Zaher-Sánchez Sarai, Satústegui-Dordá Pedro José, Ramón-Arbués Enrique, Santos-Sánchez Jose Angel, Aguilón-Leiva Juan José, Pérez-Calahorra Sofía, Juárez-Vela Raúl, Sufrate-Sorzano Teresa, Angulo-Nalda Beatriz, Garrote-Cámara María Elena, Santolalla-Arnedo Iván, Echániz-Serrano Emmanuel
Miguel Servet Hospital, Aragonese Health Service, 50017 Zaragoza, Spain.
SAPIENF Research Group, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain.
Nurs Rep. 2024 Oct 15;14(4):3007-3022. doi: 10.3390/nursrep14040219.
Delirium or an acute confusional state (ACS) is characterised as being a frequent and complex hospital complication in older adult patients, which can affect their level of independence and increase patient morbidity and mortality. Critically ill patients in the intensive care unit (ICU) frequently develop ICU delirium, leading to longer hospital and ICU stays, increased mortality and long-term impairment.
This review aims to assess existing evidence of interventions that can be considered effective for the management and prevention of delirium in ICUs, reducing short-term morbidity and mortality, ICU and hospital admission times and the occurrence of other long-term complications.
For this systematic review, we searched Medline, PubMed, Cochrane Library, CINHAL, LILACS, SciELO and Dialnet from January 2018 to August 2024, in English, Spanish and French. MeSH descriptors were adjusted to search the different databases. We also checked Prospero for ongoing systematic reviews.
The electronic search yielded a total of 2656 studies, of which 14 trials met the eligibility criteria, with a total of 14,711 participants. We included eight randomised clinical trial (RCTs), four cohort analyses, one systematic review and one observational trial, including participants over 65 years admitted to the ICU. Ten of these studies were based on pharmacological interventions, three of them examined non-pharmacological interventions and the remaining study examined mixed (pharmacological and non-pharmacological) interventions. Six placebo RCTs were included, plus four reported comparisons between different drugs. Regarding non-pharmacological interventions, nursing programmes focused on optimising modifiable risk factors or the use of therapies such as bright light are emerging. Regarding mixed interventions, we found the combination of invasive techniques and with sedoanalgesia.
Due to its satisfactory level of sedation, dexmedetomidine is presented as a viable option because, although olanzapine offers safer results, postoperative administration angiotensin inhibitor systems significantly reduced the incidence of delirium. As for propofol, no significant differences were found. Among the non-pharmacological and mixed therapies, bright light therapy was able to reduce the incidence of delirium, and the combination of epidural/general anaesthesia was effective in all subtypes of delirium. Concerning the remaining interventions, the scientific evidence is still insufficient to provide a definitive recommendation.
谵妄或急性意识模糊状态（ACS）是老年患者常见且复杂的医院并发症，会影响他们的独立水平，增加患者的发病率和死亡率。重症监护病房（ICU）中的危重症患者经常发生ICU谵妄，导致住院和ICU停留时间延长、死亡率增加以及长期功能损害。
本综述旨在评估可被视为对ICU谵妄的管理和预防有效的干预措施的现有证据，以降低短期发病率和死亡率、ICU和医院住院时间以及其他长期并发症的发生。
对于本系统综述，我们在2018年1月至2024年8月期间，以英文、西班牙文和法文检索了Medline、PubMed、Cochrane图书馆、CINHAL、LILACS、SciELO和Dialnet。调整医学主题词（MeSH）描述符以检索不同数据库。我们还在Prospero上查看了正在进行的系统综述。
电子检索共获得2656项研究，其中14项试验符合纳入标准，共有14711名参与者。我们纳入了八项随机临床试验（RCT）、四项队列分析、一项系统综述和一项观察性试验，包括入住ICU的65岁以上参与者。其中十项研究基于药物干预，三项研究考察了非药物干预，其余一项研究考察了混合（药物和非药物）干预。纳入了六项安慰剂RCT，另外四项报告了不同药物之间的比较。关于非药物干预，专注于优化可改变风险因素的护理计划或使用如强光疗法等正在兴起。关于混合干预，我们发现了侵入性技术与镇静镇痛的联合应用。
由于其令人满意的镇静水平，右美托咪定被认为是一种可行的选择，因为尽管奥氮平的结果更安全，但术后给予血管紧张素抑制剂系统可显著降低谵妄的发生率。至于丙泊酚，未发现显著差异。在非药物和混合疗法中，强光疗法能够降低谵妄的发生率，硬膜外/全身麻醉的联合应用对所有谵妄亚型均有效。关于其余干预措施，科学证据仍不足以提供明确的推荐。
