TY - JOUR
T1 - Delirium
T2 - Past, present, and future
AU - Field, R. Ryan
AU - Wall, Michael H.
PY - 2013/9/1
Y1 - 2013/9/1
N2 - Delirium was described by Hippocrates over 2500 years ago and it remains an important clinical problem today. Work continues to improve definition, prevention, diagnosis, and treatment, but relatively young science remains. Delirium affects 12 500 000 patients and costs $152 000 000 000 every year. Up to 80% of mechanically ventilated patients experience delirium, which exists as a spectrum of acute brain organ dysfunction. Multiple theories exist, including contribution from baseline pathology, medications, surgical inflammation, and environment. Biochemical models point to pathophysiology. Delirium remains largely preventable through planning and subgroup identification. Validated objective assessment models aid diagnosis, whereas protocolized multimodal intervention remains best practice. Pharmacotherapy, as chemical restraint, is reserved for cases of potential harm to self or others. Observation obviates mechanical restraint. The contribution of delirium to cognitive decline remains controversial and concerning. As dollars shrink and cost does not, delirium becomes increasingly important. In an aging population of increasing frailty, delirium will contribute increasingly to long-term morbidity and even mortality.
AB - Delirium was described by Hippocrates over 2500 years ago and it remains an important clinical problem today. Work continues to improve definition, prevention, diagnosis, and treatment, but relatively young science remains. Delirium affects 12 500 000 patients and costs $152 000 000 000 every year. Up to 80% of mechanically ventilated patients experience delirium, which exists as a spectrum of acute brain organ dysfunction. Multiple theories exist, including contribution from baseline pathology, medications, surgical inflammation, and environment. Biochemical models point to pathophysiology. Delirium remains largely preventable through planning and subgroup identification. Validated objective assessment models aid diagnosis, whereas protocolized multimodal intervention remains best practice. Pharmacotherapy, as chemical restraint, is reserved for cases of potential harm to self or others. Observation obviates mechanical restraint. The contribution of delirium to cognitive decline remains controversial and concerning. As dollars shrink and cost does not, delirium becomes increasingly important. In an aging population of increasing frailty, delirium will contribute increasingly to long-term morbidity and even mortality.
KW - current
KW - delirium
KW - management
KW - review
KW - treatment
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U2 - 10.1177/1089253213476957
DO - 10.1177/1089253213476957
M3 - Review article
C2 - 23416712
AN - SCOPUS:84882675525
VL - 17
SP - 170
EP - 179
JO - Seminars in Cardiothoracic and Vascular Anesthesia
JF - Seminars in Cardiothoracic and Vascular Anesthesia
SN - 1089-2532
IS - 3
ER -