在 ICU - 心脏骤停后谵妄。
In the ICU - delirium post cardiac arrest.
机构信息
Division of Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
出版信息
Curr Opin Crit Care. 2019 Jun;25(3):218-225. doi: 10.1097/MCC.0000000000000615.
PURPOSE OF REVIEW
The present review aims to describe the clinical impact and assessment tools capable of identifying delirium in cardiac arrest survivors and providing strategies aimed at preventing and treating delirium.
RECENT FINDINGS
Patient factors leading to a cardiac arrest, initial resuscitation efforts, and postresuscitation management all influence the potential for recovery and the risk for development of delirium. Data suggest that delirium in cardiac arrest survivors is an independent risk factor for morbidity and mortality. Recognizing delirium in postcardiac arrest patients can be challenging; however, detection is not only achievable, but important as it may aid in predicting adverse outcomes. Serial neurologic examinations and delirium assessments, targeting light sedation when possible, limiting psychoactive medications, and initiating patient care bundles are important care aspects for not only allowing early identification of primary and secondary brain injury, but in improving patient morbidity and mortality.
SUMMARY
Developing delirium after cardiac arrest is associated with increased morbidity and mortality. The importance of addressing modifiable risk factors, recognizing symptoms early, and initiating coordinated treatment strategies can help to improve outcomes within this high risk population.
目的综述
本综述旨在描述能够识别心脏骤停幸存者谵妄的临床影响和评估工具，并提供预防和治疗谵妄的策略。
最近的发现
导致心脏骤停的患者因素、初始复苏努力和复苏后管理都会影响恢复的可能性和发生谵妄的风险。数据表明，心脏骤停幸存者的谵妄是发病率和死亡率的独立危险因素。识别心脏骤停后患者的谵妄具有挑战性；然而，检测不仅是可行的，而且很重要，因为它可以帮助预测不良结局。对患者进行连续的神经系统检查和谵妄评估，尽可能实现轻度镇静，限制使用精神活性药物，并启动患者护理包，这对于不仅允许早期识别原发性和继发性脑损伤，而且改善患者的发病率和死亡率都很重要。
总结
心脏骤停后发生谵妄与发病率和死亡率增加有关。解决可改变的危险因素、早期识别症状以及启动协调的治疗策略的重要性，可以帮助改善这一高危人群的结局。
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