The complex interplay between delirium, sedation, and early mobility during critical illness: applications in the trauma unit.
The complex interplay between delirium, sedation, and early mobility during critical illness: applications in the trauma unit.
复制标题
DOI：
10.1097/aco.0b013e3283445382
复制
发表时间：
2011-04
期刊：
影响因子：
--
通讯作者：
Pandharipande P
中科院分区：
文献类型：
--
作者：
Banerjee A;Girard TD;Pandharipande P
给危重病人开镇静剂和镇痛药，以减轻疼痛和焦虑，改善病人与呼吸机的不同步，确保病人安全。这些药物本身可能导致谵妄和重症监护病房获得性虚弱，这与较差的临床结果相关。本文将重点介绍这两种疾病过程的流行病学，并讨论旨在减少这些严重并发症的策略。谵妄和ICU获得性虚弱与ICU出院后住院时间延长、费用增加和生活质量下降有关。谵妄也被证明与死亡率增加有关。旨在通过日常镇静和呼吸机停止试验的协议和协调来减少镇静暴露的策略，避免苯二氮卓类药物以支持替代镇静方案和患者的早期动员，都显示出显著改善患者的预后。谵妄和icu获得性虚弱是危重症的并发症，与幸存者较差的临床结果和功能下降有关。基于以下原则的循证方法；尽量减少镇静药物，特别是苯二氮卓类药物，谵妄监测和管理以及早期活动可减轻这些并发症。
Critically ill patients are prescribed sedatives and analgesics to decrease pain and anxiety, improve patient – ventilator dyssynchrony and ensure patient safety. These medications may themselves lead to delirium and ICU-acquired weakness, which are associated with worse clinical outcomes. This review will focus on the epidemiology of these two disease processes and discuss strategies aimed at reducing these devastating complications of critical illness. Delirium and ICU-acquired weakness are associated with longer hospital stay, increased cost and decreased quality of life after discharge from the ICU. Delirium has also shown to be associated with increased mortality. Strategies aimed at reducing sedative exposure through protocols and coordination of daily sedation and ventilator cessation trials, avoiding benzodiazepines in favor of alternative sedative regimens and early mobilization of patients have all shown to significantly improve patient outcomes. Delirium and ICU-acquired weakness are complications of critical illness associated with worse clinical outcomes and functional decline in survivors. An evidence-based approach based on the following tenets; minimization of sedative medication, particularly benzodiazepines, delirium monitoring and management and early mobilization may mitigate these complications.