Comprehensive strategy for preventing unplanned extubation in patients with post-operative delirium after gastrointestinal surgery

Table 1 Comparison of baseline demographic and clinical characteristics between groups, mean ± SD

Variable	Intervention group (n = 60)	Control group (n = 58)	t/χ2	P value
Age (years)	63.40 ± 8.70	64.10 ± 9.20	0.425	0.672
Female/male	26/34	30/30	0.290	0.590
BMI (kg/m2)	23.80 ± 3.10	24.20 ± 3.40	0.668	0.505
Surgery type (gastric/colorectal/pancreatic)	22/25/13	20/26/12	0.121	0.941
Duration of surgery (hours)	4.20 ± 1.10	4.40 ± 1.30	0.903	0.368
APACHE II score	16.30 ± 3.20	16.80 ± 3.50	0.810	0.419
POD subtype (hyperactive/mixed)	39/21	37/21	0.020	0.991
Pre-operative MMSE score	27.40 ± 1.80	27.10 ± 2.00	0.857	0.393

BMI: Body mass index; APACHE II: Acute Physiology and Chronic Health Evaluation II; POD: Post-operative delirium; MMSE: Mini-Mental State Examination.

Table 2 Comparison of primary and secondary clinical outcomes between groups, n (%)/mean ± SD

Outcome	Intervention group (n = 60)	Control group (n = 58)	t/χ2	P value
Incidence of UE	2 (3.33)	9 (15.52)		0.028
Duration of mechanical ventilation (days)	4.23 ± 1.62	6.14 ± 2.31	5.214	0.000
Duration of stay in ICU (days)	6.82 ± 2.11	9.34 ± 3.06	5.223	0.000
Duration of delirium (days)	2.12 ± 0.91	3.73 ± 1.41	7.394	0.000
Composite post-reintubation complications	0 (0.00)	5 (8.62)		0.026
Drug-related adverse events (total)	15 (25.00)	19 (32.76)	0.866	0.352

UE: Unplanned extubation; ICU: Intensive care unit.

Table 3 Nursing intervention response efficiency, restraint management, and quality indicators, mean ± SD/n (%)

Indicator	Intervention group (n = 60)	Control group (n = 58)	t/χ2	P value
Intervention response time (seconds)	48.22 ± 15.61	82.74 ± 24.32	9.207	0.000
Restraint usage rate	15 (25.00)	26 (44.83)	5.114	0.024
Duration of restraint (hours)	1.85 ± 0.61	3.53 ± 1.22	9.509	0.000
Restraint-related skin injury	1 (1.67)	7 (12.07)		0.031
CPOT assessment completion rate	59 (98.33)	42 (72.41)		0.000
CAM-ICU assessment completion rate	58 (96.67)	40 (68.97)		0.000
Timely recognition of extubation intention behaviors	55 (91.67)	36 (62.07)		0.000
Pre-restraint communication documentation rate	53 (88.33)	31 (53.45)	17.500	0.000
Skin care implementation rate	57 (95.00)	45 (77.59)		0.007

CPOT: Critical-care pain observation tool; CAM: Confusion assessment method; ICU: Intensive care unit.

Table 4 Sedation-delirium coupling status and quantified extubation intention behaviors, mean ± SD

Indicator	Intervention group (n = 60)	Control group (n = 58)	t	P value
Mean daily fluctuation in RASS score	0.86 ± 0.31	1.52 ± 0.61	7.446	0.000
Frequency of extubation intention behaviors (times/24 hours)	1.22 ± 0.57	3.65 ± 0.93	17.177	0.000
CAM-ICU positive days (%)	31.26 ± 7.42	48.64 ± 9.35	11.204	0.000

RASS: Richmond Agitation-Sedation Scale; CAM: Confusion assessment method; ICU: Intensive care unit.

Table 5 Comparison of neuroinflammatory and brain injury biomarker levels, mean ± SD

Biomarker (unit)	Timepoint	Intervention group (n = 60)	Control group (n = 58)	F (group/time/interaction)	P value
IL-6 (pg/mL)	Post-op day 1	85.40 ± 22.30	87.20 ± 24.10
	Post-op day 3	42.10 ± 12.60	76.50 ± 18.90	165.600/151.500/35.590	0.000
	Post-op day 5	28.70 ± 8.40	65.30 ± 15.20
S100β (ng/mL)	Post-op day 1	0.48 ± 0.12	0.49 ± 0.13
	Post-op day 3	0.32 ± 0.08	0.45 ± 0.11	92.500/75.460/20.020	0.000
	Post-op day 5	0.24 ± 0.06	0.41 ± 0.09
NSE (ng/mL)	Post-op day 1	18.60 ± 4.20	18.90 ± 4.50
	Post-op day 3	14.30 ± 3.10	17.80 ± 4.00	46.780/41.960/9.692	0.000
	Post-op day 5	12.10 ± 2.80	16.50 ± 3.70

IL: Interleukin; S100β: S100 calcium-binding protein β; NSE: Neuron-specific enolase; Post-op: Post-operative.

Table 6 Multivariate Cox regression analysis of unplanned extubation risk (n = 118)

Predictor	Comparison	HR	95%CI	P value
Mean daily fluctuation in RASS score	> 1.5 vs ≤ 1.5	3.850	1.421-10.447	0.008
Frequency of extubation intention behaviors	≥ 3 times/24 hours vs < 3 times/24 hours	4.210	1.561-11.366	0.005
Reduction in the IL-6 level on post-op day 3	< 30% vs ≥ 30%	2.930	1.101-7.818	0.031
Intervention response time	> 60 seconds vs ≤ 60 seconds	3.120	1.181-8.238	0.022
Restraint usage rate	High (> 50% of ICU days) vs low	2.780	1.051-7.358	0.039
Nursing assessment completion rate	Low (< 90%) vs high (≥ 90%)	3.050	1.142-8.147	0.026

RASS: Richmond Agitation-Sedation Scale; IL: Interleukin; post-op: Post-operative; ICU: Intensive care unit; HR: Hazard ratio; CI: Confidence interval.