Geriatric Research, Education and Clinical Center, (GRECC) Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
Crit Care Med. 2013 Sep;41(9):2196-208. doi: 10.1097/CCM.0b013e31829a6f1e.
To review delirium screening tools available for use in the adult ICU and PICU, to review evidence-based delirium screening implementation, and to discuss common pitfalls encountered during delirium screening in the ICU.
Review of delirium screening literature and expert opinion.
Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICU settings. Keys to effective implementation include addressing barriers to routine screening, multifaceted training such as lectures, case-based scenarios, one-on-one teaching, and real-time feedback of delirium screening, and interdisciplinary communication through discussion of a patient's delirium status during bedside rounds and through documentation systems. If delirium is present, clinicians should search for reversible or treatable causes because it is often multifactorial.
Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances.
回顾可用于成人 ICU 和 PICU 的谵妄筛查工具，回顾基于证据的谵妄筛查实施情况，并讨论 ICU 谵妄筛查中常见的陷阱。
对谵妄筛查文献和专家意见的回顾。
在过去的十年中，已经开发和验证了专门为重症成人和儿童设计的工具。在许多 ICU 环境中，已经有效地实施了谵妄筛查。有效实施的关键包括解决常规筛查的障碍、多方面的培训，如讲座、基于案例的情景、一对一教学和实时反馈谵妄筛查，以及通过床边查房和文档系统讨论患者的谵妄状态以及通过文档系统进行跨学科沟通。如果存在谵妄，临床医生应寻找可逆转或可治疗的原因，因为它通常是多因素的。
有效的谵妄筛查的实施是可行的，但需要注意实施方法，包括改变目前认为谵妄是不可避免的或重症疾病的正常部分的 ICU 文化，建立一个未来的文化，将谵妄视为一种危险的综合征，预示着不良的临床结局，并且根据个体患者的情况可能是可改变的。
