The Importance of Diagnosing and Managing ICU Delirium

 

Brenda T. Pun; and E. Wesley Ely

 

 

CHEST, 132, 2 , 2007

 

 

ICU delirium represents a form of brain dysfunction that in many cohorts has been diagnosed in 60 to85% of patients receiving mechanical ventilation. This organ dysfunction is grossly underrecognized because of a majority of patients have hypoactive or “quiet” delirium characterized by “negative” symptoms (eg, inattention and a flat affect) not alarming the treating team. Hyperactive delirium, formerly called ICU psychosis, stands out because of symptoms such as agitation that may cause harm to self or staff, but is actually rare relative to hypoactive delirium and associated with a better prognosis. Delirium is often incorrectly thought to be transient and of little consequence. After adjusting for numerous covariates, delirium is a strong, independent predictor of prolonged length of stay, reintubation, higher mortality, and cost of care. Expanded work on patient safety and recommendations by professional societies have established the importance of delirium monitoring and recommended it as standard practice in ICUs all over the world. This evidence-based review for physicians, nurses, respiratory therapists, and pharmacists will outline why it is imperative that patients be routinely monitored for delirium. This review will discuss modifiable risk factors for delirium, such as metabolic disturbances or potent sedative and analgesic medications. Attention to mitigating risk factors, along with recommended pharmacologic approaches such as antipsychotic medications, may provide resolution of delirium in some patients, while others will persist with refractory brain dysfunction and long-term cognitive impairment following critical illness.

 

fulltext

Stiamo assistendo in Terapia Intensiva ad una profonda sfida culturale: pazienti svegli, parenti presenti, staff consapevole dei limiti e delle possibilità. Non è facile "cambiare testa", ma è il primo passo per stare meglio. Tutti.

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Gestire il dolore

ico-flowchartdoloreFlowchart dolore
ico-vnrVNR
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Gestire la sedazione

ico-flowchart-sedaz-agitFlowchart sedaz/agitaz
ico-rassRASS

Gestire il delirium

ico-flowchart-deliriumFlowchart Delirium
ico-manuale-cam-icuManuale CAM-ICU
ico-schedalavoro-cam-icuScheda di lavoro CAM-ICU
ico-icdscICDSC

 

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