Reznik Michael E, Slooter Arjen J C
Departments of Neurology & Neurosurgery, Alpert Medical School, Brown University, Providence, RI, USA.
Division of Neurocritical Care, Rhode Island Hospital, 593 Eddy Street, APC 712, Providence, RI, 02903, USA.
Curr Treat Options Neurol. 2019 Nov 14;21(11):59. doi: 10.1007/s11940-019-0599-5.
Delirium occurs frequently in critically ill patients and is associated with adverse outcomes in both the short and long term. In this review, we aim to highlight recent study findings on the prevention and treatment of delirium, provide additional recommendations based on expert guidelines, and indicate knowledge gaps deserving of future study.
Multicomponent non-pharmacologic interventions have been shown to be efficacious in non-ICU populations, and multicomponent strategies such as the ABCDEF bundle have been adopted in the ICU with several studies showing a potential benefit in delirium outcomes. Meanwhile, two negative randomized clinical trials of antipsychotics in ICU patients (REDUCE and MIND-USA) have provided strong evidence that such medications neither prevent nor shorten the duration of delirium. Other potential pharmacologic treatments with promising results include dexmedetomidine and, to a lesser extent, ramelteon, but more data is needed before they may be more definitively recommended. Effective and proven delirium management strategies are still largely lacking, though there is evidence to support the use of some non-pharmacologic interventions. Future studies of novel non-pharmacologic interventions and pharmacologic agents other than antipsychotics are warranted.
谵妄在重症患者中频繁发生，且与短期和长期不良后果相关。在本综述中，我们旨在强调近期关于谵妄预防和治疗的研究发现，根据专家指南提供额外建议，并指出值得未来研究的知识空白。
多组分非药物干预已被证明在非重症监护病房人群中有效，重症监护病房已采用多组分策略，如ABCDEF集束化护理，多项研究表明其对谵妄结局有潜在益处。同时，两项针对重症监护病房患者使用抗精神病药物的阴性随机临床试验（REDUCE和MIND-USA）提供了有力证据，表明此类药物既不能预防谵妄，也不能缩短谵妄持续时间。其他有前景的潜在药物治疗包括右美托咪定，以及在较小程度上的雷美替胺，但在更明确推荐之前还需要更多数据。尽管有证据支持使用一些非药物干预措施，但仍然很大程度上缺乏有效且经过验证的谵妄管理策略。有必要对新型非药物干预措施和除抗精神病药物之外的其他药物进行未来研究。
