Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Semin Respir Crit Care Med. 2013 Apr;34(2):179-88. doi: 10.1055/s-0033-1342972. Epub 2013 May 28.
Delirium in the intensive care unit (ICU) is associated with many negative outcomes, including increased length of stay in both the ICU and the hospital, increased duration of mechanical ventilation, increased mortality, worse long-term cognitive impairment, and increased costs. The 2013 American College of Critical Care Medicine (ACCM)/Society of Critical Care Medicine (SCCM) clinical practice guidelines for pain, agitation, and delirium (PAD), based on available evidence, strongly recommend that critically ill patients be routinely monitored for delirium in the ICU using a validated tool. After conducting a thorough psychometric review of available delirium assessment tools, the 2013 PAD guideline group concluded that the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the ICU delirium screening tools with the strongest validity and reliability. This article discusses the importance and feasibility of delirium screening in the ICU and compares the most commonly used critical care delirium screening instruments. Strategies needed to implement and sustain delirium screening efforts in different critically ill populations are introduced and discussed. Accurate detection is the first step in managing ICU patients who develop delirium in an attempt to reduce the negative sequelae of delirium in this population.
重症监护病房（ICU）中的谵妄与许多不良后果相关，包括 ICU 和医院住院时间延长、机械通气时间延长、死亡率增加、认知功能障碍长期恶化和治疗费用增加。基于现有证据，2013 年美国危重病医学会（ACCM）/危重病医学会（SCCM）制定的疼痛、躁动和谵妄（PAD）临床实践指南强烈建议在 ICU 中使用经过验证的工具对重症患者进行常规谵妄监测。在对现有谵妄评估工具进行全面心理测量学审查后，2013 年 PAD 指南小组得出结论，意识模糊评估法（CAM-ICU）和重症监护谵妄筛查检查表（ICDSC）是 ICU 谵妄筛查工具中具有最强有效性和可靠性的工具。本文讨论了在 ICU 中进行谵妄筛查的重要性和可行性，并比较了最常用的重症监护谵妄筛查工具。还介绍并讨论了在不同危重症人群中实施和维持谵妄筛查工作所需的策略。准确检测是管理 ICU 患者谵妄的第一步，目的是降低该人群中谵妄的不良后果。
