transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2024-11-1-103-121FCAXAItransmed-912Research ArticleАНЕСТЕЗИОЛОГИЯ И РЕАНИМАТОЛОГИЯPAIN, CRITICAL CARE, AND ANESTHESIAОсновные особенности диагностики и лечения делирия у пациентов отделения реанимации и интенсивной терапии: систематический обзор литературыMain features of diagnosis and treatment of delirium in icu patients: a systematic reviewhttps://orcid.org/0009-0006-0547-0492РябченкоМ. А.,RiabchenkoM. A.

Максим Андреевич Рябченко, студент 6 курса

Институт медицинского образования; лечебный факультет

Санкт-Петербург

Maksim A. Riabchenko, 6th year student

Institute of Medical Education; Faculty of Medicine

Saint Petersburg

maksim2000z@mail.ruhttps://orcid.org/0000-0001-8519-7145ЛейдерманИ. Н.LeydermanI. N.

Илья Наумович Лейдерман, д. м. н., профессор

кафедра анестезиологии и реаниматологии с клиникой

197341; ул. Аккуратова, д. 2; Санкт-Петербург

Санкт-Петербург

Ilia N. Leyderman, MD, PhD, Professor

Anesthesiology and Reanimatology Clinical Chair

197341; Akkuratova str., 2; Saint Petersburg

inl230970@gmail.comФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian Federation202413032024111103121Copyright © Рябченко М.А., Лейдерман И.Н., 20242024Рябченко М.А., Лейдерман И.Н.Riabchenko M.A., Leyderman I.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/912   Актуальность

   Актуальность. Делирий — это тяжелый нервно-психический синдром, который является распространенной проблемой у пациентов в отделении реанимации и интенсивной терапии (ОРИТ). Несмотря на серьезные последствия развития делирия в ОРИТ, ряд опубликованных в последнее время работ свидетельствуют о недостаточной осведомленности медицинского персонала о ключевых принципах диагностики и лечения данного состояния.

   Цель исследования

   Цель исследования. Проанализировать и обобщить данные о лечебно-диагностических алгоритмах, позволяющих идентифицировать и проводить адекватную терапию делирия у взрослых пациентов в отделении реанимации и интенсивной терапии.

   Материалы и методы

   Материалы и методы. Проведен поиск в электронных базах данных PubMed и eLIBRARY. В обзор включены публикации, доступные для поиска на май 2023 года.

   Результаты

   Результаты. Были выявлены пять инструментов скрининга делирия у взрослых, которые валидизированы на соответствие критериям диагностики делирия, изложенным в Руководстве по диагностике и статистике Американской психиатрической ассоциации (DSM). Перспективами для улучшения клинических результатов являются многокомпонентные программы с большим количеством стратегий, направленные на выявление, оценку, профилактику и лечение делирия в ОРИТ, такие как PAD или ABCDE.

   Заключение

   Заключение. Для своевременной профилактики и эффективной коррекции делирия необходимо использовать валидизированные инструменты скрининга, а также внедрять профилактические стратегии, такие как ABCDEF. Профилактика делирия в ОРИТ путем определения уровня риска, устранения этиологических факторов развития, раннего проведения мультимодальной терапии должна входить в стандартный алгоритм действий медицинского персонала с момента поступления пациента в отделение реанимации и интенсивной терапии.

   Relevance

   Relevance. Delirium is a severe neuropsychiatric syndrome, which is a common problem in patients in the intensive care unit (ICU). Recently published works indicate a insufficiency of awareness about the key principles of diagnosis and treatment of this condition.

   The aim of the study is to analyze and summarize data on algorithms that allow the identification and correction of delirium in patients in the intensive care unit.

   Materials and methods

   Materials and methods. A comprehensive search was conducted in the electronic databases PubMed and eLIBRARY. The review includes searchable publications for May 2023.

   Results

   Results. A literature review identified five adult delirium screening tools that have been validated against The Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for delirium. Prospects for improving clinical outcomes are multi-component programs with a large number of strategies aimed at assessing, preventing and treating delirium in the ICU.

