Effect of motor subtypes of delirium in the intensive care unit on fast-track failure after cardiac surgery

Objective

The purpose of the study was to evaluate the association between motor subtypes of postoperative delirium in the intensive care unit and fast-track failure (a composite outcome of prolonged stay in the intensive care unit >48 hours, intensive care unit readmission, and 30-day mortality) after cardiac surgery.

Predicting hospital mortality and length of stay: A prospective cohort study comparing the Intensive Care Delirium Screening Checklist versus Confusion Assessment Method for the Intensive Care Unit

ObjectiveThe objective of this study was to compare two tools, the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method for the intensive care unit (ICU) (CAM-ICU), for their predictive validity for outcomes related to delirium, hospital mortality, and length of stay (LOS).MethodsThe prospective study conducted in six medical ICUs at a tertiary care hospital in Taiwan enrolled consecutive patients (≥20 years) without delirium at ICU admission. Delirium was screened daily using the ICDSC and CAM-ICU in random order. Arousal was assessed by the Richmond Agitation–Sedation Scale (RASS). Participants with any one positive result were classified as ICDSC- or CAM-ICU-delirium groups.ResultsDelirium incidence evaluated by the ICDSC and CAM-ICU were 69.1% (67/97) and 50.5% (49/97), respectively. Although the ICDSC identified 18 more cases as delirious, substantial concordance (κ = 0.63; p < 0.001) was found between tools. Independent of age, Acute Physiology and Chronic Health Evaluation II score, and Charlson Comorbidity Index, both ICDSC- and CAM-ICU-rated delirium significantly predicted hospital mortality (adjusted odds ratio: 4.93; 95% confidence interval [CI]:1.56 to 15.63 vs. 2.79; 95% CI: 1.12 to 6.97, respectively), and only the ICDSC significantly predicted hospital LOS with a mean of 17.59 additional days compared with the no-delirium group. Irrespective of delirium status, a sensitivity analysis of normal-to-increased arousal (RASS≥0) test results did not alter the predictive ability of ICDSC- or CAM-ICU-delirium for hospital mortality (adjusted odds ratio: 2.97; 95% CI: 1.06 to 8.37 vs. 3.82; 95% CI: 1.35 to 10.82, respectively). With reduced arousal (RASS<0), neither tool significantly predicted mortality or LOS.ConclusionsThe ICDSC identified more delirium cases and may have higher predictive validity for mortality and LOS than the CAM-ICU. However, arousal substantially affected performance. Future studies may want to consider patients’ arousal when deciding which tool to use to maximise the effects of delirium identification on patient mortality.     

持续输注利多卡因对腺样体切除术患儿麻醉苏醒期躁动的影响

目的　观察术中持续静脉泵注利多卡因对腺样体切除术患儿麻醉苏醒期躁动的影响。方法　选择2022年2月至6月在广东省妇幼保健院40例年龄在3～10岁,美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级择期在七氟烷全身麻醉下行腺样体切除术的患儿,按照随机数字表法将患儿分为生理盐水对照组（N组）及利多卡因持续静脉泵注组（L组）,每组各20例。N组男7例、女13例,年龄6（5,8）岁;L组男10例、女10例,年龄7（5,8）岁。患儿在诱导后,L组先静脉注射1 mg/kg利多卡因,继而以2 mg/（kg·h）持续静脉泵注利多卡因,N组给予等量生理盐水对照。主要结局指标包括躁动评分,躁动发生率,苏醒期麻醉药物追加次数;次要结局指标包括拔管后30 min疼痛评分,拔管时间及恢复室停留时间。采用独立样本t检验、Mann-Whitney U检验、Pearson Chi-Square检验。结果　L组患儿苏醒期WATCHA躁动评分较N组患儿低［1（0,2）分比3（0,4）分,P<0.05］,L组患儿躁动发生率低于N组［20%（4/20）比50%（10/20）,P<0.05］,L组患儿苏醒期麻醉药物追加率低于N组［15%（3/20）比60%（12/20）,P<0.01］。L组患儿拔管时间短于N组［（13.00±7.33）min比（19.40±7.39）min,P<0.01］,L组患儿恢复室停留时间短于N组［（42.00±7.85）min比（50.15±7.14）min,P<0.01］,L组患儿拔管后30 min疼痛评分低于N组［0（0,2）分比2（0,2）分,P<0.05］。结论　持续静脉泵注利多卡因可以减少腺样体切除术患儿麻醉苏醒期躁动的发生率,缩短拔管时间及恢复室停留时间,减轻术后疼痛,对加速患儿康复具有重要意义。     

