Ebook Principles of critical care (4th edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Principles of critical care (4th edition): Part 2
Ebook Principles of critical care (4th edition): Part 2
PART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPat Ebook Principles of critical care (4th edition): Part 2tients 10 the intensive care unit (ICƯ) who experience delirium are exhibiting an under-recognized form of organ dysfunction Delirium IS extremely common in ICU patients as factors such as comorbidity, the acute critical illness itself, and iatrogenesis intersect to create a high-risk setting for de Ebook Principles of critical care (4th edition): Part 2lirium. This neurologic complication is often hazardous, being associated with death, prolonged hospital stays, and long-term cognitive impaưment andEbook Principles of critical care (4th edition): Part 2
institutionalization Neurologic dysfunction compromises patients' ability to be removed from mechanical ventilation or to fully recover and regain indPART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPat Ebook Principles of critical care (4th edition): Part 2rium is manifesting predominantly as the hypoactive (quiet) subtype rather than the hyperactive (agitated) subtype Despite being often overlooked clinically. ICU delirium has increasingly been the subject of research during the past decade, which has brought to light the scope of the problem in crit Ebook Principles of critical care (4th edition): Part 2ically ill patients and provided clinicians with tools for routinely monitoring delirium at the bedside. This cliapter reviews the definition and saliEbook Principles of critical care (4th edition): Part 2
ent features of delirium, its primary risk factors, including drugs associated with the development of delirium, proposed pathophysiologic mechanisms.PART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPat Ebook Principles of critical care (4th edition): Part 2OGY_______________________________________The American Psychological Associations IAPA) Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV describes delirium as a disturbance m consciousness and cognition that develops over a short period of time (eg. hours to days) and tends to fluctuat Ebook Principles of critical care (4th edition): Part 2e during the course of the day/ Specifically, there are four criteria required to diagnose delirium1:1Disturbance of consciousness, with reduced awareEbook Principles of critical care (4th edition): Part 2
ness of the environment and impaired ability to focus, sustain or shift attention2Altered cognition (eg. memory impairment, disorientation, or languagPART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPat Ebook Principles of critical care (4th edition): Part 2ng or evolving dementia.3Disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.4Evidence of an etiological cause, which the DSM-IV uses to classify delirium as Delirium Due to a General Medical Condition. Substance-Induced Deliri Ebook Principles of critical care (4th edition): Part 2um. Delirium Due to Multiple Etiologies, or Delirium Not Otherwise Specified.Historically, two words were used to describe acutely confused patients TEbook Principles of critical care (4th edition): Part 2
he Roman word delirium referred to an agitated and confused person (ie. hyperactive delirium). The Greek word lethargus was used to describe a quietlyPART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPat Ebook Principles of critical care (4th edition): Part 2heir illness and therapy In both subtypes, the patient s brain is not functioning normally. It therefore makes sense that the original derivation of delirium comes from the Latin word deliiia. which literally means to “be out of your furrow." For greater clarity and to avoid misuse of terms such as Ebook Principles of critical care (4th edition): Part 2dementia and delirium. Table 82-1 lists basic definitions and clinical characteristics of each syndromeDelirium in the ICƯ has been referred to in theEbook Principles of critical care (4th edition): Part 2
medical literature using a multitude of terms, including ICU psychosis. ICU syndrome, brain failure, encephalopathy, postoperative psychosis, acute oPART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPat Ebook Principles of critical care (4th edition): Part 2tngProgress)*Diagnostic• Impaired abiky to focus, shift• Memory impairment plus oneFeaturesor sustain attention •Change in cognition (eg. memory Impairment, disorientation or language) or development in perceptual disturbances •Fluctuating courseof the following: •Aphasia •Apraxia •Agnosia •Imparcd Ebook Principles of critical care (4th edition): Part 2executive functioning • Impairments must be severe enough to cause impairments in social or occupational functioning and represent a decine from baselEbook Principles of critical care (4th edition): Part 2
ineAssociated• Sleep.’w-ake disturbances• Vrsuospawl impairmentFeatures•triremes m psychomotor activity •Emotional disturbances (fear, anuety. depressPART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPat Ebook Principles of critical care (4th edition): Part 2dical Illness• Dementia of Alỉheimer typeCauses•Medkation/substanceiloxin ingestion or withdrawal •Multifactorial•Vascular dementia •Chronic medical conditions (eg Pick disease, HIV, stroke. headmpey)Data from Aiwrten A)ttv.\Yk Aiwiin'iM. (taposttorf Sw.S&iV Minus'if Meofd fts«An. 4th ed. Text Rmsur Ebook Principles of critical care (4th edition): Part 2. Wmhngtm. ox. Arrenon Psjdutn: Assooinm: xoo.subacute befuddlement. and toxic conftisional state/ ’ Neurologists often use "encephalopathy” to referEbook Principles of critical care (4th edition): Part 2
to hypoactive delirium and "delirium" to describe only hyperactive delirium4 Among ICU practitioners. ■ delirium” is used inconsistently, as evidencedPART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPat Ebook Principles of critical care (4th edition): Part 2uld be identified for a patient with fluctuating mental status with inattention, perceptual changes, and disorganized thinking, whereas alternative terms (eg. hepatic encephalopathy) were used when the etiology of delirium was obviousIncreasingly, however, the ICU community is seeking to standardize Ebook Principles of critical care (4th edition): Part 2 delirium terminology to conform to the APA definition, with the hope that use of "delirium" to describe this syndrome of acute brain dysfunction, regEbook Principles of critical care (4th edition): Part 2
ardless of etiology, will improve cross-talk between specialists with different medical backgrounds, collaborative research efforts, and ultimately maPART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPat Ebook Principles of critical care (4th edition): Part 2a for delirium, and the underlying etiology, when known, can be used as an associated term (eg. -delirium secondary to sepsis" IS preferred over "septic encephalopathy").PREVALENCE AND SUBTYPESDelirium during critical illness occurs in 20% to 80% of ICU patients depending on the severity of illness Ebook Principles of critical care (4th edition): Part 2of the population studied and methods used to detect delirium.’-" The prevalence is highest, for example, in mechanically ventilated ICƯ patients, witEbook Principles of critical care (4th edition): Part 2
h to 80% developing delirium during their ICƯ 3tay.ỉl0'i;:‘; whereas lower prevalence rates are reported m nonventilated patients and in mixed ICƯ popPART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPat Ebook Principles of critical care (4th edition): Part 2CU delirium will likely increase as the U.S. population ages.Delirium can be subtyped based on observed changes in motor activity. resulting in hypoactive, hyperactive, and mixed subtypes/1 Peterson et a) reported these delirium subtypes in a cohort of 613 ventilated and nonventilated ICU patients i Ebook Principles of critical care (4th edition): Part 2n whom delnium was monitored for moreCHAPTER 82: Delirium in the Intensive Care UnitPART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPatPART 6Neurologic Disorders/56PART 6: Neurologic DisordersCHAPTER82Delirium in the Intensive Care UnitNathan E. BrummelTimothy D. GirardINTRODUCTIONPatGọi ngay
Chat zalo
Facebook