The risk factors of delirium in mechanical ventilation patients with chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YUAN Jiyin ,  LIU Jinggang , ZHANG Guizhen , YANG Shengqiang , YANG Wenbao

Department of Intensive Care Unit, Affiliated Huxi Hospital of Jining Medical College (Shanxian Central Hospital), Shanxian, Shandong 274300, P. R. China;

Corresponding?author：

LIU Jinggang, Email: sxzxyyicu2010@163.com

Keywords：

Pulmonary disease, Chronic obstructive; Respiration, Artificial; Delirium; Risk factors

DOI：

10.7507/1671-6205.201901010

Video：

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Objective To investigate the risk factors of delirium in mechanical ventilation patients with chronic obstructive pulmonary disease (COPD).Methods A total of 97 mechanically ventilated non-hypertensive patients with COPD who were admitted to this department from January 2018 to October 2018 were selected as subjects. The patients were divided into 49 cases with delirium and 48 cases non-delirium according to the Consciousness Assessment Method for the Intensive Care Uint. The examined data were collected in the patients such as pH, arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), neuron-specific enolase (NSE), and Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) scores were calculated in the pre-mechanical (d₀) and mechanically ventilated 3rd (d₃), 5th (d₅) days. The mechanical ventilation days were recorded in the two groups. Logistic regression analysis was used to screen the risk factors influencing delirium of patients.Results The PaCO₂, NSE, APACHEⅡ scores and mechanical ventilation days were higher in the delirium group than in the non-delirium group ［(88.1±7.5) vs. (85.3±6.2) mm Hg; (28.4±5.8) vs. (26.1±3.3) μg/L; (23.7±3.9) vs. (21.7±2.6); (7.5±1.3) d vs. (6.6±1.2) d］ and PaO₂ were lower than non-delirium group ［(54.9±5.5) vs. (57.2±3.1) mm Hg］, the differences were statistically significant (P<0.05). Multivariate logistic regression analysis showed that PaO₂, NSE, APACHEⅡ scores and mechanical ventilation days were risk factors for delirium in mechanically ventilated patients with COPD (regression coefficients were –0.177, 0.163, 0.203, 0.597 respectively, P<0.05). The PaO₂ and APACHEⅡ scores of mechanical ventilation on the 3rd and 5th day of the two groups ［d₃ (88.3±5.3) vs. (89.1±6.9) mm Hg; d₅ (90.3±9.0) vs. (91.3±6.4) mm Hg; d3 (21.7±3.0) vs. (21.4±2.2); d₅ (20.9±2.8) vs. (20.7±2.1)］ were not statistically significant (P>0.05).The NSE changes on the 3rd and 5th day of mechanical ventilation ［d₃ (30.0±5.3) vs. (26.8±3.6) μg/L; d₅ (27.3±4.3) vs. (25.7±2.6) μg/L］ were statistically significant (P<0.05).Conclusion PaO₂, NSE, APACHEⅡ score and mechanical ventilation days are risk factors for delirium in COPD patients with mechanical ventilation and NSE is one of the more important risk factors.

Citation： YUAN Jiyin, LIU Jinggang, ZHANG Guizhen, YANG Shengqiang, YANG Wenbao. The risk factors of delirium in mechanical ventilation patients with chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(6): 522-526. doi: 10.7507/1671-6205.201901010 Copy

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10.	楊磊, 張茂. 2013 年美國 ICU 成年患者疼痛、躁動和譫妄處理指南. 中華急診醫學雜志, 2013, 22(12): 1325-1326.
11.	惠姣潔, 嚴正, 臧芝棟, 等. 血漿 BDNF、NSE 和 S100β 的動態變化與 ICU 患者譫妄發生的關系研究. 中華急診醫學雜志, 2018, 27(10): 1132-1135.
12.	劉曉江, 呂杰, 安友仲. ICU 譫妄患者臨床腦功能監測指標的探索: 一項前瞻性病例對照研究. 中華危重病急救醫學, 2017, 29(4): 347-352.
13.	Puntillo KA, Arai S, Cohen NH, et al. Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med, 2010, 38(11): 2155-2160.
14.	湯鉑, 王小亭, 陳文勁, 等. 重癥患者譫妄管理專家共識. 中華內科雜志, 2019, 58(2): 108-118.
15.	張玉琴, 馬君芳, 孟艷艷. 中度創傷性腦損傷患者血清神經元特異性烯醇化酶、S100-β 蛋白變化及其與認知功能障礙的相關性. 中華創傷雜志, 2017, 10(33): 886-889.
16.	Grandi C, Tomasi CD, Fernandes K, et al. Brain-derived neurotrophic factor and neuron-specific enolase, but not S100beta, levels are associated to the occurrence of delirium in intensive care unit patients. J Crit Care, 2011, 26(2): 133-137.
17.	Rasmussen LS, Christiansen M, Rasmussen H, et al. Do blood concentrations of neuron specific enolase and S-100 beta protein reflect cognitive dysfunction after abdominal surgery?. Br J Anaesth, 2000, 84(2): 242-244.
18.	劉衛華, 杜良琴, 莫嫻婷, 等. 術后譫妄與腦損傷相關生物學標記物關系分析. 中國實用醫藥, 2015, 6(10): 30-31.
19.	Jiang ZF, Wang M, Xu JL. Thymidine kinase 1 combined with CEA, CYFRA21-1 and NSE improved its diagnostic value for lung cancer. Life Sci, 2018, 194: 1-6.

