Balas Michele C, Rice Michael, Chaperon Claudia, Smith Heather, Disbot Maureen, Fuchs Barry
University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska, USA.
Crit Care Nurse. 2012 Aug;32(4):15-26. doi: 10.4037/ccn2012480.
Delirium in older adults in critical care is associated with poor outcomes, including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment. Diagnosing delirium is complicated because many critically ill older adults cannot communicate their needs effectively. Manifestations include reduced ability to focus attention, disorientation, memory impairment, and perceptual disturbances. Nurses often have primary responsibility for detecting and treating delirium, which can be extraordinarily complicated because patients are often voiceless, extremely ill, and require high levels of sedatives to facilitate mechanical ventilation. An aggressive, appropriate, and compassionate management strategy may reduce the suffering and adverse outcomes associated with delirium and improve relationships between nurses, patients, and patients' family members.
重症监护中的老年患者谵妄与不良预后相关，包括住院时间延长、费用增加、死亡率上升、更多地使用持续镇静和身体约束、意外拔管和自行拔管的情况增加、功能衰退、新的机构收容以及认知障碍的新发。诊断谵妄很复杂，因为许多重症老年患者无法有效表达自身需求。其表现包括注意力集中能力下降、定向障碍、记忆障碍和感知障碍。护士通常主要负责检测和治疗谵妄，这可能极其复杂，因为患者往往无法表达、病情极其严重，并且需要大量镇静剂来辅助机械通气。积极、恰当且富有同情心的管理策略可能会减少与谵妄相关的痛苦和不良后果，并改善护士、患者及患者家属之间的关系。
