium symptoms may enable detection of full and subsyndromal forms of delirium. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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