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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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.	刘贞, 孟素秋, 杨圣强, 等. 早期活动对慢性阻塞性肺疾病急性加重机械通气患者谵妄及呼吸力学影响的前瞻性研究. 中国呼吸与危重监护杂志, 2016, 15(4): 324-328.
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7.	刘竞, 李勇, 蔡燕, 等. 转出重症监护病房的多发伤谵妄患者血清 S100B 水平对其临床预后的预测价值. 中华医学杂志, 2018, 98(9): 692-695.
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10.	杨磊, 张茂. 2013 年美国 ICU 成年患者疼痛、躁动和谵妄处理指南. 中华急诊医学杂志, 2013, 22(12): 1325-1326.
11.	惠姣洁, 严正, 臧芝栋, 等. 血浆 BDNF、NSE 和 S100β 的动态变化与 ICU 患者谵妄发生的关系研究. 中华急诊医学杂志, 2018, 27(10): 1132-1135.
12.	刘晓江, 吕杰, 安友仲. ICU 谵妄患者临床脑功能监测指标的探索: 一项前瞻性病例对照研究. 中华危重病急救医学, 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.	汤铂, 王小亭, 陈文劲, 等. 重症患者谵妄管理专家共识. 中华内科杂志, 2019, 58(2): 108-118.
15.	张玉琴, 马君芳, 孟艳艳. 中度创伤性脑损伤患者血清神经元特异性烯醇化酶、S100-β 蛋白变化及其与认知功能障碍的相关性. 中华创伤杂志, 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.	刘卫华, 杜良琴, 莫娴婷, 等. 术后谵妄与脑损伤相关生物学标记物关系分析. 中国实用医药, 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. 刘贞, 孟素秋, 杨圣强, 等. 早期活动对慢性阻塞性肺疾病急性加重机械通气患者谵妄及呼吸力学影响的前瞻性研究. 中国呼吸与危重监护杂志, 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. 冯清, 吴龙, 艾宇航, 等. 神经元特异性烯醇化酶、中枢神经特异蛋白与白细胞介素-6 在脓毒症相关性脑病中的诊断价值. 中华内科杂志, 2017, 56(10): 747-751.
7. 刘竞, 李勇, 蔡燕, 等. 转出重症监护病房的多发伤谵妄患者血清 S100B 水平对其临床预后的预测价值. 中华医学杂志, 2018, 98(9): 692-695.
8. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南 (2013 年修订版). 中华结核和呼吸杂志, 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. 杨磊, 张茂. 2013 年美国 ICU 成年患者疼痛、躁动和谵妄处理指南. 中华急诊医学杂志, 2013, 22(12): 1325-1326.
11. 惠姣洁, 严正, 臧芝栋, 等. 血浆 BDNF、NSE 和 S100β 的动态变化与 ICU 患者谵妄发生的关系研究. 中华急诊医学杂志, 2018, 27(10): 1132-1135.
12. 刘晓江, 吕杰, 安友仲. ICU 谵妄患者临床脑功能监测指标的探索: 一项前瞻性病例对照研究. 中华危重病急救医学, 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. 汤铂, 王小亭, 陈文劲, 等. 重症患者谵妄管理专家共识. 中华内科杂志, 2019, 58(2): 108-118.
15. 张玉琴, 马君芳, 孟艳艳. 中度创伤性脑损伤患者血清神经元特异性烯醇化酶、S100-β 蛋白变化及其与认知功能障碍的相关性. 中华创伤杂志, 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. 刘卫华, 杜良琴, 莫娴婷, 等. 术后谵妄与脑损伤相关生物学标记物关系分析. 中国实用医药, 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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