当前位置: X-MOL 学术Crit. Care › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
The future of intensive care: delirium should no longer be an issue
Critical Care ( IF 15.1 ) Pub Date : 2022-07-05 , DOI: 10.1186/s13054-022-04077-y
Katarzyna Kotfis 1 , Irene van Diem-Zaal 2, 3 , Shawniqua Williams Roberson 4, 5, 6 , Marek Sietnicki 7 , Mark van den Boogaard 2 , Yahya Shehabi 8, 9 , E Wesley Ely 4, 10, 11
Affiliation  

In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.

中文翻译:

重症监护的未来:谵妄不应再成为问题

在未来理想的重症监护病房 (ICU) 中,所有患者都不会出现谵妄,这是一种在危重病中经常观察到的脑功能障碍综合征,与更糟糕的 ICU 相关结果和长期认知障碍有关。尽管筛查谵妄需要有限的时间和精力,但在常规 ICU 护理期间,这种破坏性的疾病仍然被低估了。由于组织问题、人员短缺、苯二氮卓类药物的使用增加和家庭探视受限,COVID-19 大流行导致谵妄监测、预防和患者护理出现灾难性减少。这些限制导致谵妄发生率增加,这种情况绝不能重演。良好的镇静实践应辅以新的 ICU 设计和连通性,这将促进非药物镇静,必要时可以通过平衡的药物干预来补充抗焦虑和舒适。ICU 声音、灯光控制、楼层规划和房间布置的改进可以促进康复环境,最大限度地减少压力源并帮助预防和管理谵妄。实现无谵妄的 ICU 的基本先决条件是清醒、无镇静、无痛、舒适的患者,其管理遵循 A 到 F (A-F) 捆绑。此外,该捆绑包应该增加三个额外的字母,包括人道主义护理:获得 (G) 对患者需求的洞察,通过“家庭式”(H) 环境提供整体护理,以及重新定义 ICU 架构设计 (I)。最重要的是,没有谵妄的世界依赖于人,重症监护团队面临着优化设计的个人挑战,
更新日期:2022-07-05
down
wechat
bug