   Conclusion

   Conclusion. It is necessary to use validated screening tools, as well as implement preventive strategies such as ABCDEF. Prevention of delirium in the ICU by determining the level of risk, eliminating etiological development factors and early multimodal therapy should be included in the standard algorithm from the moment the patient is admitted to the hospital in order to reduce hospital mortality.

делирийдиагностикакритические состоянияотделение реанимации и интенсивной терапиифакторы рискаCAM-ICUICDSCCAM-ICUcritical conditionsdeliriumdiagnosticsICDSCintensive care unitrisk factorsReferences+Salluh JI, Wang H, Schneider EB, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015 Jun 3;350:h2538. DOI: 10.1136/bmj.h2538.+Salluh JI, Wang H, Schneider EB, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015 Jun 3;350:h2538. DOI: 10.1136/bmj.h2538.Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–922. DOI: 10.1016/S0140-6736(13)60688-1.Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–922. DOI: 10.1016/S0140-6736(13)60688-1.Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369(14):1306–1316. DOI:10.1056/NEJMoa1301372.Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369(14):1306–1316. DOI:10.1056/NEJMoa1301372.Pisani MA, Kong SY, Kasl SV, et al. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180(11):1092–1097. DOI:10.1164/rccm.200904-0537OC.Pisani MA, Kong SY, Kasl SV, et al. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180(11):1092–1097. DOI:10.1164/rccm.200904-0537OC.Klein Klouwenberg PM, Zaal IJ, Spitoni C, et al. The attributable mortality of delirium in critically ill patients: prospective cohort study. BMJ. 2014;349:g6652. DOI:10.1136/bmj.g6652.Klein Klouwenberg PM, Zaal IJ, Spitoni C, et al. The attributable mortality of delirium in critically ill patients: prospective cohort study. BMJ. 2014;349:g6652. DOI:10.1136/bmj.g6652.Kotfis K, Marra A, Ely EW. ICU delirium — a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther. 2018;50(2):160–167. DOI: 10.5603/AIT.a2018.0011.Kotfis K, Marra A, Ely EW. ICU delirium — a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther. 2018;50(2):160–167. DOI: 10.5603/AIT.a2018.0011.Попугаев К.А., Савин И.А., Лубнин А.Ю. и др. Делирий в реаниматологической практике. Анестезиология и реаниматология. 2012; 4:19–27.Popugaev KA, Savin IA, Lubnin AYu. Delirium in neurointensive care unit. Literature review. Russian Journal of Anaesthesiology and Reanimatology. 2012; 4:19–27. In RussianЛихванцев В.В. Неспецифический делирий в отделении интенсивной терапии и реанимации. Анестезиология и реаниматология. 2015;60(2):55–59.Likhvantsev VV. Nonspecific delirium in the intensive care unit. Russian Journal of Anaesthesiology and Reanimatology. 2015;60(2):55–59. In RussianМКБ-10: Международная статистическая классификация болезней. 10 пересмотр. М.: Медицина; 2003.ICD-10: International statistical classification of diseases. 10 revision. M.: Medicine; 2003. In RussianEuropean Delirium Association; American Delirium Society. The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Med. 2014 Oct 8;12:141. DOI: 10.1186/s12916-014-0141-2.European Delirium Association; American Delirium Society. The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Med. 2014 Oct 8;12:141. DOI: 10.1186/s12916-014-0141-2.Ely EW, Inouye SK, Bernard GR, et al. Delirium in Mechanically Ventilated Patients: Validity and Reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA. 2001;286(21):2703–2710. DOI: 10.1001/jama.286.21.2703.Ely EW, Inouye SK, Bernard GR, et al. Delirium in Mechanically Ventilated Patients: Validity and Reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA. 2001;286(21):2703–2710. DOI: 10.1001/jama.286.21.2703.Krewulak KD, Rosgen BK, Ely EW, et al. The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients. PLoS One. 2020 Nov 16;15(11):e0242378. DOI: 10.1371/journal.pone.0242378.Krewulak KD, Rosgen BK, Ely EW, et al. The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients. PLoS One. 2020 Nov 16;15(11):e0242378. DOI: 10.1371/journal.pone.0242378.Gusmao-Flores D, Salluh JIF, Chalhub RÁ, et al. