Yoğun Bakım Ünitelerindeki Yaşlı Hastalarda Deliryumun Değerlendirilmesi, Önlenmesi ve Yönetimine İlişkin Stratejiler

Abstract

Deliryum kısa sürede gelişen dikkat ve bilinç değişiklikleri ile karakterize reversibl akut mental durum bozulması olarak tanımlanmakta; hastanın psikomotor davranışlarına göre hiperaktif, hipoaktif ya da miks tip olarak sınıflandırılmaktadır. Yoğun bakım ünitelerindeki (YBÜ) yaşlı hastalarda oldukça yaygın olan deliryum prevalansı %30 ile %75,6 arasında değişmektedir. Deliryum gelişimi için en yaygın tetikleyici faktörler ağrı, metabolik rahatsızlıklar, demans, hiponatremi, dehidratasyon, enfeksiyonlar, hareketsizlik, fazla sayıda ilaç kullanma ve opioid kullanımıdır. Deliryum daha uzun süre mekanik ventilatöre bağlı olma, daha uzun süre hastanede ve YBÜ’de kalma, artmış morbidite, mortalite, taburculuk sonrası bakım evine yerleştirilme ve artmış sağlık harcamaları gibi kısa ve uzun dönemli olumsuz etkilere sahiptir. Bu nedenle deliryumun önlenmesi kadar, erken tanılanması ve tedavi edilmesi ile ilgili stratejilerin geliştirilmesi de önemlidir. Yaşlı hastalarda deliryumun saptanması, önlenmesi ve tedavisinde YBÜ hemşireleri anahtar rol oynar. Deliryum CAM-ICU gibi güvenilir ve geçerli bir değerlendirme aracı ile taranmalıdır. Yaşlı hastaların çoğunda deliryum gelişimine yol açabilecek birden fazla risk faktörü vardır; bu nedenle önleme ve tedavide çok boyutlu bir yaklaşım izlenmeli; erken uyandırma ve solunum koordinasyonu, deliryum riskini artırma olasılığı daha az olan sedatif ajanların seçilmesi, deliryumun takibi ve yönetimi, erken mobilizasyon ve egzersiz uygulamaları birlikte yapılmalıdır. Bu makalede deliryumun tanımı, klinik prezentasyonu ve sonuçları, risk faktörleri, tanılanması, yanı sıra önlenmesi ve tedavisine ilişkin literatür gözden geçirilecektir.

Keywords

• Deliryum, yaşlı, yaşlı hasta, yoğun bakım, yoğun bakım hastaları

Assessment Prevention, and Management Strategies of Delirium in Elderly Patients in Intensive Care Units

Abstract

Delirium is an acute change in mental status which manifest as a rapidly developing disturbance of attention and cognition that tends to temporal fluctuations. It is described as either hyperactive, hypoactive or miks type on the basis of patient’s psychomotor behaviors. Delirium is common among elderly patients in the intensive care units (ICUs) with a prevalence ranging from 30 to 75.6%. The the most common triggering factors for the development of delirium are pain, metabolic disturbances, dementia, hyponatremia, dehydration, infections, immobility, increased number of medications consumed, and currently receiving opioids. Its presence heralds both short and long-term adverse outcomes including prolonged mechanical ventilation, longer hospital and ICUs stay, higher morbidity and mortality, increased rates of institutionalization following discharge, and increased health care costs. Thus strategies to prevent delirium in addition to the early diagnosis and treatment of delirium are important. ICU nurses have the key roles to detect, prevent and management of delirium in the elderly patients. Detection of delirium should made by a reliable and validated delirium assessment tool like CAM-ICU . Because the aetiology is multifactorial in most elderly patients, it should be considered a multi-component approach to prevent and management; early awakening and breathing coordination, choosing sedatives that are less likely to increase risk of delirium, delirium follow and management, early mobility and exercise should implement as a bundle. In this review, we will discuss the definition and clinical presentations, outcomes, risk factors, assessing of delirium as well as prevention and treatment.

Keywords

• Delirium, elderly, elderly patients, intensive care, intensive care patients

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