Department of Intensive Care 7D16, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
Ann Intensive Care. 2016 Dec;6(1):85. doi: 10.1186/s13613-016-0186-9. Epub 2016 Sep 2.
Delirium is a frequently occurring syndrome in patients admitted to the intensive care unit (ICU) or medium care unit (MCU), yet the pathophysiology remains poorly understood. An excess of central serotonin can lead to an altered mental status, associated with autonomic hyperactivity, and neuromuscular excitation. Drugs with serotonergic properties are frequently and for prolonged periods administered to ICU/MCU patients. Therefore, central serotonergic toxicity may constitute a predisposing, contributing or precipitating factor in the emergence of delirium. The purpose of the present study is to determine the number of patients admitted to the ICU or MCU who are diagnosed with delirium and who show characteristics of serotonin toxicity in association with the administration of serotonergic drugs.
During a 10-week prospective observational cohort study in the ICU and MCU, patients aged 18 or older, diagnosed with delirium in the ICU or MCU, were included. Patients were considered as delirious in case of a positive CAM-ICU and/or at the start of haloperidol prescription on suspicion of delirium. Once included, patients were screened for recent administered serotonergic drugs and screened for physical signs associated with serotonin toxicity by a standardized physical examination by a specifically trained physician.
A total of 61 patients diagnosed with delirium were enrolled. In 44 out of 61 patients (72 %), the use of drugs potentially contributing to serotonergic toxicity was recorded. Out of 44 patients, seven (16 %) patients showed physical signs of serotonin toxicity and in addition met the Hunter serotonin toxicity criteria, suggesting the presence of serotonergic toxicity. None of these patients were recognized as such by the treating physicians.
A significant proportion of delirious patients in the ICU might in fact be classified as suffering from central serotonin toxicity. The awareness of potential serotonin toxicity is low among physicians.
谵妄是入住重症监护病房（ICU）或中型监护病房（MCU）患者中经常发生的综合征，但病理生理学仍知之甚少。中枢 5-羟色胺过多可导致精神状态改变，伴有自主神经活性亢进和神经肌肉兴奋。具有 5-羟色胺能特性的药物经常并长时间给予 ICU/MCU 患者。因此，中枢 5-羟色胺毒性可能构成谵妄发生的易患、促成或诱发因素。本研究的目的是确定诊断为谵妄并与 5-羟色胺能药物给药相关的特征性 5-羟色胺毒性的 ICU/MCU 患者人数。
在 ICU 和 MCU 进行的为期 10 周的前瞻性观察性队列研究中，纳入年龄在 18 岁或以上、在 ICU 或 MCU 中诊断为谵妄的患者。如果患者的 ICU 意识模糊评估量表（CAM-ICU）和/或开始怀疑谵妄时开始使用氟哌啶醇的情况下呈阳性，则认为患者患有谵妄。一旦纳入，通过经过专门培训的医生进行的标准化体格检查，对近期给予的 5-羟色胺能药物和与 5-羟色胺毒性相关的身体体征进行筛查。
共纳入 61 例诊断为谵妄的患者。在 61 例患者中的 44 例（72%）中，记录了潜在导致 5-羟色胺毒性的药物使用情况。在 44 例患者中，有 7 例（16%）患者出现 5-羟色胺毒性的身体体征，并且还符合 Hunter 5-羟色胺毒性标准，提示存在 5-羟色胺毒性。这些患者均未被治疗医生识别出来。
ICU 中相当一部分谵妄患者实际上可能被归类为患有中枢 5-羟色胺毒性。医生对潜在的 5-羟色胺毒性的认识程度较低。
