Delirio postoperatorio en pacientes con historial de abuso de alcohol

Sousa, Gabriela; Pinho, Carlos; Santos, Alice; Abelha, Fernando

doi:10.1016/j.redar.2016.07.009

Cited by 19 publications

(4 citation statements)

References 30 publications

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“…The results of a large cohort study suggest that alcohol plays a key role in the development of delirium in patients (Van Rompaey et al, 2009). Alcohol abuse was considered an independent risk factor for POD in elderly patients in previous studies (Sousa et al, 2017;Stewart et al, 2019), consistent with our findings. Mukherjee S believes that long-term alcohol abuse slows metabolism in the body, causing the content of ethanol and its metabolite acetaldehyde in the blood to increase sharply; because of the lipophilicity of the blood-brain barrier, the two compounds easily pass through the barrier and cause direct damage to nerve tissue (Mukherjee, 2013).…”

Section: Patient Factorssupporting

confidence: 92%

Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis

et al. 2022

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ObjectivesThe purpose of this study was to identify risk factors for delirium after total joint arthroplasty (TJA) and provide theoretical guidance for reducing the incidence of delirium after TJA.MethodsThe protocol for this meta-analysis is registered with PROSPERO (CRD42020170031). We searched PubMed, the Cochrane Library and Embase for observational studies on risk factors for delirium after TJA. Review Manager 5.3 was used to calculate the relative risk (RR) or standard mean difference (SMD) of potential risk factors related to TJA. STATA 14.0 was used for quantitative publication bias evaluation.ResultsIn total, 25 studies including 3,767,761 patients from 9 countries were included. Old age has been widely recognized as a risk factor for delirium. Our results showed that the main risk factors for delirium after TJA were patient factors (alcohol abuse: RR = 1.63; length of education: SMD = −0.93; and MMSE score: SMD = −0.39), comorbidities (hypertension: RR = 1.26; diabetes mellitus: RR = 1.67; myocardial infarction: RR = 17.75; congestive heart failure: RR = 2.54; dementia: RR = 17.75; renal disease: RR = 2.98; history of stroke: RR = 4.83; and history of mental illness: RR = 2.36), surgical factors (transfusion: RR = 1.53; general anesthesia: RR = 1.10; pre-operative albumin: SMD = −0.38; pre-operative hemoglobin: SMD = −0.29; post-operative hemoglobin: SMD = −0.24; total blood loss: SMD = 0.15; duration of surgery: SMD = 0.29; and duration of hospitalization: SMD = 2.00) and drug factors (benzodiazepine use: RR = 2.14; ACEI use: RR = 1.52; and beta-blocker use: RR = 1.62).ConclusionsMultiple risk factors were associated with delirium after TJA. These results may help doctors predict the occurrence of delirium after surgery and determine the correct treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42020170031.

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Section: Patient Factorssupporting

confidence: 92%

Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis

et al. 2022

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“…One of the recommendations given by Smulter et al (47) is to have better reports in clinical records about clinical findings in the PACU because, of all the patients who develop delirium in this unit, only 23 % are diagnosed and 1 % correctly identified and registered. The Nu-DESC also showed improvement in the recognition rate and allowed clinical staff to better record the findings (46).…”

Section: Nu-desc and Its Use In The Pacumentioning

confidence: 92%

“…POD was evaluated by the Nu-DESC in patients between 16 (45) and over 80 years old, finding that the most affected patients were older adults (> 65), especially those over 80 (39) who had ASA 3 or 4 in the pre-surgical period, while younger patients (with ASA 1 or 2) developed delirium in a smaller amount. Age influenced the incidence of delirium, which was between 4.3 % (45) and 12.3 % (39) in post-operative patients, who also had a more extended stay in the PACU (24 % vs. 10 %) and hospitalization unit (7 vs. 4 days) compared to those who did not develop POD (46). Studies also showed that the Nu-DESC is highly effective in detecting hyperactive and mixed types, and moderately effective in the hypoactive type (47), with higher scores for disorientation and psychomotor retardation (43).…”

Section: Nu-desc and Its Use In The Pacumentioning

confidence: 99%

Nursing Delirium Screening Scale, a Tool for Early Detection of Delirium: Integrative Review

