Öznur ERBAY DALLI, Gülbahar ÇALIŞKAN, Yasemin YILDIRIM, Nermin KELEBEK GİRGİN

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

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.

Anahtar Kelimeler:

deliryum, yoğun bakım, hemşirelik

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

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.

Keywords:

deliryum, yoğun bakım, hemşirelik,

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