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Yoğun Bakım Deliryumunun Erken Tespitinde Rekalibre PRE-DELIRIC Modelinin Prospektif Değerlendirilmesi

Yıl 2023, Cilt: 49 Sayı: 1, 55 - 61, 09.06.2023
https://doi.org/10.32708/uutfd.1247178

Öz

Deliryum, yoğun bakımda (YB) önemli bir sorundur ve artan mekanik ventilasyon (MV) süresi, daha yüksek mortalite ve daha uzun süreli bilişsel işlev bozukluğu gibi olumsuz hasta sonuçları ile ilişkilidir. Bu nedenle deliryumun erken tespiti önem arz etmektedir. Bu çalışmanın amacı, bir deliryum erken tespit modelinin YB hastalarında öngörü yeteneğini prospektif olarak değerlendirmektir. Araştırma, tek merkezli prospektif olarak Mart 2022-Mayıs 2022 tarihleri arasında yürütüldü. Araştırmanın yürütüldüğü tarih aralığında YB’ne kabulü yapılan ve 24 saatten fazla izlenmesi beklenen, 18 yaş üstü hastalar çalışmaya dâhil edildi. Araştırmanın verileri; “Hasta Tanıtım Formu”, “Yoğun Bakım Ünitesinde Konfüzyon Değerlendirme Metodu”, “Richmond Ajitasyon Sedasyon Skalası” ve rekalibre edilmiş “PRE-DELIRIC model” ile toplandı. Araştırmanın örneklemini belirtilen tarih aralığında dâhil edilme kriterlerine uyan 188 hasta oluşturdu. Deliryumlu hastalarda ortalama PRE-DELIRIC skoruna göre (30.32±8.36) ROC eğrisi altındaki alan (AUROC), modelin deliryumu öngörmedeki ayırt edici gücünün 0.937 (%95 güven aralığı: 0.903-0.972) olarak anlamlı olduğunu gösterdi (p=0.001). Modelin %19 kesme değeri ile duyarlılığının %87.5, özgüllüğünün %87.1 olduğu saptandı. Sonuç olarak, rekalibre edilmiş PRE-DELIRIC modelin, YB hastalarında deliryum riskini belirlemede iyi ayırt edicilik özellikler gösterdiği belirlenmiştir. Hesaplaması kolay bu model, hemşirelerin ve hekimlerin YB hastalarında deliryum riskini tahmin etmesine ve erken dönemlerde gerekli önlemleri almalarına yardımcı olacaktır.

Destekleyen Kurum

Bu araştırmada herhangi bir destek alınmamıştır.

