Sedation in intensive care units and postoperative delirium

Cilj istraživanja: Ciljevi istraživanja su utvrditi vrste sedacije u jedinici intenzivnog liječenja OB Zadar u postoperativnih bolesnika te povezanost sedacije i pojave delirija. Utvrditi korelaciju između dužine boravka postoperativnih pacijenata u JIL-u i dužine boravka pacijenta na mehaničkoj ventilaciji s pojavom delirija. Utvrditi postoji li korelacija između individualnih čimbenika (dob, spol, ASA status, komorbiditeti) i vrste sedacije. Utvrditi postoji li korelacija između individualnih čimbenika (dob, spol, ASA status, komorbiditeti, primjena analgezije) i primjene Haldola. Ispitanici i metode: Istraživanje je provedeno retrospektivno uvidom u medicinsku dokumentaciju postoperativnih pacijenata hospitaliziranih u JIL-u u periodu od 1.1.2021. do 1.1.2022. godine. U istraživanom periodu u JIL-u hospitalizirano je 281 pacijent koji je bio na operativnom zahvatu. Iz medicinske dokumentacije prikupljeni su: individualni čimbenici (dob, spol, ASA status, komorbiditeti), vrsta kirurškog zahvata, vrsta i trajanje sedacije, dužina anestezije tijekom operativnog zahvata, analgezija tijekom boravka u JIL-u, ishod i dani boravka u JIL-u. Rezultati: U istraživanju je sudjelovalo 163 muškarca i 118 žena. Prosječna dob ispitanika bila je 63,7 godina. Abdominalnih kirurških zahvata bilo je 47%, neurokirurških zahvata 22,4%, torakalnih zahvata 11,4%, a ostalih manje od 5%. Prosjek boravka u JIL-u bio je 3,65 dana. Od toga su pacijenti primali kontinuiranu infuziju Midazolama 1,31 dan u kombinaciji sa Sufentanilom kojeg su primali 1,52 dana. Također primali su i Propofol 0,12 dana, Morphine 0,20 dana, Dexdor 0,1 dan, a Ketamin i Haldol manje od 0,1 dana. Da bi se spriječio razvoj delirija i okupirala bol kod pacijenta, pacijenti su 2,85 dana primali analgeziju. Samo 7% pacijenata nije primilo nikakvu anesteziju iza operativnog zahvata. Utvrđena je pojavnost delirija nisko povezana s dužinom boravka u JIL-u, a povezana je s postojanjem psihičke bolesti u anamnezi pacijenata. Rezultati pokazuju da postoji visoka povezanost između delirija i primjene Haldola u terapiji. Zaključak: Provedeno istraživanje pokazuje da je Midazolam u kombinaciji sa Sufentanilom i dalje prvi izbor u sedaciji postoperativnih pacijenata hospitaliziranih u JIL-u. Pojavnost delirija povezana je s anamnezom psihičkih bolesti, kao i s dobi pacijenta i ASA statusom, a izbor nadzora delirija je Haldol. Zbog ograničenog pristupa dokumentaciji rezultate treba tumačiti s oprezom. Potrebna su daljnja istraživanja s boljim pristupom podacimaThe aim of the research: The aims of the research were to determine the types of sedation in the intensive care unit of OB Zadar in postoperative patients and the relationship between sedation and the appearance of delirium. To determine the correlation between the length of stay of postoperative patients in the ICU, and the length of stay of the patient on mechanical ventilation with the onset of delirium. To determine whether there is a correlation between individual factors (age, gender, ASA status, comorbidities) and the type of sedation. To determine whether there is a correlation between individual factors (age, sex, ASA status, comorbidities, use ofanalgesia) and the use of Haldol. Subjects and Methods: There search was conducted retrospectively by reviewing the medical documentation of postoperative patients hospitalized in the ICU in the period 1.1.2021. until 1.1.2022. years. In the investigated period, 281 patients who underwent surgery were hospitalized in the ICU. Individual factors (age, sex, ASA status, comorbidities), type of surgery, type and duration of sedation, duration of anesthesia during surgery, analgesia during stayin ICU, outcome and days of stay in ICU were collected from medical records. Results: 163 men and 118 women participated in the research. The average age of the respondents was 63.7 years. Abdominal surgery was 47%, neurosurgery 22.4%, Thoracic 11.4%, andotherslessthan 5%. The average stay in the ICU was 3.65 days. Of these, patients received continuous infusion of Midazolam for 1.31 days in combination with Sufentanil, which they received for 1.52 days. Propofol 0.12 days, Morphine 0.20 days, Dexdor 0.1 days, and Ketamine and Haldol less than 0.1 days. In order to prevent the development of delirium and occupy the patient's pain, the patients received analgesia for 2.85 days. Only 7% of patients did not receive any anesthesia after the operation. It was found that the incidence of delirium is lowly related to the length of stay in the ICU, and it is related to the existence of a mental illness in the patient's anamnesis. The results also show that there is a high correlation between delirium and the use of Haldol in therapy. Conclusion: The conducted research shows that Midazolam in combination with Sufentanil is still the first choice in the sedation of postoperative patients hospitalized in the ICU. The incidence of delirium is related to the anamnesis of psychiatric diseases, as well as to the patient's age and ASA status, and the choice of delirium control is Haldol. Due to limited access to the documentation, the results should be interpreted with caution. Further research with better access to data is needed