Abstrakt

To explore delirium in liver transplant ICU patients and its management.

Huien-Chun Liao, Shu-Ming Chen, Chin-Tang Tu, Ying-Chen Chiu, Ya-Lie Ku

Methods: This preliminary study explored, through purposive sampling, patients who were hospitalized in the liver ICU of a medical centre in southern Taiwan (IRB approval number 201601364B0) between November 25, 2016, and July 24, 2017. Before collecting the delirium-related data of the patients, a delirium assessment scale was developed by the principal investigator and one nursing practitioner (NP) in the liver ICU. The content validity of the delirium assessment scale was evaluated by three ICU medical and nursing experts. Additionally, one head nurse and one NP observed, assessed, and recorded the delirious behaviours of nine liver transplant ICU patients during the day and night shifts to ensure the consistency of assessment. After ensuring the content validity and consistent assessment of delirium, the NP formally collected the data of liver transplant ICU patients by using the delirium assessment scale.

Findings: The content validity of the delirium assessment scale, evaluated by three ICU medical professionals and one NP, approached 0.975. The consistencies of assessment for the Richmond Agitation and Sedation Scale (RASS), pain scores, and delirium assessment scale were evaluated by one head nurse and one NP through assessing the data of 9 liver transplant ICU patients and revealed by ICC of .984, .997, and .992. The preliminary 12 liver transplant ICU delirium patients had the hyperactive RASS scores (0–3) and their pain scores were 3-8 for 1 week. Additionally, most patients exhibited glucose ranging from 120 to 300 mg/dL and Hb ranging from 7 to 11 mg/dL. Furthermore, most patients exhibited CRP ranging from 20 to 60 mg/L. The highest frequency of sedative administration was observed in the first week of hospitalization, whereas the pain medication was used for almost 2 weeks. For the 12 liver transplant patients with delirium in the ICU, problems such as constipation and passing urine were managed by using softening agents and diuretics. Moreover, psychiatrists were advised to change the sleeping or sedation medications that were administered to the patients with delirium. Furthermore, the patients underwent restriction, early weaning from ventilator, and peppermint oil wiping to relieve the distention of the abdomen. The use of earplugs and watching TV were also applied to the liver transplanted patients with delirium as alternative interventions to relieve their delirium symptoms.

Conclusion: Delirium persisted for longer in the liver transplant ICU patients than in general ICU patients. Furthermore, higher glucose and infection, and lower Hb were observed in the 12 liver transplant delirium patients. Sedatives were frequently administered in the first week of hospitalization for managing delirium, while pain medication was administered for almost 2 weeks in the 12 liver transplant ICU delirium patients. In addition to the medications, alternative treatments and interventions were applied to the 12 liver transplant ICU delirium patients for managing their delirium.