[Experts consensus on the management of delirium in critically ill patients].

医学 谵妄 镇静 重症监护医学 器质性精神障碍 精神科 重症监护室 重症监护 麻醉
作者
Bo Tang,X T Wang,Wanying Chen,S. Zhu,Y G Chao,Bo Zhu,Wei He,B Wang,Futao Cao,Yunna Liu,Xingwen Fan,Hui Yang,Qianghong Xu,H Zhang,Ruirui Gong,Wenzhao Chai,H M Zhang,Guangzhi Shi,L H Li,Q B Huang,L N Zhang,M G Yin,Xiuling Shang,X M Wang,Fang Tian,L X Liu,Ruixia Zhu,Jun Wu,Ying Wu,Cuixin Li,Yuan Zong,J T Hu,Jue Liu,Qian Zhai,Lijing Deng,Yunhua Deng,D W Liu
出处
期刊:PubMed 卷期号:58 (2): 108-118 被引量:22
标识
DOI:10.3760/cma.j.issn.0578-1426.2019.02.007
摘要

To establish the experts consensus on the management of delirium in critically ill patients. A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group. Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 36 experts to reassess all the statements. (1) Delirium is not only a mental change, but also a clinical syndrome with multiple pathophysiological changes. (2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function. (3) Pain is a common cause of delirium in critically ill patients. Analgesia can reduce the occurrence and development of delirium. (4) Anxiety or depression are important factors for delirium in critically ill patients. (5) The correlation between sedative and analgesic drugs and delirium is uncertain. (6) Pay attention to the relationship between delirium and withdrawal reactions. (7) Pay attention to the relationship between delirium and drug dependence/withdrawal reactions. (8) Sleep disruption can induce delirium. (9) We should be vigilant against potential risk factors for persistent or recurrent delirium. (10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases, and can also be alleviated with the improvement of primary diseases. (11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis. (12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium, especially subclinical delirium. (13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium. (14) Daily assessment is helpful for early detection of delirium. (15) Hopoactive delirium and mixed delirium are common and should be emphasized. (16) Delirium may be accompanied by changes in electroencephalogram. Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant. (17) Pay attention to differential diagnosis of delirium and dementia/depression. (18) Pay attention to the role of rapid delirium screening method in delirium management. (19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium. (20) The key to the management of delirium is etiological treatment. (21) Improving environmental factors and making patient comfort can help reduce delirium. (22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium. (23) Communication with patients should be emphasized and strengthened. Family members participation can help reduce the incidence of delirium and promote the recovery of delirium. (24) Pay attention to the role of sleep management in the prevention and treatment of delirium. (25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium. (26) When using antipsychotics to treat delirium, we should be alert to its effect on the heart rhythm. (27) Delirium management should pay attention to brain functional exercise. (28) Compared with non-critically illness related delirium, the relief of critically illness related delirium will not accomplished at one stroke. (29) Multiple management strategies such as ABCDEF, eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients. (30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment. (31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management. Consensus can promote delirium management in critically ill patients, optimize analgesia and sedation therapy, and even affect prognosis.谵妄是ICU中常见的一种急性临床综合征,可导致患者病死率增加,机械通气时间和住院时间延长,引起长期的认知功能障碍,增加医疗费用,严重影响患者的预后。为规范重症患者的谵妄管理,由中国冷静治疗研究组根据国内外最新文献资料和多年来的应用推广经验,组织相关重症医学专家在充分讨论和沟通基础上制定了"重症患者谵妄管理专家共识"。旨在改进重症患者的谵妄管理,优化镇痛镇静治疗,改善患者的预后。.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
程小小完成签到,获得积分10
刚刚
刚刚
小蘑菇应助坂井泉水采纳,获得10
1秒前
1秒前
TEN110684应助烂漫的乐曲采纳,获得10
2秒前
布布发布了新的文献求助10
2秒前
fzy完成签到,获得积分10
2秒前
于雷是我发布了新的文献求助10
5秒前
adamchris发布了新的文献求助10
6秒前
6秒前
研友_Z6QYbn完成签到,获得积分10
6秒前
务实慕青发布了新的文献求助10
6秒前
执行正义发布了新的文献求助10
7秒前
7秒前
9秒前
活泼的抽屉完成签到,获得积分10
10秒前
橘子发布了新的文献求助10
10秒前
11秒前
鸿鹄发布了新的文献求助20
11秒前
科研通AI2S应助师德采纳,获得10
12秒前
yrj发布了新的文献求助10
13秒前
13秒前
123发布了新的文献求助10
13秒前
fanmo完成签到 ,获得积分0
14秒前
14秒前
liushuyu完成签到,获得积分10
14秒前
小二郎应助xiaodaiduyan采纳,获得30
14秒前
英姑应助务实慕青采纳,获得10
15秒前
小二郎应助zcydbttj2011采纳,获得10
15秒前
寒塘渡鹤影完成签到,获得积分10
16秒前
16秒前
sun发布了新的文献求助10
17秒前
小二郎应助12345采纳,获得10
17秒前
上官若男应助科研通管家采纳,获得10
18秒前
Akim应助科研通管家采纳,获得10
19秒前
Singularity应助科研通管家采纳,获得20
19秒前
爆米花应助科研通管家采纳,获得10
19秒前
科研通AI2S应助科研通管家采纳,获得10
19秒前
Ava应助科研通管家采纳,获得10
19秒前
明明发布了新的文献求助10
19秒前
高分求助中
좌파는 어떻게 좌파가 됐나:한국 급진노동운동의 형성과 궤적 2500
Sustainability in Tides Chemistry 1500
TM 5-855-1(Fundamentals of protective design for conventional weapons) 1000
Cognitive linguistics critical concepts in linguistics 800
Threaded Harmony: A Sustainable Approach to Fashion 799
Livre et militantisme : La Cité éditeur 1958-1967 500
氟盐冷却高温堆非能动余热排出性能及安全分析研究 500
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 基因 遗传学 催化作用 物理化学 免疫学 量子力学 细胞生物学
热门帖子
关注 科研通微信公众号,转发送积分 3051601
求助须知:如何正确求助?哪些是违规求助? 2708914
关于积分的说明 7414939
捐赠科研通 2353282
什么是DOI,文献DOI怎么找? 1245459
科研通“疑难数据库(出版商)”最低求助积分说明 605681
版权声明 595846