A screening, prevention, and restoration model for saving the injured brain in intensive care unit survivors.
A screening, prevention, and restoration model for saving the injured brain in intensive care unit survivors.
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DOI：
10.1097/ccm.0b013e3181f245d3
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发表时间：
2010-10
影响因子：
8.8
通讯作者：
Ely EW
中科院分区：
文献类型：
--
作者：
Vasilevskis EE;Pandharipande PP;Girard TD;Ely EW
我们面临着一个深刻的、新出现的公共卫生问题，表现为急性和慢性大脑功能障碍。这影响了重症监护病房(ICU)的年轻和老年幸存者，并正在改变社会的面貌。三分之二的ICU患者出现精神错乱，这与住院时间更长、费用增加和死亡率过高有关。此外，超过一半的ICU幸存者患有痴呆症，影响他们的身体和认知功能，似乎与他们ICU精神错乱的持续时间有关。需要一种关于集约主义者如何处理大脑的新范式。我们提出了一个三步法来解决这种新出现的流行病，其中包括筛查、预防和脑功能恢复(SPR)。筛查结合了危险因素识别和使用经过验证的仪器进行的精神错乱评估。预防急性和慢性脑功能障碍需要实施一种核心护理模式，该模式将循证实践相结合：唤醒和呼吸协调与靶向镇静、精神错乱监测和运动/早期活动(ABCDE)相结合。REVERATION引入了对ICU幸存者进行持续筛查和治疗的战略，这些幸存者具有持续脑功能障碍的高风险。这个实用的系统应用了许多循证的概念，结合了个性化医学、基于系统的实践以及为改善急性和慢性认知结果而进行的持续研究和开发。
We face a profound and emerging public health problem in the form of acute and chronic brain dysfunction. This affects both young and elderly intensive care unit (ICU) survivors and is altering the landscape of society. Two-thirds of ICU patients develop delirium, and this is associated with longer stays, increased costs and excess mortality. In addition, over one-half of ICU survivors suffer a dementia-like illness that impacts their physical and cognitive functional abilities and which appears to be related to the duration of their ICU delirium. A new paradigm of how Intensivists handle the brain is required. We propose a 3-step approach to address this emerging epidemic, which includes Screening, Prevention, and Restoration of brain function (SPR). Screening combines risk factor identification and delirium assessment using validated instruments. Prevention of acute and chronic brain dysfunction requires implementation of a core model of care that combines evidence-based practices: awakening and breathing coordination with target -based sedation, delirium monitoring, and exercise / early mobility (ABCDE). Restoration introduces strategies of ongoing screening and treatment for ICU survivors at high risk of ongoing brain dysfunction. This practical system applying many evidence-based concepts, incorporates personalized medicine, systems based practice, and continuing research and development towards improving acute and chronic cognitive outcomes.