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Objective@#To study the application effect of graded nursing intervention for ICU patients combined with the Pre-Deliric prediction model.@*Methods@#A total of 288 ICU patients were elected and divided into the control group (141 cases from May 2017 to October 2017) and the intervention group (147 cases from November 2017 to April 2018) according to hospitalization time. The control group received conventional delirium prevention measures. The intervention group was assessed within 24 h following admission with Pre-Deliric prediction model to screen the risk of delirium, and then they received grading prevention care based on the assessment results of delirium risks. The data of this study were collected by Numeric Rating Scale, Critical-Care Pain Observation Tool, Richmond Agitation and Sedation Scale, Confusion Assessment Method for the ICU. The incidence and duration of delirium, 28d survival rate, ICU length of stay of the two groups were statistically analyzed.@*Results@#Compared with the control group, we detected that the incidence of delirium in the intervention group was significantly lower (χ2=5.043, P<0.05), 21.7%(32/147) vs. 35.5%(50/141). Compared with the control group, we found that the duration of delirium in the intervention group was significantly shorter,(1.68±1.24) vs.(2.82±1.60)d, the ICU length of stay in the intervention group were significantly shorter than the control group(t=4.45, P<0.01), (3.42±3.02)d vs (6.21±4.56)d. There was no significant difference in the 28-day ICU survival rate between the two groups (P>0.05).@*Conclusions@#the risk assessment and grading nursing care combined with Pre-Deliric prediction model could effectively prevent the occurrence and shorten the duration of delirium, and also shorten the ICU length of stay.It was significant for improve the quality of nursing.
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Objective To study the application effect of graded nursing intervention for ICU patients combined with the Pre-Deliric prediction model. Methods A total of 288 ICU patients were elected and divided into the control group (141 cases from May 2017 to October 2017) and the intervention group (147 cases from November 2017 to April 2018) according to hospitalization time. The control group received conventional delirium prevention measures. The intervention group was assessed within 24 h following admission with Pre-Deliric prediction model to screen the risk of delirium, and then they received grading prevention care based on the assessment results of delirium risks. The data of this study were collected by Numeric Rating Scale, Critical-Care Pain Observation Tool, Richmond Agitation and Sedation Scale, Confusion Assessment Method for the ICU. The incidence and duration of delirium, 28d survival rate, ICU length of stay of the two groups were statistically analyzed. Results Compared with the control group, we detected that the incidence of delirium in the intervention group was significantly lower (χ2=5.043, P<0.05), 21.7%(32/147) vs. 35.5%(50/141). Compared with the control group, we found that the duration of delirium in the intervention group was significantly shorter,(1.68 ± 1.24) vs.( 2.82 ± 1.60)d, the ICU length of stay in the intervention group were significantly shorter than the control group(t=4.45﹐P<0.01), (3.42±3.02)d vs (6.21± 4.56)d. There was no significant difference in the 28-day ICU survival rate between the two groups (P>0.05). Conclusions the risk assessment and grading nursing care combined with Pre-Deliric prediction model could effectively prevent the occurrence and shorten the duration of delirium, and also shorten the ICU length of stay. It was significant for improve the quality of nursing.
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Objective To assess and compare the predicted abilities of PRE- DELIRIC and E-PRE-DELIRIC two delirium prediction models in ICU patients. Methods From January 2017 to April 2017, 265 critically ill patients who met the inclusion criteria were included in this study. The clinical data of all the included patients, respectively calculated the scores with both PRE-DELIRIC and E-PRE-DELIRIC rating software were collected. Forecasting performance of two different models of discrimination and calibration were assessed. 2 medical staff assessed 20 patients with the Chinese version PRE-DELIRIC and E-PRE-DELIRIC,while the intraclass correlation coefficients were accumulated to evaluate the inter-rater reliability. Results The average scores of PRE-DELIRIC were46.41 ± 14.05in delirium group and20.08 ± 9.96 in patients without delirium, the difference between scores was statistically significant (t=14.34, P<0.05). The average scores of E-PRE-DELIRIC were36.23±13.34in delirium group and14.45±9.56 in patients without delirium, the difference between scores was statistically significant (t=14.59, P<0.05). The AUROCC and its 95％CI of the PRE-DELIRIC and E-PRE-DELIRIC for prediction of delirium were 0.928(0.891-0.965) and 0.904(0.861-0.947) respectively in all patients. Discrimination was generally good for two models. The PRE-DELIRIC and E-PRE-DELIRIC sensitivity were 0.841, 0.812, specificity was 0.939, 0.913, the threshold values of PRE-DELIRIC model was 36.5％and E-PRE-DELIRIC model was 30.5％. The Youden′s index of PRE–DELIRIC model was 0.779, which better than 0.725 of E-PRE-PREDIRIC model. Conclusions The PRE-DELIRIC and E-PRE-DELIRIC models both have high accuracy in predicting delirium of patients in intensive care unit. PRE-DELIRIC does better performance than E-PRE-DELIRIC, but has imitation in terms of time. E-PRE-DELIRIC model can be used in ICU patients who develop delirium within 24 h following admission.
