Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
Lancet Child Adolesc Health. 2020 Apr;4(4):312-321. doi: 10.1016/S2352-4642(19)30377-3. Epub 2020 Feb 20.
Delirium is a syndrome characterised by an acute and fluctuating alteration in cognition and awareness. It occurs frequently in children with serious medical illness, and is associated with adverse outcomes such as increased length of hospital stay, duration of mechanical ventilation, hospital costs, and mortality. Delirium-especially the hypoactive subtype-is often overlooked by paediatric practitioners, but can be reduced by mitigating risks and effectively managed if detected early. Non-modifiable risk factors of delirium include young age (age <2 years), cognitive or neurological disabilities, need for invasive mechanical ventilation, severe underlying illness and pre-existing chronic conditions, and poor nutritional status. Routine bedside screening using validated tools can enable early detection of delirium. To reduce delirium in hospitalised children, health-care providers should optimise the hospital environment (eg, by reducing sleep disruption and keeping the child stimulated during the day), improve pain management, and decrease sedation (particularly use of benzodiazepines).
谵妄是一种以认知和意识急性波动为特征的综合征。它在患有严重疾病的儿童中经常发生，并与不良结局相关，如住院时间延长、机械通气时间延长、住院费用增加和死亡率增加。谵妄——尤其是低活动型亚型——经常被儿科医生忽视，但如果及早发现，可以通过降低风险和有效管理来减少。谵妄的不可改变的危险因素包括年龄较小（<2 岁）、认知或神经发育障碍、需要有创机械通气、严重基础疾病和既往慢性疾病以及营养状况不佳。使用经过验证的工具进行常规床边筛查可以实现早期发现谵妄。为了减少住院儿童的谵妄，医疗保健提供者应优化医院环境（例如，减少睡眠中断并在白天让孩子保持兴奋），改善疼痛管理，并减少镇静（特别是使用苯二氮䓬类药物）。