帕瑞昔布钠对神经外科术后镇痛及躁动的影响

目的观察帕瑞昔布钠用于神经外科术后镇痛和躁动的作用。方法 40例择期神经外科手术患者,随机均分为帕瑞昔布钠组(P组)和对照组(C组),关硬脑膜后分别静注帕瑞昔布钠40 mg(10 ml)或生理盐水10 ml,同时给予托烷司琼5 mg。观察血流动力学、呼吸恢复时间、睁眼时间、拔管时间、躁动发生与程度、恶心呕吐发生率,记录拔管时、拔管后5、10 min时的躁动评分(RS)及Ramsay镇静(RSS)评分;并记录术后6、12、24 h VAS、RS及RSS评分。结果注药前、注药后5、10 min两组患者MAP和HR差异无统计学意义;拔管时及拔管后5、10 min时C组MAP高于、HR快于注药前和P组(P<0.05)。拔管时及拔管后5、10 min C组RS评分明显高于、RSS评分低于P组(P<0.05)。两组患者呼吸恢复时间、睁眼时间、拔管时间、术后恶心呕吐的发生率差异均无统计学意义。术后6、12、24 h C组VAS、RS评分明显高于、RSS评分低于P组(P<0.05)。结论帕瑞昔布钠可安全用于神经外科术后镇痛,并可有效预防躁动。     

帕瑞昔布钠联合丙泊酚用于全麻患者苏醒期躁动的临床观察

目的观察帕瑞昔布钠联合丙泊酚治疗全麻患者苏醒期躁动的疗效。方法全麻拔管后出现苏醒期躁动的90例患者随机分为三组：帕瑞昔布加丙泊酚组（A组）、芬太尼加丙泊酚组（B组）、曲马多加丙泊酚组（c组）,每组30例,分别静脉注射帕瑞昔布钠40mg＋丙泊酚lmg／kg、芬太尼1μg／kg＋丙泊酚1mg／kg、曲马多1mg／kg＋丙泊酚1mg／kg进行治疗。观察三组药物治疗苏醒期躁动的疗效、用药前后VAS评分及Ramsay镇静评分、苏醒时间以及药物的不良反应。结果A、B两组治躁动的有效率高于C组（P〈0．05）;与用药前比较,三组患者用药后VAS评分均降低（P〈0．05）,C组VAS评分高于A、B两组;Ramsay镇静评分均升高,B组Ramsay镇静评分高于A、C两组（P〈0．05）;B组苏醒时间较长。结论帕瑞昔布钠联合丙泊酚是治疗苏醒期躁动较为安全有效的药物组合,芬太尼加丙泊酚效果较好,但可出现一过性呼吸抑制,且苏醒时间较长,而曲马多加丙泊酚治疗效果欠佳。     

不同浓度七氟醚对小儿全麻苏醒期躁动发生率的影响

目的探讨不同浓度的七氟醚对小儿全麻苏醒期躁动发生率的影响。方法选择择期在全麻下行小儿骨科、会阴或下腹部手术患儿88例,随机分成A、B两组,每组各44例。所有患儿术前均不给药。采用面罩吸入浓度为1%～7%七氟醚+1.5%氧气作全麻诱导,至睫毛反应消失。开放静脉通道后即泵入瑞芬太尼。A、B两组患者呼气末的七氟醚浓度分别维持在0.5最低肺泡有效浓度(MAC)、1MAC,监测各项生命体征,维持患儿辅助呼吸及呼气末CO2(ETCO2)。观察两组患者麻醉平稳、呼吸抑制的程度、血流动力学的稳定性、药物用量和苏醒情况。结果两组患者术中麻醉效果佳,血流动力学稳定。A组患者苏醒期躁动发生率为11.3%(5/44),显著低于B组的36.4%(16/44),两者比较差异有统计学意义(P<0.05)。两组间的睁眼时间及离室时间的比较差异均有统计学意义(P<0.05),两组患者七氟醚及瑞芬太尼用量比较差异有统计学意义(P<0.01),而两组的体动反应、呼吸抑制发生例数及手术时间比较差异无统计学意义(P>0.05)。结论低浓度七氟醚联合瑞芬太尼应用于小儿吸入复合麻醉的麻醉效果平稳,苏醒快,安全性高,躁动发生率较高浓度七氟醚低,且可减少药物用量。     