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium : a systematic review and meta-analysis of clinical studies. Crit Care 16, R115 (2012). DOI: 10.1186/cc11407.Gusmao-Flores D, Salluh JIF, Chalhub RÁ, et al. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium : a systematic review and meta-analysis of clinical studies. Crit Care 16, R115 (2012). DOI: 10.1186/cc11407.Rummel NE, Vasilevskis EE, Han JH, et al. Implementing delirium screening in the ICU: secrets to success. Crit Care Med. 2013 Sep;41(9):2196–208. DOI: 10.1097/CCM.0b013e31829a6f1e.Rummel NE, Vasilevskis EE, Han JH, et al. Implementing delirium screening in the ICU: secrets to success. Crit Care Med. 2013 Sep;41(9):2196–208. DOI: 10.1097/CCM.0b013e31829a6f1e.Khan BA, Perkins AJ, Gao S, et al. The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU. Crit Care Med. 2017 May;45(5):851–857. DOI: 10.1097/CCM.0000000000002368.Khan BA, Perkins AJ, Gao S, et al. The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU. Crit Care Med. 2017 May;45(5):851–857. DOI: 10.1097/CCM.0000000000002368.Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, et al. Risk factors for intensive care delirium : a systematic review. Intensive Crit Care Nurs. 2008 Apr;24(2):98–107. DOI: 10.1016/j.iccn.2007.08.005.Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, et al. Risk factors for intensive care delirium : a systematic review. Intensive Crit Care Nurs. 2008 Apr;24(2):98–107. DOI: 10.1016/j.iccn.2007.08.005.Vasilevskis EE, Han JH, Hughes CG, et al. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol. 2012 Sep;26(3):277–87. DOI: 10.1016/j.bpa.2012.07.003.Vasilevskis EE, Han JH, Hughes CG, et al. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol. 2012 Sep;26(3):277–87. DOI: 10.1016/j.bpa.2012.07.003.Гельфанд Б.Р., Линев Д.В., Ярошецкий А.И. и др. Делирий у больных в критических состояниях: критерии оценки тяжести, прогноз, лечение. Анналы хирургии. 2016;21(1–2):60–73. URL: https://cyberleninka.ru/article/n/deliriy-u-bolnyh-v-kriticheskih-sostoyaniyah-kriterii-otsenki-tyazhesti-prognoz-lechenie.Gel’fand BR, Linev DV, Yaroshetskiy AI, et al. Delirium in patients in critical conditions: criteria for assessing the severity, prognosis, treatment. Annaly khirurgii (Annals of Surgery, Russian journal). 2016; 21 (1–2): 60–73. URL: https://cyberleninka.ru/article/n/deliriy-u-bolnyh-v-kriticheskih-sostoyaniyah-kriterii-otsenki-tyazhesti-prognoz-lechenie In RussianDunne SS, Coffey JC, Konje S, et al. Biomarkers in delirium : A systematic review. J Psychosom Res. 2021 Aug;147:110530. DOI: 10.1016/j.jpsychores.2021.110530.Dunne SS, Coffey JC, Konje S, et al. Biomarkers in delirium : A systematic review. J Psychosom Res. 2021 Aug;147:110530. DOI: 10.1016/j.jpsychores.2021.110530.Cerejeira J, Nogueira V, Luís P, et al. The cholinergic system and inflammation: common pathways in delirium pathophysiology. J Am Geriatr Soc. 2012 Apr;60(4):669–75. DOI: 10.1111/j.1532-5415.2011.03883.x.Cerejeira J, Nogueira V, Luís P, et al. The cholinergic system and inflammation: common pathways in delirium pathophysiology. J Am Geriatr Soc. 2012 Apr;60(4):669–75. DOI: 10.1111/j.1532-5415.2011.03883.x.Hart RP, Levenson JL, Sessler CN, et al. Validation of a cognitive test for delirium in medical ICU patients. Psychosomatics. 