Brummel Nathan E, Girard Timothy D
Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Handb Clin Neurol. 2019;167:357-375. doi: 10.1016/B978-0-12-804766-8.00019-4.
Delirium is an acute and transient brain dysfunction that is characterized by disturbances in consciousness, affecting both its content (i.e., attention) and level (i.e., arousal). It affects as many as 50% of those admitted to an intensive care unit (ICU). Once believed to be an inconsequential outcome of critical illness, it is now recognized that delirium is harmful in both the short- and long-term. Despite occurring frequently in critically ill patients, delirium often goes unrecognized. Well-validated delirium screening tools, designed for use in the ICU, should be used to reliably detect delirium. The first step in delirium treatment is to identify and address potentially modifiable risk factors. Multiple trials have shown that benzodiazepines are a risk factor for delirium in a dose-dependent manner. Sedation with nonbenzodiazepine-based strategies are an effective means by which to reduce delirium. Nonpharmacologic strategies such as those which seek to reduce sensory impairment, sleep deprivation, and immobility are effective. Pharmacologic treatment with antipsychotics, though commonly used, is not supported by findings from placebo-controlled trials. Recent data support from multiple trials support the use of the "ABCDEF bundle" as a means by which to reduce delirium.
谵妄是一种急性和短暂性脑功能障碍，其特征为意识紊乱，影响意识内容（即注意力）和水平（即觉醒）。在重症监护病房（ICU）的患者中，多达50%会受到影响。谵妄曾被认为是危重病无关紧要的结果，现在人们认识到它在短期和长期都具有危害性。尽管谵妄在重症患者中经常发生，但往往未被识别。应使用经过充分验证、专为ICU设计的谵妄筛查工具来可靠地检测谵妄。谵妄治疗的第一步是识别并处理潜在的可改变风险因素。多项试验表明，苯二氮䓬类药物是谵妄的风险因素，且呈剂量依赖性。采用非苯二氮䓬类药物的镇静策略是减少谵妄的有效方法。诸如旨在减少感觉障碍、睡眠剥夺和活动受限的非药物策略是有效的。使用抗精神病药物进行药物治疗虽然常用，但安慰剂对照试验的结果并不支持。多项试验的最新数据支持使用“ABCDEF集束化治疗方案”作为减少谵妄的一种方法。
