Wake Forest University School of Medicine, Winston-Salem, NC.
Oregon Health & Science University, Portland, OR.
Chest. 2021 Oct;160(4):1326-1334. doi: 10.1016/j.chest.2021.06.002. Epub 2021 Jun 5.
Delirium is a serious and complex problem facing critically ill patients, their families, and the health care system. When delirium develops, it is associated with prolonged hospital stays, increased costs, and long-term cognitive impairment in many patients. This article uses a clinical case to discuss our approach to delirium prevention and treatment in the ICU. We believe that an effective strategy to combat delirium requires implementation and adherence to a pain and sedation protocol as part of bundled care, use of a validated tool to detect delirium when present, and a focus on nonpharmacologic care strategies, including reorientation, early mobility, and incorporating family into care when possible. At present, the evidence does not support the routine administration of medications to prevent or treat delirium. A pharmacologic approach may be needed for agitated delirium, and we discuss our evaluation of the evidence for and against particular medications. Although delirium can be a distressing problem, there is evidence that it can be addressed through careful attention to prevention, detection, and minimizing the long-term impact on patients and their families.
谵妄是危重症患者、患者家属和医疗体系面临的一个严重且复杂的问题。当谵妄发生时，许多患者会出现住院时间延长、费用增加和长期认知障碍等问题。本文通过一个临床病例，讨论了我们在 ICU 中预防和治疗谵妄的方法。我们认为，要想有效对抗谵妄，需要实施并坚持疼痛和镇静方案作为综合护理的一部分，使用经过验证的工具在出现谵妄时进行检测，并关注非药物治疗策略，包括重新定向、早期活动以及在可能的情况下让患者家属参与护理。目前，尚无证据支持常规使用药物来预防或治疗谵妄。对于躁动的谵妄可能需要药物治疗，我们讨论了针对特定药物的利弊的评估证据。虽然谵妄可能是一个令人痛苦的问题，但有证据表明，通过仔细关注预防、检测和尽量减少对患者及其家属的长期影响，是可以解决这个问题的。
