Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Incidence and Procedure-Related Risk Factors of Delirium in Patients Admitted to an Intensive Care Unit

중환자실 입원 환자의 섬망 발생과 처치 관련 위험인자

  • Ahn, Jee Seon (Graduate Program in Cognitive Science, Yonsei University) ;
  • Oh, Jooyoung (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Park, Jaesub (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Kim, Jae-Jin (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Park, Jin Young (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine)
  • 안지선 (연세대학교 대학원 인지과학 협동과정) ;
  • 오주영 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 박재섭 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 김재진 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 박진영 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소)
  • Received : 2018.12.24
  • Accepted : 2019.06.25
  • Published : 2019.06.30
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Abstract

Objectives : Although delirium is a common complication among patients hospitalized in intensive care units(ICUs), little is known about the roles that diagnostic and therapeutic procedures play in its development. This study investigates the procedure-related risk factors of delirium in ICU patients. Methods : All the consecutive patients admitted to the ICU between June 2016 and May 2017 were routinely evaluated for delirium by psychiatrists. In total, 1156 patients met the inclusion criteria and were retrospectively analyzed. A multiple logistic regression analysis was conducted to investigate independent risk factors of delirium development while adjusting for other characteristics. Results : The age, Acute Physiology and Chronic Health Evaluation (APACHE II) score, proportion of patients who had undergone an operation, and proportion of patients who were foley catheterized, mechanically ventilated, and physically restrained were higher in the delirium group. The multiple logistic regression analysis confirmed that the use of restraint was an independent risk factor of delirium (odds ratio : 10.006 ; 95% confidence interval : 6.120-16.360 ; p<0.001). The patient factors independently associated with delirium were an advanced age and a higher APACHE II score. The incidence of delirium was 15.3%. Conclusions : There is a high prevalence of delirium influenced by potentially harmful procedures in patients in ICU settings. The use of physical restraint had the strongest association with the development of delirium. These findings advocate the need to target procedure-related risk factors such as the use of restraints as preventive intervention measures for ICU delirium.

연구목적 섬망은 중환자실에서 흔히 발생하는 것으로 알려져 있으나, 중환자실에서 일반적으로 수행되는 처치(procedure)와 섬망 발생 사이의 연관성을 조사한 연구는 아직까지 부족한 실정이다. 본 연구는 중환자실의 처치를 중점으로 섬망의 위험인자를 조사하기 위하여 후향적 관찰 연구를 시행하였다. 방 법 2016년 6월부터 2017년 5월까지 강남세브란스병원 중환자실에 입원한 환자 중 선정기준을 만족하는 1,156명의 환자를 포함하였으며, 섬망은 중환자실에 입실한 환자 전수를 정신건강의학과 전문의가 매일 규칙적으로 평가하였다. 문헌 고찰을 통해 선정한 섬망의 처치 관련 위험인자(risk factors for procedure-related)에 대한 노출 여부를 섬망 발생에 따라 비교하고, 유의한 차이를 보이는 변수에 대해 다중 로지스틱 회귀분석을 시행하여 섬망 발생 위험 확률을 높이는 요인을 확인하였다. 결 과 섬망 발생에 따라 유의한 차이를 보인 요인은 연령, 중증도, 수술 여부, 배액관 삽입, 도뇨관 삽입, 기관내 삽관과 신체 억제대가 있었다. 다중 로지스틱 회귀분석 결과에서 환자의 연령, 질병의 중증도와 신체 억제대 사용은 독립적으로 섬망 발생 위험 확률을 높이는 것으로 나타났다. 섬망 발생률은 15.3%였다. 결 론 신체 억제대의 사용은 중환자실 환자의 섬망 발생 위험 확률을 높이는 데 크게 기여하는 것으로 보인다. 이러한 결과는 중환자실의 섬망을 중재하기 위하여 연령과 중증도가 높은 고위험군에 대한 최소한의 신체 억제대 사용과 집중적인 관찰의 필요성을 시사한다.

Keywords

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Fig. 1. The fow chart of study inclusion.

Table 1. Comparison patient and procedure characteristics between delirium group and non-delirium group

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Table 2. Multivariate logistic regression analysis of risk factors related to delirium

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