A++ 성인 ICU syndrome(중환자실 증후군) 문헌고찰

문서 내 토픽

1. ICU syndrome/delirium

ICU syndrome인 delirium은 집중 치료실에서의 care에 있어 잘 알려진 문제이다. 이것은 혼돈과 섬망을 주호소로 한다. 주로 노인 분들에게 발생하며 재원기간이 길수록 발병은 증가한다. ICU syndrome/delirium 의 병리학적 기전은 알려지지 않았으나 그것의 발전에 영향을 미치는 몇몇의 요소는 이전의 정신과적 문제, 신체적 요소(혈액학적 요소 혹은 뇌의 기능에 영향을 미치는 약물의 사용)와 관련이 있을 것으로 보여진다.
2. 연구 방법

31명의 ICU 환자를 대상으로 관찰 및 인터뷰하였음. 관찰기간은 weaning 과정에서부터 extubation 후 수일 동안 이었으며 환자 인터뷰는 병동으로 간 후 6~10일(1차), 퇴원 후 4~8주(2차)로 실시하였다. 대상자는 ventilator를 하고 있는 자로 의식이 없는 환자는 제외 시켰다. 최종 분석에는 19명의 대상자의 자료가 참고 되었다.
3. 연구 결과

19명의 대상자는 severe ICU syndrome/Delirium (SD), Moderate ICU syndrome(MD), Normal ICU syndrome(ND)의 세 그룹으로 나뉘었다. SD 그룹에서는 초조한 행동, 교란되거나 기괴한 행동, 두려워 함, 혼돈된 감정과 더불어 현실감각의 상실, 수면 장애 등의 증상이 이미 의식이 회복된 후에도 나타났다. MD 그룹에서는 반복적인 비현실 감각이 extubation 직 후 수일간 나타났으며 대부분의 시간에는 정상이나 갑자기 폭발하거나 안정되지 않고 중얼거리는 말을 한다. ND 그룹에서는 섬망의 증상은 거의없고 시간이나 장소의 지남력이 떨어졌다. 여환에게서 ND 그룹이 모두 나왔으며, ventilation 기간과 ICU 재원 일수가 길수록 SD 그룹이 많았다. Hb 수치가 유의하게 SD 그룹에서 낮았고, SD 그룹에서 fentanyl 과 midazolam의 하루 용량이 유의하게 많았다.
4. 논의

본 연구의 제한점은 질병이환률, 사망률, 대상자 선정의 엄격성에 의해 19명의 소수가 최종 분석대상이었다. 그러나 3그룹으로 분명히 나뉘어진 점 등에 의해 나름의 결론을 도출한다. 대상자 나이는 평균 70세로 노환이 많았고 Ventilator care 기간, Hb 수치, opioids 와 sedative 제제의 사용과 ICU syndrome인 delirium과는 유의미한 관계가 있었다. SD 그룹의 증상은 ICU 재원 기간 중 일찍(환자 의식이 돌아오고 난 후) 나타났고 이를 통해 ICU syndrome은 early phenomenon이라는 결론을 내본다. Hb 요인이 ICU syndrome과 관련 있다는 것은 종전의 Hensen 의 연구와 유사한 결과이다. ICU syndrome에 걸린 환자가 안 걸린 환자보다 더 아플 것이라는 결론을 내렸다.

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1. ICU syndrome/delirium

ICU syndrome, also known as ICU delirium, is a serious and common condition that affects many patients in the intensive care unit (ICU). It is characterized by acute changes in mental status, including confusion, disorientation, and altered levels of consciousness. This condition can have significant negative impacts on patient outcomes, including increased length of stay, higher risk of mortality, and long-term cognitive impairment. Understanding the underlying causes and risk factors for ICU syndrome/delirium is crucial for developing effective prevention and management strategies. Factors such as severe illness, use of certain medications, sleep disturbances, and environmental stressors in the ICU setting can all contribute to the development of this condition. Comprehensive assessment, early recognition, and a multidisciplinary approach to care are essential for addressing ICU syndrome/delirium and improving patient outcomes. Ongoing research is needed to further elucidate the pathophysiology of this complex condition and to identify the most effective interventions for its prevention and treatment.
2. 연구 방법

The research methodology is a critical component of any scientific study, as it determines the validity and reliability of the findings. In the context of a study on ICU syndrome/delirium, the research methods should be carefully designed to address the specific research questions and objectives. This may involve a combination of quantitative and qualitative approaches, such as prospective observational studies, randomized controlled trials, and qualitative interviews with patients and healthcare providers. The study population should be clearly defined, and appropriate sampling techniques should be used to ensure that the sample is representative of the target population. Data collection methods, such as standardized assessment tools, medical record review, and patient/caregiver interviews, should be rigorously implemented to ensure the accuracy and completeness of the data. The data analysis plan should be well-documented and should include appropriate statistical techniques to identify risk factors, evaluate the effectiveness of interventions, and explore the relationships between various factors. The research methodology should also address ethical considerations, such as informed consent, patient privacy, and the minimization of risks to participants. Overall, a well-designed and executed research methodology is essential for generating high-quality evidence that can inform clinical practice and guide the development of effective interventions for ICU syndrome/delirium.
3. 연구 결과

The research results on ICU syndrome/delirium should provide valuable insights into the prevalence, risk factors, and outcomes associated with this condition. The findings should be presented in a clear and concise manner, with a focus on the key findings and their implications for clinical practice. The study should report on the incidence and duration of ICU syndrome/delirium, as well as the associated patient outcomes, such as length of stay, mortality, and long-term cognitive impairment. The analysis of risk factors should identify the demographic, clinical, and environmental factors that contribute to the development of ICU syndrome/delirium, which can inform the development of targeted prevention and management strategies. The study should also evaluate the effectiveness of any interventions or care practices that were implemented, such as the use of delirium screening tools, non-pharmacological interventions, or changes to the ICU environment. The research results should be discussed in the context of existing literature and should highlight the strengths and limitations of the study. Overall, the research findings should provide a comprehensive understanding of ICU syndrome/delirium and its impact on patient outcomes, which can inform clinical decision-making and guide future research in this important area.
4. 논의

The discussion section of a research study on ICU syndrome/delirium should provide a critical analysis of the study's findings and their implications for clinical practice and future research. This section should address the key strengths and limitations of the study, including any methodological considerations, potential sources of bias, and the generalizability of the findings. The discussion should also situate the study's results within the broader context of existing literature on ICU syndrome/delirium, highlighting how the current findings contribute to or diverge from previous research. The discussion should explore the potential mechanisms underlying the development of ICU syndrome/delirium, drawing on relevant theoretical frameworks and empirical evidence. This may include a discussion of the physiological, psychological, and environmental factors that contribute to the condition, as well as the complex interplay between these factors. The discussion should also consider the clinical implications of the findings, including the potential impact on patient outcomes, healthcare utilization, and the development of targeted prevention and management strategies. Finally, the discussion should outline future research directions, identifying key knowledge gaps and suggesting areas for further investigation. This may include the need for larger-scale, longitudinal studies, the exploration of novel interventions or care practices, and the investigation of the long-term cognitive and functional outcomes associated with ICU syndrome/delirium. Overall, the discussion section should provide a comprehensive and critical analysis of the study's findings, with a focus on translating the research into meaningful improvements in clinical practice and patient care.

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