ABSTRACT
Objective:To evaluate the predictive value of regional cerebral oxygen saturation (rScO 2) for the occurrence of sepsis-associated encephalopathy (SAE). Methods:The data of 94 patients with sepsis admitted to the intensive care unit of Nanjing Drum Tower Hospital from September 2019 to June 2021 were collected. The patients were divided into SAE group and non-SAE group according to the evaluation results of daily intensive care unit confusion assessment method (CAM-ICU) during ICU treatment. The general data such as age and gender of the patients, rScO 2 on 1, 2, 3, 5, and 7 days of ICU admission, and prognostics were recorded. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of rScO 2 on SAE during ICU stay. Results:All 94 patients were enrolled in the analysis, of whom 59.6% (56/94) were male, and the mean age was (50.1±15.1) years old; the incidence of SAE was 31.9% (30/94). The levels of rScO 2 within first 3 days of ICU admission in the SAE group were significantly lower than those in the non-SAE group (1 day: 0.601±0.107 vs. 0.675±0.069, 2 days: 0.592±0.090 vs. 0.642±0.129, 3 days: 0.662±0.109 vs. 0.683±0.091, all P < 0.05). However, there was no significant difference in rScO 2 level on the 5th or the 7th day between the SAE and non-SAE groups (5 days: 0.636±0.065 vs. 0.662±0.080, 7 days: 0.662±0.088 vs. 0.690±0.077, both P > 0.05). ROC curve analysis showed that 1-day rScO 2 had the greatest predictive value for SAE [1 day: area under the ROC curve (AUC) = 0.77, 95% confidence interval (95% CI) was 0.65-0.89, P < 0.01; 2 days: AUC = 0.60, 95% CI was 0.48-0.72, P > 0.05; 3 days: AUC = 0.55, 95% CI was 0.41-0.68, P > 0.05]; with 1-day rScO 2 = 0.640 as the diagnostic threshold, the sensitivity was 73.4%, the specificity was 80.0%. Compared with the non-SAE group, the length of ICU stay and hospital stay in the SAE group were significantly longer [length of ICU stay (days): 13.6±7.1 vs. 9.0±4.3, length of hospital stay (days): 20.1±8.0 vs. 15.8±6.1, both P < 0.05], but the ICU mortality between the two groups was not statistically different. Conclusions:The incidence of SAE is relatively high in ICU patients, and the occurrence of SAE can be predicted by monitoring rScO 2. The rScO 2 value on the first day of ICU admission is closely related to the occurrence of SAE, and may be the target of sepsis resuscitation to guide the treatment and improve the long-term prognosis.
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Background: ACS (Acute confusional states) are on the rise taking the shape of an epidemic. These states are common among the elderly, but young individuals are also not spared. Prompt diagnosis and management of these states can decrease the associated morbidity and mortality.Methods: In this prospective observational study, etiological profile of ACS was evaluated in a total 100 patients, selected over a period of one year, after they fulfilled the CAM (Confusion Assessment Method) criteria.Results: Among 100 patients of ACS, mean age was 54.77�.50 years, males were 66% and 34% were females. The most common diagnosis provisionally made on the basis of history and clinical examination was metabolic encephalopathy in 37% patients, meningoencephalitis (24%), CVA (Cerebrovascular accident) (18%), seizures (9%), sepsis (6%), poisoning (6%). Whereas the final diagnosis made after subjecting the patients to relevant investigations, was metabolic encephalopathy in 37% of patients, meningoencephalitis (20%), CVA (18%), sepsis (12%), unprovoked seizures (6%), poisoning (6%) and undetermined in 1%. The final diagnosis matched the provisional diagnosis in most of the patients except sepsis as a provisional diagnosis was underdiagnosed. The mean duration of hospital stay was 7.6�67days and the hospital stay was most commonly complicated by aspiration pneumonia and acute kidney injury.Conclusions: This study emphasizes that the ACS is an emergency medical situation, where prompt identification, workup and treatment should be done parallelly and urgently to prevent the morbidity and mortality.
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Objective To investigate the current status of application of the Confusion assessment method for the Intensive Care Unit (Cam-ICU),and to explore its influencing factors.Methods A total of 300 patients admitted to were enrolled.The researchers and nurses used Cam-ICU to assess patients' delirium,respectively,and the differences in deliriun assessment were analyzed.Results For delirium assessment,the Kappa value was 0.546 between the researchers and nurses.The consensus rate was 17.6％ for hypoactive delirium,and 77.8％ for hyperactive delirium in 44 delirium patients.Logistic regression analysis showed that APACHE Ⅱ score,RASS score and delirium type were influencing factors of accurate assessment of delirium.Conclusion The consistence of assessment of delirium by ICU nurses is generally good,but the accuracy of assessment of hypoactive delirium is the worst.
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Objective To explore whether perioperative bright light therapy could inhibit the occurrence of postoperative delirium in tumor patients undergoing open hepatobiliary surgery. Methods Totally120 elderly tumor patients scheduled for open hepatobiliary surgery and postoperative ICU treatment were recruited and randomized into bright light and control group with 60 cases per group in accordance with the random number table.Bright light was delivered to the patients at an intensity of 10 000 lux from 2 days before surgery to postoperative day 7.Each intervention began at 7 am and lasted for 2 hours.Delirium was screened using the Confusion Assessment Method for Intensive Care Unit(CAM-ICU) during the first 7 days after surgery. The differences in the incidence of postoperative delirium, the duration of delirium and the length of ICU as well as postoperative hospital stay were compared. Results Demographic characteristics and surgical outcomes were similar between groups. The incidence of postoperative delirium were 46.67%(28/60)and 23.33%(14/60)for control group and bright light group respectively with a significant difference (χ2=7.179,P=0.007). The difference was seen on postoperative days 3 (χ2=5.187, P = 0.023) and 4 (χ2=8.749,P = 0.003). The incidences of delirium on postoperative days 3 for bright light and control group were 5.08%(3/59)and 18.64%(11/59)respectively.On postoperative day 4, the incidences of delirium for bright light and control group were 0 (0/58) and 14.04% (8/57) respectively.There was no difference in the duration of delirium(χ2=1.248,P=0.264),the length of ICU stay (χ2=0.036,P=0.849)or the hospital stay(χ2=1.706,P=0.192). Conclusion Bright light is useful in preventing postoperative delirium in elderly tumor patients undergoing open hepatobiliary surgery.