1. Jackson P, Khan A. Delirium in critically ill patients. Crit Care Clin, 2015, 31(3): 589-603.
2. Inouye S, Robinson T, Blaum C, et al. American geriatrics society abstracted clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc, 2015, 63(1): 142-150.
3. 劉貞, 孟素秋, 楊圣強, 等. 早期活動對慢性阻塞性肺疾病急性加重機械通氣患者譫妄及呼吸力學影響的前瞻性研究. 中國呼吸與危重監護雜志, 2016, 15(4): 324-328.
4. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1): 263-306.
5. Van Rompaey B, Elseviers MM, Schuurmans MJ, et al. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care, 2009, 13(3): R77.
6. 馮清, 吳龍, 艾宇航, 等. 神經元特異性烯醇化酶、中樞神經特異蛋白與白細胞介素-6 在膿毒癥相關性腦病中的診斷價值. 中華內科雜志, 2017, 56(10): 747-751.
7. 劉競, 李勇, 蔡燕, 等. 轉出重癥監護病房的多發傷譫妄患者血清 S100B 水平對其臨床預后的預測價值. 中華醫學雜志, 2018, 98(9): 692-695.
8. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南 (2013 年修訂版). 中華結核和呼吸雜志, 2013, 36(4): 255-264.
9. Boettger S, Nunez DG, Meyer R, et al. Delirium in the intensive care setting: A reevaluation of the validity of the CAM-ICU and ICDSC versus the DSM-IV-TR in determining a diagnosis of delirium as part of the daily clinical routine. Palliat Support Care, 2017, 16(1): 1-9.
10. 楊磊, 張茂. 2013 年美國 ICU 成年患者疼痛、躁動和譫妄處理指南. 中華急診醫學雜志, 2013, 22(12): 1325-1326.
11. 惠姣潔, 嚴正, 臧芝棟, 等. 血漿 BDNF、NSE 和 S100β 的動態變化與 ICU 患者譫妄發生的關系研究. 中華急診醫學雜志, 2018, 27(10): 1132-1135.
12. 劉曉江, 呂杰, 安友仲. ICU 譫妄患者臨床腦功能監測指標的探索: 一項前瞻性病例對照研究. 中華危重病急救醫學, 2017, 29(4): 347-352.
13. Puntillo KA, Arai S, Cohen NH, et al. Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med, 2010, 38(11): 2155-2160.
14. 湯鉑, 王小亭, 陳文勁, 等. 重癥患者譫妄管理專家共識. 中華內科雜志, 2019, 58(2): 108-118.
15. 張玉琴, 馬君芳, 孟艷艷. 中度創傷性腦損傷患者血清神經元特異性烯醇化酶、S100-β 蛋白變化及其與認知功能障礙的相關性. 中華創傷雜志, 2017, 10(33): 886-889.
16. Grandi C, Tomasi CD, Fernandes K, et al. Brain-derived neurotrophic factor and neuron-specific enolase, but not S100beta, levels are associated to the occurrence of delirium in intensive care unit patients. J Crit Care, 2011, 26(2): 133-137.
17. Rasmussen LS, Christiansen M, Rasmussen H, et al. Do blood concentrations of neuron specific enolase and S-100 beta protein reflect cognitive dysfunction after abdominal surgery?. Br J Anaesth, 2000, 84(2): 242-244.
18. 劉衛華, 杜良琴, 莫嫻婷, 等. 術后譫妄與腦損傷相關生物學標記物關系分析. 中國實用醫藥, 2015, 6(10): 30-31.
19. Jiang ZF, Wang M, Xu JL. Thymidine kinase 1 combined with CEA, CYFRA21-1 and NSE improved its diagnostic value for lung cancer. Life Sci, 2018, 194: 1-6.

Chinese Journal of Respiratory and Critical Care Medicine

The risk factors of delirium in mechanical ventilation patients with chronic obstructive pulmonary disease

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