engleski

Delirium in ICU - what can we do differently?

Delirium is an acute confusional state that encompasses a wide array of clinical manifestations. Delirium prevalence in ICU ranges from 28% to 83%. Such variation can be attributed to heterogeneity in the evaluated population (e.g. severity of illness, ventilated versus non- ventilated) as well as in the definition and instrument chosen for delirium detection. Despite its elevated prevalence, delirium remains largely unrecognized. There is current evidence demonstrating that delirium is associated with worse outcomes for critically ill patients mainly including increased duration of mechanical ventilation, hospital length of stay and mortality. Oversedation plays a role in the development of delirium in term of prolonged duration of mechanical ventilation and length of ICU stay. Interestingly, not only sedative exposure, but also the type of sedative may influence the development of delirium. There is increasing evidence that the use of benzodiazepines is strongly associated with the occurrence of delirium. The use of non-GABA (or benzodiazepine- sparing) sedation strategies was tested in patients undergoing mechanical ventilation. Currently available data suggest that dexmedetomidine use in ICU practice as well as in intraoperative sedation can provide benefit and reduce delirium incidence.

delirium ; sedation ; dexmedetomidine ; intensive care medicine

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