Kaynakça

  • 1. Reznik ME, Slooter AJC. Delirium Management in the ICU. Curr Treat Options Neurol. 2019;21(11):59.
  • 2. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018;46(9):e825-e873.
  • 3. Salluh JI, Wang H, Schneider EB, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015;350:h2538.
  • 4. Park SY, Lee HB. Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines. Acute Crit Care. 2019;34(2):117-125.
  • 5. Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370-1379.
  • 6. Zamoscik K, Godbold R, Freeman P. Intensive care nurses' experiences and perceptions of delirium and delirium care. Intensive Crit Care Nurs. 2017;40:94-100.
  • 7. Elliott SR. ICU delirium: a survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit. Intensive Crit Care Nurs. 2014;30(6):333-338.
  • 8. Trogrlić Z, Ista E, Ponssen HH, et al. Attitudes, knowledge and practices concerning delirium: a survey among intensive care unit professionals. Nurs Crit Care. 2017;22(3):133-140.
  • 9. van den Boogaard M, Pickkers P, Slooter AJ, et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ. 2012;344:e420.
  • 10. van den Boogaard M, Schoonhoven L, Maseda E, et al. Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study. Intensive Care Med. 2014;40(3):361-369.
  • 11. Linkaitė G, Riauka M, Bunevičiūtė I, Vosylius S. Evaluation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for the patients in the intensive care unit. Acta Med Litu. 2018;25(1):14-22.
  • 12. Cowan SL, Preller J, Goudie RJB. Evaluation of the E-PRE-DELIRIC prediction model for ICU delirium: a retrospective validation in a UK general ICU. Crit Care. 2020;24(1):123.
  • 13. İnal MT, Memiş D, İnal V et al. Evaluation of Pre-Delirium Score in Intensive Care Patients. J Turk Soc Intens Care. 2018;16(1):26-29.
  • 14. Sayılan S, Ozen V, Tosun B, Aydın Sayılan, A, Ozen N. Evaluation of the PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model in intensive care units in Turkey. Authorea. 2021;14:1-7.
  • 15. Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370-1379.
  • 16. Akıncı SB, Rezaki M, Özdemir H, ark. Yoğun Bakım Ünitesinde Konfüzyon Değerlendirme Ölçeğinin Geçerlik Güvenilirlik Çalışması. Türk Anest Rean Der. 2005;33(4): 333-341.
  • 17. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338-1344.
  • 18. Sılay F, Akyol A. Yoğun Bakım Ünitelerinde Sedasyon-Ajitasyon ve Ağrı Değerlendirmesinde Kullanılan İki Ölçüm Aracının Türkçe’ye Uyarlanması: Geçerlik ve Güvenirlik Çalışması. Yoğun Bakım Hemşireliği Dergisi. 2018;22(2):50-65.
  • 19. Smit L, Wiegers EJA, Trogrlic Z, et al. Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study. J Intensive Care. 2022;10(1):54.
  • 20. Mercadante S, Ferrera P, Villari P, Casuccio A, Intravaia G, Mangione S. Frequency, indications, outcomes, and predictive factors of opioid switching in an acute palliative care unit. J Pain Symptom Manage. 2009;37(4):632-641.
  • 21.Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5(9):1315-1316.
  • 22.Liang S, Chau JPC, Lo SHS, Bai L, Yao L, Choi KC.Validation of PREdiction of DELIRium in ICu patients (PRE-DELIRIC) among patients in intensive care units: A retrospective cohort study. Nurs Crit Care. 2021;26(3):176-182.
  • 23.Sosa FA, Roberti J, Franco MT, Kleinert MM, Patrón AR,Osatnik J. Assessment of delirium using the PRE-DELIRICmodel in an intensive care unit in Argentina. Rev Bras Ter Intensiva. 2018;30(1):50-56.
  • 24.Wassenaar A, Schoonhoven L, Devlin JW, et al. Deliriumprediction in the intensive care unit: comparison of two delirium prediction models. Crit Care. 2018;22(1):114.
  • 25.Miyamoto K, Nakashima T, Shima N, et al. Utility of aprediction model for delirium in intensive care unit patients (PRE-DELIRIC) in mechanically ventilated patients with sepsis. Acute Med Surg. 2020;7(1):e589.
  • 26.Wilson JE, Mart MF, Cunningham C, et al. Delirium. Nat Rev Dis Primers. 2020;6(1):90.
  • 27.Magny E, Le Petitcorps H, Pociumban M, et al. Predisposing and precipitating factors for delirium in community-dwelling older adults admitted to hospital with this condition: A prospective case series. PLoS One. 2018;13(2):e0193034.
  • 28.Ormseth CH, LaHue SC, Oldham MA, Josephson SA,Whitaker E, Douglas VC. Predisposing and Precipitating Factors Associated With Delirium: A Systematic Review.JAMA Netw Open. 2023;6(1):e2249950.
  • 29.Zaal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43(1):40-47.
  • 30.Mattar I, Chan MF, Childs C. Risk factors for acute delirium incritically İll adult patients: a systematic review. International Scholarly Research Notices, 2013;2013:1-10.
  • 31.Olson T. Delirium in the intensive care unit: role of the critical care nurse in early detection and treatment. Dynamics. 2012;23(4):32-36.
  • 32.Özsaban A, Acaroglu R. Delirium assessment in intensive care units: practices and perceptions of Turkish nurses. Nurs Crit Care. 2016; 21(5): 271-278.

Prospective Evaluation of the Recalibrated PRE-DELIRIC Model for Early Detection of Intensive Care Delirium

Yıl 2023, Cilt: 49 Sayı: 1, 55 - 61, 09.06.2023
https://doi.org/10.32708/uutfd.1247178

Öz

Delirium is a common problem in intensive care units (ICU) and is associated with adverse patient outcomes such as increased mechanical ventilation (MV) duration, higher mortality, and greater longer-term cognitive dysfunction. Therefore, early detection of delirium is important. The aim of this study was to prospectively evaluate the predictive ability of a delirium early detection model in ICU patients. The study was conducted as a single-center prospective study between March 2022 and May 2022. The study included patients aged over 18 years who were admitted to the intensive care unit during the study period and expected to be followed up for longer than 24 hours. The data of the study were collected with the “Patient Identification Form”, “The Confusion Assessment Method for ICU”, “Richmond Agitation Sedation Scale” and the recalibrated “PRE-DELIRIC model”. The sample of the study consisted of 188 patients who met the inclusion criteria within the specified date range. The area under the ROC curve (AUROC) according to the mean PRE-DELIRIC score (30.32±8.36) in patients with delirium showed that the discriminative power of the model in predicting delirium was significant as 0.937 (95% confidence interval: 0.903-0.972) (p=0.001). In conclusion, it has been determined that the recalibrated PRE-DELIRIC model has good discriminative properties in determining the risk of delirium in ICU patients. This easy-to-calculate model will help nurses and physicians predict the risk of delirium in patients and take the necessary precautions in the early stages.