1996 Nov-Dec;37(6):533–46. DOI: 10.1016/S0033-3182(96)71517-7.Hart RP, Levenson JL, Sessler CN, et al. Validation of a cognitive test for delirium in medical ICU patients. Psychosomatics. 1996 Nov-Dec;37(6):533–46. DOI: 10.1016/S0033-3182(96)71517-7.Hosker C, Ward D. Hypoactive delirium BMJ 2017; 357:j2047 DOI: 10.1136/bmj.j2047.Hosker C, Ward D. Hypoactive delirium BMJ 2017; 357:j2047 DOI: 10.1136/bmj.j2047.Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–1344. DOI:10.1164/rccm.2107138.Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–1344. DOI:10.1164/rccm.2107138.Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289(22):2983–2991. DOI:10.1001/jama.289.22.2983.Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289(22):2983–2991. DOI:10.1001/jama.289.22.2983.Khan BA, Guzman O, Campbell NL, et al. Comparison and agreement between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in evaluating patients’ eligibility for delirium assessment in the ICU. Chest. 2012;142(1):48–54. DOI:10.1378/chest.11-2100.Khan BA, Guzman O, Campbell NL, et al. Comparison and agreement between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in evaluating patients’ eligibility for delirium assessment in the ICU. Chest. 2012;142(1):48–54. DOI:10.1378/chest.11-2100.Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370–1379. DOI: 10.1097/00003246-200107000-00012.Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370–1379. DOI: 10.1097/00003246-200107000-00012.Bergeron N, Dubois M-J, Dumont M, et al. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859–64. DOI: 10.1007/s001340100909.Bergeron N, Dubois M-J, Dumont M, et al. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859–64. DOI: 10.1007/s001340100909.Radtke FM, Franck M, Schneider M, et al. Comparison of three scores to screen for delirium in the recovery room. Br J Anaesth. 2008 Sep;101(3):338–43. DOI: 10.1093/bja/aen193.Radtke FM, Franck M, Schneider M, et al. Comparison of three scores to screen for delirium in the recovery room. Br J Anaesth. 2008 Sep;101(3):338–43. DOI: 10.1093/bja/aen193.Han JH, Wilson A, Vasilevskis EE, et al. Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med. 2013; 62(5):457–465. DOI: 10.1016/j.annemergmed.2013.05.003.Han JH, Wilson A, Vasilevskis EE, et al. Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med. 2013; 62(5):457–465. DOI: 10.1016/j.annemergmed.2013.05.003.Gélinas C, Fillion L, Puntillo KA, et al. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006;15(4):420–427.Gélinas C, Fillion L, Puntillo KA, et al. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006;15(4):420–427.Cortés-Beringola A, Vicent L, Martín-Asenjo R, et al. Diagnosis, prevention, and management of delirium in the intensive cardiac care unit. Am Heart J. 2021 Feb.; 232:164–176. DOI: 10.1016/j.ahj.2020.11.011.Cortés-Beringola A, Vicent L, Martín-Asenjo R, et al. Diagnosis, prevention, and management of delirium in the intensive cardiac care unit. Am Heart J. 2021 Feb.; 232:164–176. DOI: 10.1016/j.ahj.2020.11.011.Trogrlić Z, van der Jagt M, Bakker J, et al. A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes. Crit Care. 2015 Apr 9;19(1):157. DOI: 10.1186/s13054-015-0886-9.Trogrlić Z, van der Jagt M, Bakker J, et al. A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes. Crit Care. 2015 Apr 9;19(1):157. DOI: 10.1186/s13054-015-0886-9.Alkhateeb T, Semler MW, Girard TD, et al. Comparison of SAT and SBT Conduct During the ABC Trial and PILOT Trial. J Intensive Care Med. 2023 Nov 19:8850666231213337. DOI: 10.1177/08850666231213337.Alkhateeb T, Semler MW, Girard TD, et al. Comparison of SAT and SBT Conduct During the ABC Trial and PILOT Trial. J Intensive Care Med. 2023 Nov 19:8850666231213337. DOI: 10.1177/08850666231213337.

The authors declare that there are no conflicts of interest present.