Delirium e fatores associados em unidades de terapia intensiva: estudo piloto de coorte

Abstract

<jats:p>OBJETIVOS: Detectar a incidência de delirium e os fatores associados à sua ocorrência em unidades de terapia intensiva (UTIs). MÉTODO: Estudo piloto de coorte efetuado em três UTIs. A amostra foi composta de pacientes adultos clínicos e cirúrgicos, com tempo de internamento superior a 24 horas. O delirium foi monitorizado através do Confusion Assessment Method for the Intensive Care Unit. Utilizaram-se os testes Qui-quadrado de Pearson e Exato de Fisher para comparação entre os grupos, considerando-se como estatisticamente significantes os valores de p&lt;0,05. Os resultados também foram apresentados através do Risco Relativo. RESULTADOS: A amostra foi constituída por 59 pacientes, sendo que destes 33,9% (n=20) cursaram com delirium, com predominância do espectro hipoativo, com 50% dos casos (n=10). Ressalta-se que 90% dos pacientes apresentaram o início dos episódios nas primeiras 24 horas de internamento e a média de duração dos episódios foi de aproximadamente 02 dias. Dentre as variáveis pesquisadas, houve uma associação positiva e estatisticamente significante entre o uso de contenção física e ocorrência da disfunção (RR=3,10; p=0,01). CONCLUSÃO: A incidência de delirium na amostra foi elevada, predominando o subtipo hipoativo. O uso de contenção física elevou em três vezes o risco de desenvolvimento do delirium.</jats:p>

Ação de fármacos sedativos para o desenvolvimento de delirium e perfil funcional de pacientes internados em unidades de terapia intensiva

“…The development of delirium is linked to individual issues, such as gender and age, according to reports in the literature (Girard, Thompson, Pandharipande, Brummel, Jackson, 2018& Lago, Faustino, Merces, Silva, Pessoa, Oliveira, 2020) being male and being 60 years of age or older are reaffirmed, in the present study, when analyzing the sociodemographic description of the participants, with such variables predisposing to such cognitive alteration, being considered as probable nonmodifiable risk factors and of greater representativeness when associated.…”

“…Of the pharmacological agents susceptible to delirium, patients who used Midazolam, during their stay in intensive care units, developed changes in alertness, as predicted in the literature (Girard, Thompson, Pandharipande, Brummel, Jackson, 2018& Lago, Faustino, Merces, Silva, Pessoa, Oliveira, 2020& Haenggi et al, 2013& Cerveira, Pupo, Santos, 2017& Shinotsuka, Salluh, 2013& Nunes, Bastos, 2016& Patel, Grambell, Speroff, Scott, Pun, 2009& Burry et al, 2017& Gusmão-Flores, Carvalho, Quarantini, 2013& Riker et al, 2009& Shehabi et al, 2018, a baixas dosagens e poucos dias de uso, assim como previsto em estudos anteriores (Cerveira, Pupo, Santos, 2017& Patel, Grambell, Speroff, Scott, Pun, 2009& Riker et al, 2009& Shehabi et al, 2018, highlighting the influence of benzodiazepines in the process of capturing neurotransmitters via the Central Nervous System and its potential for sedation.…”

“…Hypertensive individuals with confirmation of previous cardiac diseases -Heart failure, Atrial Fibrillation and Acute Myocardial Infarction, for example, mostly had a relationship with positive cases of delirium. This fact, not discussed in isolation in the literature, was cited as a risk factor (Pessoa, Nacul, 2006& Lago, Faustino, Merces, Silva, Pessoa, Oliveira, 2020 in two studies when it is reliably linked to other possible triggers of delirium without its pathophysiology described.…”

“…Individuals over 18 years of age, who had verbal capacity for the applicability of the scales and who had used a drug with sedative action for more than 24 hours, with description of intravenous administration in the medical record (prescription) were included. Patients with pathologies and/or skull/face surgeries that compromised verbal communication for the application of the scales were excluded; previous cognitive disorders; uni or bilateral lower limb amputations; neurological, renal and hepatic dysfunctions described in medical records; artificial airway with plastic or metallic tracheostomy (due to the absence of a speech valve) and which had been admitted through external hospital transfer (Lago et al, 2020).…”

“…To assess the behavioral state of sedated individuals, the Richmond Agitation Sedation Scale (RASS) was used, with individuals with +2/-2 interval evaluating the existence of cognitive impairment. Delirium was investigated through the application of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), already translated and validated into Portuguese, through 4 blocks to ascertain the fluctuation of mental state, inattention, disorganized thinking and level of awareness, with its diagnosis confirmed when items 1 and 2 are positive and characterizations 3 or 4 are present (Guimarães et al, 2014& Devlin, Skrobik, Gelinas, Needhan, Slooter, 2018& Knobel, Capone, Ferraz, Machado, 2003& Lobo, Silva Filho, Lima, Ferriolli, Moriguti, 2010& Carvalho, Almeida, Gusmão-Flores, 2013& Reade, Finfer, 2014& atel et al, 2009& Lago et al, 2020.…”