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Objective To investigate the effects of analgesia and sedation scheme on ICU delirium among patients with cardiac surgery. Methods A total of 235 patients undergoing mechanical ventilation were enrolled via simple random number sampling method from January to December,2016, and divided into the experimental group(117 cases)and the control group(118 cases).The experimental group received analgesia and sedation scheme designed by our department,and the control group received routine sedation protocol. The incidence of ICU delirium, the dosages of drugs, duration of mechanical ventilation, length of ICU stay were recorded. Results The compliance rate of shallow sedation in the experimental group was 87.17% (102/117), which was lower than 57.62% (68/118) in the control group with statistical difference(χ2=25.642,P<0.05).The incidence of ICU delirium in the experimental group was 17.09% (20/117), which was lower than 34.75% (41/118) in the control group with statistical difference (χ2=9.524, P<0.05). The dosages of sedation drugs were: dexmedetomidine, (269.46 ± 32.47) μg,disoprofol,(286.84±81.96)mg,the duration of mechanical ventilation was(14.31±1.43)h,the length of ICU stay was(16.02±1.25)h.Those data were all lower than those of the control group[(507.29±58.27) μg,(575.63±95.74)mg,(20.45±2.29)h,(22.82±2.45)h]with statistical difference(t=-5.529--4.371, P<0.05). Conclusion Analgesia and sedation scheme was worthy of popularization and application.
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Objective To investigate the clinical value of simplified Chinese version NU-DESC in assessment of ICU delirium in domestic ICU,and provide easy ICU delirium assessment tool for clinical nurses.Methods We used simplified Chinese version NU-DESC to assess patients in domestic ICU from July to September 2011,and compared with the gold standard DSM-IV diagnosis results.Their validity,reliability and effectiveness were evaluated to analyze the application value of NU-DESC in ICU.Results The area under the ROC curve of simplified Chinese version of Nu-DESC was 0.951,the sensitivity was 82％,the specificity was 90％,the false negative rate was 18％,the false positive rate was 10％,Youden's index was 0.72,the positive likelihood ratio was 7.99,the negative likelihood ratio was 0.20,the agreement rate was 87％,Kappa value was 0.71,the positive predictive value was 77％,the negative predictive value was 92％.Conclusions The simplified Chinese version NU-DESC can easily be understood,used and accepted by nurses.They can be used as an assessment tool for nurses to judge ICU delirium for ICU patients.
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Objective To analyze the associated factors of ICU delirium after cardiac surgery,and propose the proper treatment strategy.Methods 124 patients after cardiac surgery were observed.The basic information including gender,age,blood type,respirator assistant time and ICU hospitalizing time was recorded.SPSS software was used for statistical analysis.Results Among the 124 patients,the incidence of ICU delirium was 17％.There was significant difference between patients with ICU delirium and without ICU delirium on age,respirator assistant time and ICU hospitalizing time.The ICU delirium incidence was dramatically different among different blood types,and the incidence of blood type A was much more higher than blood type B and O.Univariate Logistic regression analysis showed that age,mechanical ventilation time,ICU time,gender and blood types were the related factors of delirium in ICU.Conclusions Age,respirator assistant time,ICU hospitalizing time,and blood type are all influencing factors of ICU delirium.Patients who are male,older,or with longer usage of respirator,or with longer ICU hospitalizing time are more likely to develop ICU delirium.The incidence of ICU delirium is quite different among different blood types,blood type A is more easily to occur ICU delirium than blood type O and B.