Sedative Agents and Prophylaxis in ICU Delirium

被引:0
作者
Norman B.C. [1 ]
Hughes C.G. [2 ]
机构
[1] Division of Pulmonary & Critical Care, Department of Medicine, Vanderbilt University School of Medicine, 1215 21st Ave. South, Suite 6000, Nashville, 37232, TN
[2] Division of Anesthesia Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, 1211 21st Ave, 526 MAB, Nashville, 37212, TN
关键词
Delirium; Intensive care unit; Prevention; Risk factors; Treatment;
D O I
10.1007/s40140-014-0084-3
中图分类号
学科分类号
摘要
Delirium is a form of acute brain dysfunction in the critically ill that is associated with significant morbidity and mortality in addition to increases in healthcare costs. Important risk factors for delirium include a patient’s underlying illness, metabolic disturbances, sedative and psychoactive medications, and underlying cognitive impairment. Vigilant monitoring and recognition are the first step in reducing the burden of delirium. The Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (IDCSC) are the validated methods of diagnosing delirium in the intensive care unit. Definitive evidence of treatments to reduce the incidence or duration of delirium in the intensive care unit is limited. Protocolized care to ensure minimization of sedation and appropriate sedative selection, early ventilator liberation, adequate treatment of pain, early mobility, and proper sleep hygiene offer the best hope of reducing the incidence of delirium and its burden on healthcare and society. © 2014, Springer Science + Business Media New York.
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页码:33 / 40
页数:7
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  • [1] Pandharipande P., Cotton B.A., Shintani A., Thompson J., Costabile S., Pun B.T., Dittus R., Ely E.W., Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients, Intensive Care Med, 33, 10, pp. 1726-1731, (2007)
  • [2] Watson P., Sleep in the ICU: where dreams go to die, Minerva Anestesiol, 77, 6, pp. 568-570, (2011)
  • [3] Watson P.L., Ceriana P., Fanfulla F., Delirium: is sleep important?, Best Pract Res Clin Anaesthesiol, 26, 3, pp. 355-366, (2012)
  • [4] Inouye S.K., Westendorp R.G., Saczynski J.S., Delirium in elderly people, Lancet, 383, 9920, pp. 911-922, (2014)
  • [5] Milbrandt E.B., Deppen S., Harrison P.L., Shintani A.K., Speroff T., Stiles R.A., Truman B., Bernard G.R., Dittus R.S., Ely E.W., Costs associated with delirium in mechanically ventilated patients, Crit Care Med, 32, 4, pp. 955-962, (2004)
  • [6] Ely E.W., Gautam S., Margolin R., Francis J., May L., Speroff T., Truman B., Dittus R., Bernard R., Inouye S.K., The impact of delirium in the intensive care unit on hospital length of stay, Intensive Care Med, 27, 12, pp. 1892-1900, (2001)
  • [7] Lin S.M., Liu C.Y., Wang C.H., Lin H.C., Huang C.D., Huang P.Y., Fang Y.F., Shieh M.H., Kuo H.P., The impact of delirium on the survival of mechanically ventilated patients, Crit Care Med, 32, 11, pp. 2254-2259, (2004)
  • [8] Ely E.W., Shintani A., Truman B., Speroff T., Gordon S.M., Harrell F.E., Inouye S.K., Bernard G.R., Dittus R.S., Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit, J Am Med Assoc, 291, 14, pp. 1753-1762, (2004)
  • [9] Shehabi Y., Riker R.R., Bokesch P.M., Wisemandle W., Shintani A., Ely E.W., Group S.S., Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients, Crit Care Med, 38, 12, pp. 2311-2318, (2010)
  • [10] Pisani M.A., Kong S.Y., Kasl S.V., Murphy T.E., Araujo K.L., Van Ness P.H., Days of delirium are associated with 1-year mortality in an older intensive care unit population, Am J Respir Crit Care Med, 180, 11, pp. 1092-1097, (2009)