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Delirium in critical illness: clinical manifestations, outcomes, and management

التفاصيل البيبلوغرافية
العنوان: Delirium in critical illness: clinical manifestations, outcomes, and management
المؤلفون: Katarzyna Kotfis, Brenda T. Pun, E. Wesley Ely, Pratik P. Pandharipande, Joanna L. Stollings, Gerald Chanques
المساهمون: Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
المصدر: Intensive Care Medicine
Intensive Care Medicine, Springer Verlag, In press, ⟨10.1007/s00134-021-06503-1⟩
بيانات النشر: Springer Science and Business Media LLC, 2021.
سنة النشر: 2021
مصطلحات موضوعية: Adult, medicine.medical_specialty, Critical Care, [SDV]Life Sciences [q-bio], Critical Illness, Sedation, Hypoglycemia, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, mental disorders, medicine, Antipsychotics, Humans, Dementia, 030212 general & internal medicine, ICU Liberation, Intensive care medicine, Pandemics, ComputingMilieux_MISCELLANEOUS, Coma, SARS-CoV-2, business.industry, Delirium, COVID-19, medicine.disease, Intensive care unit, 3. Good health, Intensive Care Units, Cognitive impairment, 030228 respiratory system, Respiratory failure, Narrative Review, medicine.symptom, business
الوصف: Delirium is the most common manifestation of brain dysfunction in critically ill patients. In the intensive care unit (ICU), duration of delirium is independently predictive of excess death, length of stay, cost of care, and acquired dementia. There are numerous neurotransmitter/functional and/or injury-causing hypotheses rather than a unifying mechanism for delirium. Without using a validated delirium instrument, delirium can be misdiagnosed (under, but also overdiagnosed and trivialized), supporting the recommendation to use a monitoring instrument routinely. The best-validated ICU bedside instruments are CAM-ICU and ICDSC, both of which also detect subsyndromal delirium. Both tools have some inherent limitations in the neurologically injured patients, yet still provide valuable information about delirium once the sequelae of the primary injury settle into a new post-injury baseline. Now it is known that antipsychotics and other psychoactive medications do not reliably improve brain function in critically ill delirious patients. ICU teams should systematically screen for predisposing and precipitating factors. These include exacerbations of cardiac/respiratory failure or sepsis, metabolic disturbances (hypoglycemia, dysnatremia, uremia and ammonemia) receipt of psychoactive medications, and sensory deprivation through prolonged immobilization, uncorrected vision and hearing deficits, poor sleep hygiene, and isolation from loved ones so common during COVID-19 pandemic. The ABCDEF (A2F) bundle is a means to facilitate implementation of the 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS) Guidelines. In over 25,000 patients across nearly 100 institutions, the A2F bundle has been shown in a dose-response fashion (i.e., greater bundle compliance) to yield improved survival, length of stay, coma and delirium duration, cost, and less ICU bounce-backs and discharge to nursing homes.
تدمد: 1432-1238
0342-4642
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::54d3d3585b413ff6e6a6807db5e4f472
https://doi.org/10.1007/s00134-021-06503-1
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....54d3d3585b413ff6e6a6807db5e4f472
قاعدة البيانات: OpenAIRE
الوصف
تدمد:14321238
03424642