Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, Tennessee.
Semin Respir Crit Care Med. 2021 Feb;42(1):112-126. doi: 10.1055/s-0040-1710572. Epub 2020 Aug 3.
Delirium is a debilitating form of brain dysfunction frequently encountered in the intensive care unit (ICU). It is associated with increased morbidity and mortality, longer lengths of stay, higher hospital costs, and cognitive impairment that persists long after hospital discharge. Predisposing factors include smoking, hypertension, cardiac disease, sepsis, and premorbid dementia. Precipitating factors include respiratory failure and shock, metabolic disturbances, prolonged mechanical ventilation, pain, immobility, and sedatives and adverse environmental conditions impairing vision, hearing, and sleep. Historically, antipsychotic medications were the mainstay of delirium treatment in the critically ill. Based on more recent literature, the current Society of Critical Care Medicine (SCCM) guidelines suggest against routine use of antipsychotics for delirium in critically ill adults. Other pharmacologic interventions (e.g., dexmedetomidine) are under investigation and their impact is not yet clear. Nonpharmacologic interventions thus remain the cornerstone of delirium management. This approach is summarized in the ABCDEF bundle (ssess, prevent, and manage pain; oth SAT and SBT; hoice of analgesia and sedation; elirium: assess, prevent, and manage; arly mobility and exercise; amily engagement and empowerment). The implementation of this bundle reduces the odds of developing delirium and the chances of needing mechanical ventilation, yet there are challenges to its implementation. There is an urgent need for ongoing studies to more effectively mitigate risk factors and to better understand the pathobiology underlying ICU delirium so as to identify additional potential treatments. Further refinements of therapeutic options, from drugs to rehabilitation, are current areas ripe for study to improve the short- and long-term outcomes of critically ill patients with delirium.
谵妄是一种常见于重症监护病房（ICU）的大脑功能障碍的衰弱形式。它与发病率和死亡率增加、住院时间延长、住院费用增加以及出院后长期认知障碍有关。易患因素包括吸烟、高血压、心脏病、败血症和前期痴呆。诱发因素包括呼吸衰竭和休克、代谢紊乱、长时间机械通气、疼痛、活动受限以及镇静剂和不良环境条件损害视力、听力和睡眠。历史上，抗精神病药物是治疗重症患者谵妄的主要药物。根据最近的文献，目前重症监护医学学会（SCCM）的指南建议不要常规使用抗精神病药物治疗重症成人的谵妄。其他药物干预措施（如右美托咪定）正在研究中，其影响尚不清楚。因此，非药物干预仍然是谵妄管理的基石。这种方法总结在 ABCDEF 包中（评估、预防和管理疼痛；提供 SAT 和 SBT；选择镇痛和镇静；谵妄：评估、预防和管理；早期活动和锻炼；家庭参与和授权）。该方案的实施降低了发生谵妄和需要机械通气的几率，但在实施过程中存在挑战。目前迫切需要进行持续研究，以更有效地降低风险因素，并更好地了解 ICU 谵妄的病理生物学，从而确定其他潜在的治疗方法。进一步完善从药物到康复的治疗选择，是当前研究的热点领域，旨在改善患有谵妄的重症患者的短期和长期预后。
