The frequency of sepsis-associated delirium in the intensive care unit and effect on nursing workload

The Frequency of Sepsis-Associated Delirium in the Intensive Care Unit and Effect on Nursing Workload The research was carried out to determine the frequency of sepsis-related delirium and its effect on nurse workload in the intensive care unit. This descriptive and relation-seeking, cross-sectional study was conducted with the participation of 158 patients in the Adult Intensive Care Unit of Ankara City Hospital Gynecology and Obstetrics Hospital between October 28 and July 28, 2022. In data collection; Patient Identification Form, Confusion Assesment Method of the Intensive Care Unit (CAM-ICU), Ramsay Sedation Scale (RSS), Sequential Organ Failure Assessment Score (SOFA) and Therapeutic Intervation Scoring System-28 (TISS-28) tools were used. In the analysis of data; Number, percentage, mean, standard deviation, chi-square/fisher's exact, independent sample t-test, correlation analysis, simple and multiple linear regression analyzes were used. In the study, 12.7% of the patients had sepsis, 39.9% had delirium, and 10.1% had Sepsis-Associated Delirium (SAD). It was determined that SAD was more common in males (19%), and 56.3% of the patients were admitted to the unit as an emergency (p<0.05). Age (X̄±SD=75.31+16.53), APACHE II (X̄±SD=16.75+4.61), SOFA (X̄±SD=9.18+3.41) and lactate levels of patients who developed SAD (X̄±SD=2.93+1.06) mean scores were significantly high (p<0.001), GCS scores (X̄±SD=10.31+1.88) were significantly low (p<0.001), CRP levels were (X̄±SD=152.80+95.54) was found to be significantly higher (p<0.05). It was determined that there was a moderate positive correlation between the SOFA score of the patients and the development of both sepsis (r/p=0.505/0.001) and SAD (r/p=0.531/0.001). It was determined that 36% of the patients who developed SAD had MAP<65mmHg, 52.2% used vasopressors, 33.3% had hypoxia, 25% had creatinine>1.2 mg/dl, and these variables made a significant difference. (p<0.001). The most common source of infection in patients with SAD was bloodstream infection (44.4%) (X2/p=26,287/0.001). It was determined that 25% of the patients who developed SAD had leukopenia and 10.8% had leukocytosis, but it did not make a significant difference for the development of SAD (p>0.05). In the study, it was determined that the presence of sepsis, delirium and SAD in intensive care patients significantly increased the nursing workload mean score of TISS-28 (p<0.001). It was concluded that the mean nurse care time was 5.5 hours in patients with SAD and an additional 1.8 hours were needed for care compared to patients who did not develop SAD (p<0.001). In addition, among the variables affecting the nursing workload; it was found that the presence of sepsis alone explained 14.2% (R2=0.142), 24% of the presence of delirium (R2=0.240) and 22.8% (R2=0.228) of the presence of SAD (R2=0.228) of the total variance in the TISS-28 score ( p<0.001). In addition, in the multiple linear regression model to determine the other factors affecting the nursing workload; there were a significant relationship between TISS-28 score with male gender, presence of infection, hypoxia and comorbid disease, MAP<65mmHg, use of antibiotics, vasopressor and invasive mechanical ventilation, creatinine≥1.2 mg/dL, physical-chemical restriction and sleep cycle disruption (F=20.329; p=0.001) and these independent variables explained 59.6% (R2=0.596) of the total variance in the TISS-28 score. Accordingly, it was determined that the use of antibiotics, vasopressors and invasive mechanical ventilation variables significantly increased the nursing workload (p<0.05). As a result, it was determined in the study that the rate of SAD development in ICU was low when compared to the literature, but it increased the nurse workload significantly. SAD is affected by factors that increase the severity of the disease, and identifying and controlling these risk factors can reduce the rate of SAD development and nursing workload. Keywords: Delirium, intensive care unit, nursing workload, sepsis, sepsis-associated delirium