Northeastern University School of Pharmacy, Boston, MA 02118, USA.
Best Pract Res Clin Anaesthesiol. 2012 Sep;26(3):385-93. doi: 10.1016/j.bpa.2012.08.002.
Delirium affects up to 80% of critically ill patients and negatively influences patient outcome. Consensus guidelines advocate that a validated screening tool like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC) be used to identify delirium rather than a subjective approach. The CAM-ICU and ICDSC have the most rigorous psychometric data to support their use. The differences between these two instruments are far less important to the outcome of patients than the regular and reliable use of either in routine ICU care. Implementation of a large-scale delirium screening effort is both feasible and sustainable and should be accompanied by both didactic and bedside education. An ICU clinical road map should be used on a daily basis that promotes delirium assessment, establishes a targeted sedation goal and defines the analgesic/sedative regimen that is best suited to maintain patient comfort, prevent delirium and promote wakefulness.
谵妄影响多达 80%的重症患者，并对患者的预后产生负面影响。共识指南主张使用经过验证的筛选工具，如重症监护谵妄筛查量表（CAM-ICU）或重症监护意识模糊评估量表（ICDSC）来识别谵妄，而不是采用主观方法。CAM-ICU 和 ICDSC 具有最严格的心理测量学数据来支持其使用。这两种工具之间的差异对患者的预后影响远不如在常规 ICU 护理中定期和可靠地使用任何一种工具重要。实施大规模的谵妄筛查工作是可行和可持续的，并且应该伴随着教学和床边教育。每天都应使用 ICU 临床路线图，以促进谵妄评估，确定有针对性的镇静目标，并确定最适合维持患者舒适度、预防谵妄和促进清醒的镇痛/镇静方案。