Kaynakça

  • 1. Reznik ME, Slooter AJC. Delirium Management in the ICU. Curr Treat Options Neurol. 2019;21(11):59.
  • 2. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018;46(9):e825-e873.
  • 3. Salluh JI, Wang H, Schneider EB, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015;350:h2538.
  • 4. Park SY, Lee HB. Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines. Acute Crit Care. 2019;34(2):117-125.
  • 5. Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370-1379.
  • 6. Zamoscik K, Godbold R, Freeman P. Intensive care nurses' experiences and perceptions of delirium and delirium care. Intensive Crit Care Nurs. 2017;40:94-100.
  • 7. Elliott SR. ICU delirium: a survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit. Intensive Crit Care Nurs. 2014;30(6):333-338.
  • 8. Trogrlić Z, Ista E, Ponssen HH, et al. Attitudes, knowledge and practices concerning delirium: a survey among intensive care unit professionals. Nurs Crit Care. 2017;22(3):133-140.
  • 9. van den Boogaard M, Pickkers P, Slooter AJ, et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ. 2012;344:e420.
  • 10. van den Boogaard M, Schoonhoven L, Maseda E, et al. Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study. Intensive Care Med. 2014;40(3):361-369.
  • 11. Linkaitė G, Riauka M, Bunevičiūtė I, Vosylius S. Evaluation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for the patients in the intensive care unit. Acta Med Litu. 2018;25(1):14-22.
  • 12. Cowan SL, Preller J, Goudie RJB. Evaluation of the E-PRE-DELIRIC prediction model for ICU delirium: a retrospective validation in a UK general ICU. Crit Care. 2020;24(1):123.
  • 13. İnal MT, Memiş D, İnal V et al. Evaluation of Pre-Delirium Score in Intensive Care Patients. J Turk Soc Intens Care. 2018;16(1):26-29.
  • 14. Sayılan S, Ozen V, Tosun B, Aydın Sayılan, A, Ozen N. Evaluation of the PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model in intensive care units in Turkey. Authorea. 2021;14:1-7.
  • 15. Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370-1379.
  • 16. Akıncı SB, Rezaki M, Özdemir H, ark. Yoğun Bakım Ünitesinde Konfüzyon Değerlendirme Ölçeğinin Geçerlik Güvenilirlik Çalışması. Türk Anest Rean Der. 2005;33(4): 333-341.
  • 17. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338-1344.
  • 18. Sılay F, Akyol A. Yoğun Bakım Ünitelerinde Sedasyon-Ajitasyon ve Ağrı Değerlendirmesinde Kullanılan İki Ölçüm Aracının Türkçe’ye Uyarlanması: Geçerlik ve Güvenirlik Çalışması. Yoğun Bakım Hemşireliği Dergisi. 2018;22(2):50-65.
  • 19. Smit L, Wiegers EJA, Trogrlic Z, et al. Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study. J Intensive Care. 2022;10(1):54.
  • 20. Mercadante S, Ferrera P, Villari P, Casuccio A, Intravaia G, Mangione S. Frequency, indications, outcomes, and predictive factors of opioid switching in an acute palliative care unit. J Pain Symptom Manage. 2009;37(4):632-641.
  • 21.Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5(9):1315-1316.
  • 22.Liang S, Chau JPC, Lo SHS, Bai L, Yao L, Choi KC.Validation of PREdiction of DELIRium in ICu patients (PRE-DELIRIC) among patients in intensive care units: A retrospective cohort study. Nurs Crit Care. 2021;26(3):176-182.
  • 23.Sosa FA, Roberti J, Franco MT, Kleinert MM, Patrón AR,Osatnik J. Assessment of delirium using the PRE-DELIRICmodel in an intensive care unit in Argentina. Rev Bras Ter Intensiva. 2018;30(1):50-56.
  • 24.Wassenaar A, Schoonhoven L, Devlin JW, et al. Deliriumprediction in the intensive care unit: comparison of two delirium prediction models. Crit Care. 2018;22(1):114.
  • 25.Miyamoto K, Nakashima T, Shima N, et al. Utility of aprediction model for delirium in intensive care unit patients (PRE-DELIRIC) in mechanically ventilated patients with sepsis. Acute Med Surg. 2020;7(1):e589.
  • 26.Wilson JE, Mart MF, Cunningham C, et al. Delirium. Nat Rev Dis Primers. 2020;6(1):90.
  • 27.Magny E, Le Petitcorps H, Pociumban M, et al. Predisposing and precipitating factors for delirium in community-dwelling older adults admitted to hospital with this condition: A prospective case series. PLoS One. 2018;13(2):e0193034.
  • 28.Ormseth CH, LaHue SC, Oldham MA, Josephson SA,Whitaker E, Douglas VC. Predisposing and Precipitating Factors Associated With Delirium: A Systematic Review.JAMA Netw Open. 2023;6(1):e2249950.
  • 29.Zaal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43(1):40-47.
  • 30.Mattar I, Chan MF, Childs C. Risk factors for acute delirium incritically İll adult patients: a systematic review. International Scholarly Research Notices, 2013;2013:1-10.
  • 31.Olson T. Delirium in the intensive care unit: role of the critical care nurse in early detection and treatment. Dynamics. 2012;23(4):32-36.
  • 32.Özsaban A, Acaroglu R. Delirium assessment in intensive care units: practices and perceptions of Turkish nurses. Nurs Crit Care. 2016; 21(5): 271-278.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Hemşirelik
Bölüm Özgün Araştırma Makaleleri
Yazarlar

