Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Postoperative mental disorders are a common complication of cardiovascular surgery, with serious consequences. The main types of postoperative mental disorders include postoperative delirium and postoperative cognitive dysfunction. Their incidence ranges up to 15%-80%. ⋯ For postoperative prevention, multimodal approach is applied. It includes early extubation, early enteral nutrition, early mobilization, regular evaluation of cognitive function, activation of cognitive function and optimal analgesia, which requires teamwork of medical staff who care for patients. Combining all these methods can show promising results in reducing the incidence of postoperative mental disorders as a complication in cardiovascular surgery.
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Delirium is a complication of intensive care treatment associated with permanent cognitive decline and increased mortality after hospital discharge. In several studies, postoperative pain was found as a possible precipitating factor. Aggressive pain treatment is part of current multicompartment protocols for delirium prevention after hip fracture. Protocol based sedation, pain and delirium management in intensive care units have been shown to have clinical and economic advantages.
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Delirium is a common problem in intensive care patients, frequently underdiagnosed and resulting in prolonged hospital stay and a high risk of morbidity and mortality. On the other hand, reversibility of the condition points to the importance of prevention, early diagnosis and immediate therapy. ⋯ Delirium management includes haloperidol as the first line medication, but also olanzapine and risperidone as atypical neuroleptics. Benzodiazepines are used in delirium caused by alcohol withdrawal.
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Mental disorders are characterized by disturbances of thought, perception, affect and behavior, which occur as a result of brain damage. Recognizing and treating these conditions is necessary not only for psychiatrists but for all physicians. Disorder of mental function is one of the most common associated conditions in intensive care unit (ICU) patients. ⋯ The primary objective of prevention is appropriate therapy and correction of potential imbalances possibly underlying disturbances, stabilization of vital functions as well as early return to daily activities. Doctors and other medical staff must be aware of the importance and consequences of behavioral and emotional disorders in critically ill patients. Additional research is needed to discover the ways to prevent and/ or reduce the frequency and severity of the consequences and treatment of cognitive and emotional disorders.
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The use of physical or chemical restraint in delirious patients in the intensive care unit (ICU) is related to an array of ethical and medicolegal dilemmas. In most cases, they arise from insufficient knowledge of the regulations in force or due to their vague wording. The aim of this review article is to outline the basic views of the medical profession regarding restraint use as a method in the treatment of delirium and to give an insight into the existing legislation at the national and international level. ⋯ A delirious patient must be treated in accordance with medical ethics, international conventions and the laws and regulations related to patient rights. This includes the general principles of respecting the patient's autonomy and dignity, giving him or her timely information, notification of informed consent, as well as abiding by the rules of the profession integrated in every hospital written instructions on the treatment of a patient in delirium. A detailed medicolegal frame of restraint use in delirious patients is given by the Croatian Hospital Accreditation Rules, which is currently the highest existing standard for restraint use in delirious patients in ICU, as well as in the other hospital departments.