Current controversies and future perspectives on treatment of intensive care unit delirium in adults.
Current controversies and future perspectives on treatment of intensive care unit delirium in adults.
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DOI：
10.5492/wjccm.v8.i3.18
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发表时间：
2019-06-12
期刊：
影响因子：
--
通讯作者：
Di Napoli, Raffaela
中科院分区：
文献类型：
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作者：
Cascella, Marco;Fiore, Marco;Di Napoli, Raffaela
谵妄是重症监护病房（ICU）急性脑功能障碍最常见的表现。虽然抗精神病药物被广泛用于治疗这一严重并发症，但最近的证据强调，这些药物并没有降低ICU谵妄（ICU- d）的患病率，也没有提高生存率、ICU时间或住院时间。值得注意的是，到目前为止，还没有确定预防或治疗谵妄的药理学策略。在这种情况下，迫切需要新的科学证据。对特定的icu亚组的调查，或侧重于不同的临床环境，以及对抗精神病药物以外的药物的研究，如右美托咪定或褪黑激素，可能是有趣的研究领域。同时，由于有证据表明可以有效预防重症监护，文献建议加强所有旨在通过非药物方法预防的策略，主要侧重于纠正危险因素。治疗谵妄的更合适的策略仍然是使用抗精神病药物，在仔细的个案分析后选择正确的剂量。虽然关于右美托咪定使用的证据仍然是相互矛盾和稀少的，但这种药物为icu的预防和治疗提供了有趣的前景。本文旨在概述当前循证医学实践的药理学方法。本文还讨论了目前正在进行的关于该主题的临床研究的现状和未来研究的前景。
Delirium is the most frequent manifestation of acute brain dysfunction in intensive care unit (ICU). Although antipsychotics are widely used to treat this serious complication, recent evidence has emphasized that these agents did not reduce ICU delirium (ICU-D) prevalence and did not improve survival, length of ICU or hospital stay after its occurrence. Of note, no pharmacological strategy to prevent or treat delirium has been identified, so far. In this scenario, new scientific evidences are urgently needed. Investigations on specific ICU-D subgroups, or focused on different clinical settings, and studies on medications other than antipsychotics, such as dexmedetomidine or melatonin, may represent interesting fields of research. In the meantime, because there is some evidence that ICU-D can be effectively prevented, the literature suggests strengthening all the strategies aimed at prevention through no-pharmacological approaches mostly focused on the correction of risk factors. The more appropriate strategy useful to treat established delirium remains the use of antipsychotics managed by choosing the right doses after a careful case-by-case analysis. While the evidence regarding the use of dexmedetomidine is still conflicting and sparse, this drug offers interesting perspectives for both ICU-D prevention and treatment. This paper aims to provide an overview of current pharmacological approaches of evidence-based medicine practice. The state of the art of the on-going clinical research on the topic and perspectives for future research are also addressed.