Delirium in the intensive care unit

被引:63
作者
Morandi, Alessandro [1 ,2 ,3 ]
Jackson, James C. [1 ,4 ,5 ]
Ely, E. Wesley [1 ]
机构
[1] Vanderbilt Univ Sch Med, Ctr Hlth Serv Res, Nashville, TN 37232 USA
[2] Poliambulanza Hosp, Dept Internal Med & Geriatr, Brescia, Italy
[3] Geriatr Res Grp, Brescia, Italy
[4] Vanderbilt Univ Sch Med, Div Allergy Pulm Crit Care Med, Nashville, TN 37232 USA
[5] Vanderbilt Univ Sch Med, Dept Psychiat, Nashville, TN 37232 USA
关键词
SERUM ANTICHOLINERGIC ACTIVITY; MECHANICALLY VENTILATED PATIENTS; CONFUSION ASSESSMENT METHOD; AGITATION-SEDATION SCALE; ACUTE BRAIN-DYSFUNCTION; CRITICALLY-ILL PATIENTS; OLDER-ADULTS; POSTOPERATIVE DELIRIUM; HIP-FRACTURE; SUBSYNDROMAL DELIRIUM;
D O I
10.1080/09540260802675296
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Delirium is a common manifestation of acute brain dysfunction in critically ill patients with prevalence as high as 75%. In the last years there has been a progressive increase of publications regarding intensive care (ICU) delirium, acknowledging its importance. The occurrence of delirium in ICU is related to more adverse outcomes including self-extubation and removal of catheters, prolonged hospitalization, increased costs, higher mortality, and potentially, long-term cognitive impairment. The pathophysiology explaining the processes subtending the development of delirium is still elusive, though several theories have been discussed. It is known that different risk factors are associated with delirium in the ICU. Patients in ICU frequently receive medications to treat pain and to ensure sedation, but an association between these drugs and delirium has been shown. Therefore, this pharmacological exposure should be modified to reduce the risk factors. Giving the multifactorial genesis of delirium, multicomponent interventions to prevent delirium developed in non-ICU settings can be adapted to critically ill patients with the purpose of reducing the incidence. When delirium is diagnosed the use of typical and atypical antipsychotics may be effective for its treatment. Future studies should evaluate target interventions to prevent delirium in the ICU.
引用
收藏
页码:43 / 58
页数:16
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