Measures of Salivary Cortisol Predict the Development of Delirium in the Intensive Care Unit

• Main Authors: Yang, Ning-Chi, 楊濘綺
• Other Authors: Wang, Jeng
• Format: Others
• Language: zh-TW
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/25855161342750187576

碩士 === 長庚科技大學 === 護理研究所 === 100 === Delirium is a deleterious complication among critically ill patients. As patients at intensive care units (ICUs) developing delirium, those patients may suffer from prolonged use of mechanical ventilation and increased mortality. This study aimed to establish the incidence rate of delirium and its risk factors at surgical ICUs, with special interests in determining the association between salivary Cortisol level and the occurrence of delirium. A prospective and a repeated measure design were applied at surgical ICUs of a medical center in southern Taiwan. Once patients admitted to the ICU within 24 hours were recruited, their demographics, severity of illness, and the use of medication were collected. The CAM-ICU and the salivary Cortisol were used twice a day to measure the occurrence of delirium for 5 consecutive days. As a result, 40 patients (mean= 68 years) were involved in the study. Totally 187 patient days were recorded. There were 21 subjects developing delirium, 52.3% of incidence rate was established, and 16 (72.6%) of 40 patients having delirium at the first days of admission to surgical ICUs. The symptom usually lasted for 2 days, without specific time period in a day. The most common type of delirium was hypoactive (57.1%). The risk factors were identified by a multivariable logistic regression with GEE method. Cortisol level (OR：3.387，CI：1.256-9.129，p<0.05), and physical restraints (OR：3.823，CI：1.335-10.946，p<0.05); and used mechanical ventilation(OR：1.609，CI：1.190-2.177，p<0.05) were significantly associated with the development of delirium. We only used the delirium and salivary Cortisol in the multivariate analysis with GEE method, we found the salivary Cortisol may be predicted the occurrence of delirium (OR：1.839，CI：1.049-3.222，p<0.05，per 0.001 ug /dl increase) In conclusion, delirium is a serious medical issue in the surgical ICUs. Salivary Cortisol may be used as a screening tool to detect the occurrence of delirium in surgical ICU patients. Detection and recognition of delirium in a timely manner is important for health care professionals.