Stabilization of tetanus toxoid formulation containing aluminium hydroxide adjuvant against agitation

The aggregation of tetanus toxoid leads to reduced bioavailability of the vaccine and failure of immunization programmes in many parts of the globe. One of the main reasons for denaturation and aggregation of tetanus toxoid formulations is agitation of the protein during transport. We have identified that agitation leads to collapse of the gel matrix of aluminium hydroxide which is used as an adjuvant in these preparations. This results in desorption of the toxoid from the matrix, which then loses its antigenicity due to agitation-induced denaturation of the protein. We show that incorporation of some compatible osmolytes like sorbitol, glucose and arginine, but not trehalose, is able to protect the adjuvant matrix from degradation, and retain the integrity of the vaccine preparation in terms of its antigenicity.     

复方利多卡因乳膏预防全麻术后躁动和咽喉疼痛的临床观察

目的：观察复方利多卡因乳膏在预防全麻术后躁动和咽喉疼痛方面的临床效果。方法：将我院200例按美国麻醉师协会（ASA）分级标准评为Ⅰ～Ⅱ级的拟行气管插管全麻择期手术患者随机均分为A组和B组,2组均以咪唑安定、舒芬太尼、罗库溴铵、依托咪酯乳剂诱导,七氟醚、丙泊酚、瑞芬太尼维持麻醉。A组气管插管前用复方利多卡因乳膏2～3g均匀涂抹于气管导管套囊及前端,麻醉后用复方利多卡因乳膏1.5～2g均匀涂抹于导尿管外侧辅助导尿;B组常规气管插管及导尿。观察记录2组患者自主呼吸恢复时间、呼之睁眼时间、拔管时间、躁动程度评级、身体舒适度评分、术后24h咽喉疼痛程度评级,并观察2组不良反应。结果：2组患者手术结束后,自主呼吸恢复时间、呼之睁眼时间及拔管时间差异无统计学意义（P〉0.05）;而躁动程度评级和术后24h咽喉疼痛程度评级A组显著低于B组,身体舒适度评分A组显著高于B组,差异均有统计学意义（P〈0.05）。2组患者均未见明显过敏反应和局麻药中毒发生。结论：复方利多卡因乳膏可有效预防和减轻全麻患者术后躁动和咽喉疼痛的发生,且不良反应轻微。     

Detecting agitation and aggression in people with dementia using sensors—A systematic review

Agitation and aggression are among the most challenging symptoms of dementia. Agitated persons with dementia can harm themselves, their caregivers, or other patients in a care facility. Automatic detection of agitation would be useful to alert caregivers so that appropriate interventions can be performed. The building blocks in the automatic detection of agitation and aggression are appropriate sensing platforms and generalized predictive models. In this article, we perform a systematic review of studies that use different types of sensors to detect agitation and aggression in persons with dementia. We conclude that actigraphy shows some evidence of correlation with incidences of agitation and aggression; however, multimodal sensing has not been fully evaluated for this purpose. Based on this systematic review, we provide guidelines and recommendations for future research directions in this field.     

一次性网帽在躁动患者脉搏血氧饱和度监测中的应用

<正>脉搏血氧饱和度监测是利用近红外光谱吸光度原理持续动态地监测血液氧合情况的无创技术,脉搏血氧饱和度监测仪为指夹型,监测时将探头夹在患者手指或脚趾的甲床上,使传感器的光源正好对着指(趾)甲的根部,数秒钟后监