Effect of cluster-based nursing strategy for sedation and analgesia on delirium in patients on mechanical ventilation after traumatic brain injury
GUO Shanshan1, ZHANG Dan2, YE Qi3, LI Na2, ZHU Chenghong3, SONG Xupeng4, TU Yue5, PANG Xipeng5
1.Medical Examination Center,2. Endoscopy Room,3. Nursing Department, Featured Medical Center of PLA Rocket Force, Beijing 100088, China; 4. Second Brigade of Logistics College of PAP, Tianjin 300162, China; 5. Neurological ICU of Featured Medical Center of PAP, Tianjin 300162, China
Abstract：Objective To evaluate the effect of cluster-based nursing strategies for sedation and analgesia on delirium in patients on mechanical ventilation after traumatic brain injury.Methods Ninety patients with traumatic brain injury who were transferred to the ICU between April 2017 and April 2018 and received mechanical ventilation were selected using the convenient sampling method. They were given routine nursing and cluster-based sedation and analgesia nursing. Another 90 patients on mechanical ventilation after traumatic brain injury were treated with routine nursing as control group. Age, sex, length of ICU stay, APACHE Ⅱ score, the incidence of delirium, duration of mechanical ventilation, types and duration of delirium were recorded.Results There was no significant difference in age, sex, duration of mechanical ventilation and APACHE Ⅱ score between the two groups (P>0.05). The length of ICU stay in the intervention group was significantly shorter than that in the control group [(12.86±3.24)d vs (16.24±2.63)d, P<0.05]. Compared with the control group, the number of cases of delirium in the intervention group was significantly reduced (52% vs 66%, P<0.05), and the duration of delirium was significantly shorter [(3.27±0.59)d vs (4.79±0.52)d, P<0.05]. There was no significant difference in the types of delirium (P>0.05).Conclusions Cluster-based nursing for sedation and analgesia can effectively shorten the duration of delirium in patients on mechanical ventilation after traumatic brain injury, and reduce the incidence of delirium and ICU stay.
Klein K P,Zaal I J,Spitoni C,et al.The attributable mortality of delirium in critically ill patients: prospective cohort study[J]. BMJ, 2014, 349: g6652.
Pandharipande P P,Girard T D,Jackson J C,et al. Long-term cognitive impairment after critical illness[J]. N Engl J Med,2013, 369(14): 1306-1316.
[4]
Balas M,Buckingham R,Braley T,et al. Extending the ABCDE bundle to the post-intensive care unit setting[J]. J Gerontol Nurs,2013, 39(8): 39-51.
[5]
Balas M C,Vasilevskis E E,Burke W J,et al. Critical care nurses’ role in implementing the “ABCDE bundle” into practice[J]. Crit Care Nurse,2012, 32(2): 35-38.
Wang W,Li H L,Wang D X,et al. Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial[J]. Crit Care Med,2012, 40(3): 731-739.
Esteban A,Anzueto A,Alía I,et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review[J]. Am J Respir Crit Care Med,2000, 161(5): 1450-1458.
[10]
Yang L,Ye L,Zheng Z,et al. Evaluation of the effectiveness and safety of the awakening and breathing coordination,delirium monitoring/management,and early exercise/mobility bundle: several confounders to be considered[J]. Crit Care Med,2014, 42(10): e680-681.
[11]
Balas M C,Vasilevskis E E,Olsen K M,et al. Effectiveness and safety of the awakening and breathing coordination,delirium monitoring/management,and early exercise/mobility bundle[J]. Crit Care Med,2014, 42(5): 1024-1036.
Pandharipande P,Banerjee A,McGrane S,et al. Liberation and animation for ventilated ICU patients: the ABCDE bundle for the back-end of critical care[J]. Crit Care,2010, 14(3): 157-159.
[16]
Davidson J E,Harvey M A,Bemis-Dougherty A,et al. Implementation of the pain,agitation,and delirium clinical practice guidelines and promoting patient mobility to prevent post-intensive care syndrome[J]. Crit Care Med,2013, 41(9 Suppl 1): 136-145.
2019, Vol. 30 
