Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Pulmonary and Critical Care and Health Services Research, Vanderbilt University and VA-GRECC, Nashville, TN, USA.
Intensive Care Med. 2017 Sep;43(9):1329-1339. doi: 10.1007/s00134-017-4860-7. Epub 2017 Jun 13.
Delirium, a prevalent organ dysfunction in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy, and the neurosciences sought to address five questions: (1) What is the current standard of care in managing ICU delirium? (2) What have been the major recent advances in delirium research and care? (3) What are the common delirium beliefs that have been challenged by recent trials? (4) What are the remaining areas of uncertainty in delirium research? (5) What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium, identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda.
谵妄是危重症患者常见的器官功能障碍，与发病率增加独立相关。过去十年，住院患者（包括危重症患者）的谵妄研究呈指数级增长，这一研究突出表明，需要从机制上更好地理解谵妄，以促进最终预防和治疗谵妄的研究。在这份特邀的循证论文中，一个由来自重症医学、精神病学、儿科学、麻醉学、老年医学、外科、神经病学、护理、药学和神经科学领域的多国家和多专业的临床医生和研究人员组成的国际小组，旨在回答五个问题：(1) 目前 ICU 谵妄管理的标准护理是什么？(2) 谵妄研究和护理方面最近有哪些重大进展？(3) 最近的试验对哪些常见的谵妄观念提出了挑战？(4) 谵妄研究中仍存在哪些不确定的领域？(5) 在未来 10 年内，有哪些领域/试验值得开展？本文简要回顾了谵妄的流行病学，讨论了目前针对有谵妄风险或出现谵妄的危重症患者的最佳管理实践，确定了我们在理解谵妄方面的最新进展和知识空白，并讨论了研究机会和实施障碍，旨在促进综合研究议程。