Öznur Erbay Dallı 0000-0003-2282-0846

Gülbahar Çalışkan 0000-0002-0053-9087

Yasemin Yıldırım 0000-0002-8970-3743

Nermin Kelebek Girgin 0000-0002-5882-1632

Yayımlanma Tarihi 9 Haziran 2023
Kabul Tarihi 5 Mart 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 49 Sayı: 1

Kaynak Göster

APA Erbay Dallı, Ö., Çalışkan, G., Yıldırım, Y., Kelebek Girgin, N. (2023). Yoğun Bakım Deliryumunun Erken Tespitinde Rekalibre PRE-DELIRIC Modelinin Prospektif Değerlendirilmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 49(1), 55-61. https://doi.org/10.32708/uutfd.1247178
AMA Erbay Dallı Ö, Çalışkan G, Yıldırım Y, Kelebek Girgin N. Yoğun Bakım Deliryumunun Erken Tespitinde Rekalibre PRE-DELIRIC Modelinin Prospektif Değerlendirilmesi. Uludağ Tıp Derg. Haziran 2023;49(1):55-61. doi:10.32708/uutfd.1247178
Chicago Erbay Dallı, Öznur, Gülbahar Çalışkan, Yasemin Yıldırım, ve Nermin Kelebek Girgin. “Yoğun Bakım Deliryumunun Erken Tespitinde Rekalibre PRE-DELIRIC Modelinin Prospektif Değerlendirilmesi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49, sy. 1 (Haziran 2023): 55-61. https://doi.org/10.32708/uutfd.1247178.
EndNote Erbay Dallı Ö, Çalışkan G, Yıldırım Y, Kelebek Girgin N (01 Haziran 2023) Yoğun Bakım Deliryumunun Erken Tespitinde Rekalibre PRE-DELIRIC Modelinin Prospektif Değerlendirilmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49 1 55–61.
IEEE Ö. Erbay Dallı, G. Çalışkan, Y. Yıldırım, ve N. Kelebek Girgin, “Yoğun Bakım Deliryumunun Erken Tespitinde Rekalibre PRE-DELIRIC Modelinin Prospektif Değerlendirilmesi”, Uludağ Tıp Derg, c. 49, sy. 1, ss. 55–61, 2023, doi: 10.32708/uutfd.1247178.
ISNAD Erbay Dallı, Öznur vd. “Yoğun Bakım Deliryumunun Erken Tespitinde Rekalibre PRE-DELIRIC Modelinin Prospektif Değerlendirilmesi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49/1 (Haziran 2023), 55-61. https://doi.org/10.32708/uutfd.1247178.
JAMA Erbay Dallı Ö, Çalışkan G, Yıldırım Y, Kelebek Girgin N. Yoğun Bakım Deliryumunun Erken Tespitinde Rekalibre PRE-DELIRIC Modelinin Prospektif Değerlendirilmesi. Uludağ Tıp Derg. 2023;49:55–61.
MLA Erbay Dallı, Öznur vd. “Yoğun Bakım Deliryumunun Erken Tespitinde Rekalibre PRE-DELIRIC Modelinin Prospektif Değerlendirilmesi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi, c. 49, sy. 1, 2023, ss. 55-61, doi:10.32708/uutfd.1247178.
Vancouver Erbay Dallı Ö, Çalışkan G, Yıldırım Y, Kelebek Girgin N. Yoğun Bakım Deliryumunun Erken Tespitinde Rekalibre PRE-DELIRIC Modelinin Prospektif Değerlendirilmesi. Uludağ Tıp Derg. 2023;49(1):55-61.

ISSN: 1300-414X, e-ISSN: 2645-9027

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