2020

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Objective: To analyze the context and use of the Nursing Delirium Screening Scale (Nu-DESC) for early detection of delirium in adult patients, compiling the available evidence. Method: Searching for relevant articles on databases such as Cinahl, Medline, Ovid, Scopus, and Web of Science. Inclusion criteria: Articles written in English, Spanish, and Portuguese, published between January 2013 and October 2019. Search terms: “nursing delirium screen,” “inpatient delirium screening,” and “nursing assessment.” We identified 23 articles in which the Nu-DESC was used. Two reviewers independently assessed the articles using the CASPe (Critical Appraisal Skills Program in Spanish) tool. Results: The Nu-DESC is employed in different contexts such as the adult intensive care unit (ICU), post-anesthetic care unit (PACU), palliative care unit, and hospitalization unit. It is more frequently used in the PACU with a more sensitive threshold (≥ 1); the test showed greater sensitivity of 54.5 % (95 % CI: 32.2–75.6) and specificity of 97.1 % (95 % CI: 95.3–98.4). Conclusion: The Nu-DESC facilitates the recognition of delirium episodes by the nursing team, makes care quicker and individualized for each patient, avoiding immediate pharmacological interventions, and coordinate interdisciplinary actions for diagnosis, especially in post-anesthetic care units.

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“…In survivors of critical illness, duration of delirium is associated with short- and long-term mortality, long-term cognition, and functional outcomes ( 29 , 37 , 282 , 283 ). These effects of delirium are expected to exist in patients with SAWS ( 35 , 37 , 284 ); thus, studies that include delirium as an outcome of treatment in this population are indicated.…”

Section: Section 3: Establishing Best Practices To Improve Clinical Outcomes (T 3 Research)mentioning

confidence: 99%

Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement

Steel¹,

Afshar²,

Edwards³

et al. 2021

Am J Respir Crit Care Med

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Background: Severe alcohol withdrawal syndrome (SAWS) is highly morbid, costly, and common among hospitalized patients, yet minimal evidence exists to guide inpatient management. Research needs in this field are broad, spanning the translational science spectrum. Goals: This research statement aims to describe what is known about SAWS, identify knowledge gaps, and offer recommendations for research in each domain of the Institute of Medicine T 0 –T 4 continuum to advance the care of hospitalized patients who experience SAWS. Methods: Clinicians and researchers with unique and complementary expertise in basic, clinical, and implementation research related to unhealthy alcohol consumption and alcohol withdrawal were invited to participate in a workshop at the American Thoracic Society 2019 International Conference. The committee was subdivided into four groups on the basis of interest and expertise: T 0 –T 1 (basic science research with translation to humans), T 2 (research translating to patients), T 3 (research translating to clinical practice), and T 4 (research translating to communities). A medical librarian conducted a pragmatic literature search to facilitate this work, and committee members reviewed and supplemented the resulting evidence, identifying key knowledge gaps. Results: The committee identified several investigative opportunities to advance the care of patients with SAWS in each domain of the translational science spectrum. Major themes included 1 ) the need to investigate non–γ-aminobutyric acid pathways for alcohol withdrawal syndrome treatment; 2 ) harnessing retrospective and electronic health record data to identify risk factors and create objective severity scoring systems, particularly for acutely ill patients with SAWS; 3 ) the need for more robust comparative-effectiveness data to identify optimal SAWS treatment strategies; and 4 ) recommendations to accelerate implementation of effective treatments into practice. Conclusions: The dearth of evidence supporting management decisions for hospitalized patients with SAWS, many of whom require critical care, represents both a call to action and an opportunity for the American Thoracic Society and larger scientific communities to improve care for a vulnerable patient population. This report highlights basic, clinical, and implementation research that diverse experts agree will have the greatest impact on improving care for hospitalized patients with SAWS.

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Delirio postoperatorio en pacientes con historial de abuso de alcohol

Cited by 19 publications

References 30 publications

Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis

Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis

Nursing Delirium Screening Scale, a Tool for Early Detection of Delirium: Integrative Review

Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement

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