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The future of intensive care: delirium should no longer be an issue
In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9254432/ https://www.ncbi.nlm.nih.gov/pubmed/35790979 http://dx.doi.org/10.1186/s13054-022-04077-y |
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author | Kotfis, Katarzyna van Diem-Zaal, Irene Roberson, Shawniqua Williams Sietnicki, Marek van den Boogaard, Mark Shehabi, Yahya Ely, E. Wesley |
author_facet | Kotfis, Katarzyna van Diem-Zaal, Irene Roberson, Shawniqua Williams Sietnicki, Marek van den Boogaard, Mark Shehabi, Yahya Ely, E. Wesley |
author_sort | Kotfis, Katarzyna |
collection | PubMed |
description | In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care. |
format | Online Article Text |
id | pubmed-9254432 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-92544322022-07-06 The future of intensive care: delirium should no longer be an issue Kotfis, Katarzyna van Diem-Zaal, Irene Roberson, Shawniqua Williams Sietnicki, Marek van den Boogaard, Mark Shehabi, Yahya Ely, E. Wesley Crit Care Perspective In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care. BioMed Central 2022-07-05 /pmc/articles/PMC9254432/ /pubmed/35790979 http://dx.doi.org/10.1186/s13054-022-04077-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Perspective Kotfis, Katarzyna van Diem-Zaal, Irene Roberson, Shawniqua Williams Sietnicki, Marek van den Boogaard, Mark Shehabi, Yahya Ely, E. Wesley The future of intensive care: delirium should no longer be an issue |
title | The future of intensive care: delirium should no longer be an issue |
title_full | The future of intensive care: delirium should no longer be an issue |
title_fullStr | The future of intensive care: delirium should no longer be an issue |
title_full_unstemmed | The future of intensive care: delirium should no longer be an issue |
title_short | The future of intensive care: delirium should no longer be an issue |
title_sort | future of intensive care: delirium should no longer be an issue |
topic | Perspective |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9254432/ https://www.ncbi.nlm.nih.gov/pubmed/35790979 http://dx.doi.org/10.1186/s13054-022-04077-y |
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