■急诊室(ED)正面临人满为患和ED登机的流行病,特别是那些经常出现的老年人,或发展,ED中的谵妄。谵妄与并发症增加有关,住院时间更长,死亡率,以及医疗保健系统的成本。然而,我们只有有限的知识如何成功地预防和治疗在ED中谵妄,可持续,和成本有效的方式。我们对ED中谵妄预防和治疗方案的最新文献进行了叙述性综述。我们旨在描述ED在建立谵妄管理计划中使用的成功谵妄管理策略的组成部分。
■我们回顾了10项研究(2005-2023年),这些研究报告了ED中的谵妄干预措施,并描述已研究的这些干预措施的不同组成部分。这些干预措施包括:优化血液动力学和氧合,治疗疼痛,水合和营养支持,避免使用镇静催眠药,抗精神病药和抗胆碱能药,促进睡眠,感官刺激,限制在ED中花费的时间,教育提供者和工作人员,并制定纳入电子健康记录的多学科谵妄协议。
■通过我们对ED中有关谵妄预防和治疗计划的最新文献的叙述性回顾,我们已经确定了ED中成功的谵妄预防策略的9个组成部分.我们还讨论了进一步研究的三个高度优先领域,包括确定谵妄预防策略的最有效组成部分,在非髋部进行额外的高质量试验。
UNASSIGNED: Emergency departments (EDs) are facing an epidemic of overcrowding and ED boarding, particularly of older adults who often present with, or develop, delirium in the ED. Delirium is associated with increased complications, longer hospital length of stay, mortality, and costs to the healthcare system. However, we only have limited knowledge of how to successfully prevent and treat delirium in the ED in a pragmatic, sustainable, and cost-effective way. We present a narrative review of recent literature of delirium prevention and treatment programs in the ED. We aim to describe the components of successful delirium management strategies to be used by EDs in building delirium management programs.
UNASSIGNED: We reviewed 10 studies (2005-2023) that report delirium interventions in the ED, and describe the different components of these interventions that have been studied. These interventions included: optimizing hemodynamics and oxygenation, treating pain, hydration and nutrition support, avoiding sedative hypnotics, antipsychotics and anticholinergics, promoting sleep, sensory stimulation, limiting the time spent in the ED, educating providers and staff, and developing multidisciplinary delirium protocols integrated into the electronic health record.
UNASSIGNED: Through our narrative review of the recent literature on delirium prevention and treatment programs in the ED, we have identified nine components of successful delirium prevention strategies in the ED. We also discuss three high priority areas for further research including identification of most effective components of delirium prevention strategies, conduct of additional high-quality trials in non-hip.