Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jul 19, 2024; 14(7): 1027-1033
Published online Jul 19, 2024. doi: 10.5498/wjp.v14.i7.1027
High-risk factors for delirium in severely ill patients and the application of emotional nursing combined with pain nursing
Hong-Ru Li, Yu Guo
Hong-Ru Li, Yu Guo, Emergency Intensive Care Unit, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou 215000, Jiangsu Province, China
Author contributions: Li HR designed the research study; Li HR and Guo Y performed the research; Li HR and Guo Y contributed new reagents and analytical tools; Li HR and Guo Y analyzed the data and wrote the manuscript; and all authors have read and approved the final version of the manuscript.
Institutional review board statement: This retrospective study was reviewed and approved by the Ethics Committee of the Fourth Affiliated Hospital of Soochow University (Approval No. 2024241010).
Informed consent statement: All the patients signed an informed consent form before inclusion in the study.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: No other data provided.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu Guo, MNurs, Nurse, Emergency Intensive Care Unit, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), No. 9 Chongwen Road, Suzhou Industrial Park, Suzhou 215000, Jiangsu Province, China. 17715227037@163.com
Received: April 1, 2024
Revised: May 15, 2024
Accepted: June 4, 2024
Published online: July 19, 2024
Processing time: 101 Days and 17.6 Hours
Abstract
BACKGROUND

Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset, rapid progression, obvious fluctuations, and preventable, reversible, and other characteristics. Patients with delirium in the intensive care unit (ICU) are often missed or misdiagnosed and do not receive adequate attention.

AIM

To analyze the risk factors for delirium in ICU patients and explore the application of emotional nursing with pain nursing in the management of delirium.

METHODS

General data of 301 critically ill patients were retrospectively collected, including histories (cardiovascular and cerebrovascular diseases, hypertension, smoking, alcoholism, and diabetes), age, sex, diagnosis, whether surgery was performed, and patient origin (emergency/clinic). Additionally, the duration of sedation, Richmond Agitation Sedation Scale score, combined emotional and pain care, ventilator use duration, vasoactive drug use, drainage tube retention, ICU stay duration, C-reactive protein, procalcitonin, white blood cell count, body temperature, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission. Patients were assessed for delirium according to confusion assessment method for the ICU, and univariate and multivariate logistic regression analyses were performed to identify the risk factors for delirium in the patients.

RESULTS

Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients. The results showed that 16 risk factors were closely related to delirium, including combined emotional and pain care, history of diabetes, and patient origin. Multivariate logistic regression analysis revealed that no combined emotional and pain care, history of diabetes, emergency source, surgery, long stay in the ICU, smoking history, and high APACHE II score were independent risk factors for delirium in ICU patients.

CONCLUSION

Patients with diabetes and/or smoking history, postoperative patients, patients with a high APACHE II score, and those with emergency ICU admission need emotional and pain care, flexible visiting modes, and early intervention to reduce delirium incidence.

Keywords: Critical illness; Delirium; Risk factor; Intensive care unit; Emotional nursing; Pain nursing

Core Tip: Delirium incidence in intensive care unit (ICU) patients remains high and seriously affects their prognosis. To reduce the incidence of delirium in ICU patients, medical staff should be fully aware of delirium in critically ill patients and intervene it promptly. Medical staff should focus on the influence of combined emotional and pain care on delirium occurrence and establish individualized flexible visitation modes according to the patient’s situation. We found that history of diabetes, smoking history, emergency referral to the ICU, surgery, long stay in the ICU, and high Acute Physiology and Chronic Health Evaluation II score were identified to be risk factors for delirium in critically ill patients.