Delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation: a prospective cohort study

Abstract

Background COPD combined with respiratory failure is very common in intensive care unit (ICU). We aimed to evaluate the current status and influencing factors of delirium in elderly COPD patients with undergoing mechanical ventilation. Methods Patients with COPD combined with respiratory failure and mechanically ventilated who were admitted to the ICU of our hospital were selected. The characteristics of included patients were assessed. Pearson correlation analysis was performed to evaluate the characteristics of patients and delirium. Logistic regression analysis was conducted to identify the risk factors of delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation. Results A total of 237 COPD combined with respiratory failure patients were included, the incidence of delirium was 21.94%. Pearson correlation analysis indicated that age (r = 0.784), BMI (r = 0.709), hypertension (r = 0.696), APACHE II score (r = 0.801), CPOT (r = 0.513), sedation(r = 0.626) and PaO2 (r = 0.611) were all correlated with the occurrence of delirium (all p < 0.05). Logistic regression analysis indicated that age ≥ 75y (OR 3.112, 95% CI 2.144–4.602), BMI ≤ 19 kg/m2 (OR 2.742, 95% CI 1.801–3.355), hypertension(OR 1.909, 95% CI 1.415–2.421), APACHE II score ≥ 15 (OR 2.087, 95% CI 1.724–2.615), CPOT ≥ 5 (OR 1.778, 95% CI 1.206–2.641), sedation(OR 3.147, 95% CI 2.714–3.758), PaO2 ≤ 75 mmHg(OR 2.196, 95%CI 1.875–3.088) were the risk factors of delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation (all p < 0.05). Conclusions Delirium is common in patients with COPD and respiratory failure undergoing mechanical ventilation, and there are many related influencing factors. Medical staff should pay more attention to patients with risk factors and take intervention measures as soon as possible to reduce the incidence of delirium.

Inhibition of RXRA-mediated PLA2G2A improves delirium in COPD mice by regulating endoplasmic reticulum stress pathway and inhibiting cell apoptosis

“…There are multiple causes of delirium in COPD patients, and there is currently no specific drug treatment available [14]. Clinical studies have confirmed that alle- viating the onset of delirium in patients is often beneficial for the treatment of COPD [5]. Our study confirmed that overexpression of RXRA mediates PLA2G2A to improve delirium in COPD mice.…”

“…It induces disorders in patients' consciousness, thinking, and perception. Clinical studies have confirmed that the incidence of delirium in middle-aged and elderly COPD patients is high, and the mortality rate of COPD patients with delirium is higher than that of ordinary patients [5]. Alleviating COPD in patients also effectively alleviates their delirium state.…”

The adjusted impact of different severities of acute exacerbations and medications on the risk of developing dementia in COPD patients

“…In addition, Xuecai Fu et al mentioned that delirium was more common among severe COPD patients, especially among those admitted to the ICU or who required mechanical ventilation (related to abnormal function of neurotransmitters, damage of the blood–brain barrier and ICU syndrome). [ 39 ] Some of these studies further noted that severe COPD was a risk factor for developing dementia. Most elderly patients choose to visit the ED for critical conditions or initial airway management.…”

Delyro Rizikos Veiksniai Ir Prevencija Intensyvios Terapijos Skyriuje

“…Tai galima paaiškinti senyvo amžiaus pacientų pažeidžiamumu dėl amžinių metabolizmo pakitimų, hipoksemijos bei psichologinio streso, patiriamo ITS [6]. Pastebėta, jog užsitęsus hipoksemijai, didėja delyro išsivystymo tikimybė, todėl lėtinė obstrukcinė plaučių liga (LOPL), kvėpavimo nepakankamumas taip pat laikomi rizikos veiksniais [2,8]. Be to, pacientai, sergantys LOPL, dažnai gydomi kortikosteroidais, kurie didina delyro riziką [2,9].…”

“…DPV yra bene plačiausiai tyrinėjamas rizikos veiksnys, susijęs su delyro atsiradimu [7]. Taikant DPV, sukeliamas stipresnis ir ilgiau trunkantis uždegiminis atsakas, kuris sutrikdo neuromediatorių veiklą smegenyse ir pažeidžia hematoencefalinį barjerą, kas didina delyro atsiradimo tikimybę [8]. Daugelis tyrimų patvirtina, jog sedacija taip pat gali provokuoti šios būklės išsivystymą [1][2][3].…”