Prevalence of delirium in intensive care patients and association with sedoanalgesia, severity and mortality

Abstract

Objective: To establish the prevalence of delirium and its subsyndrome in intensive care and to associate it with the use of sedative and analgesia, severity and mortality. Method: Carried out in two intensive care units of adult patients, this is a quantitative and transversal study, with 157 patients, using the Richmond Agitation-Sedation Scale to assess the level of sedation and the Intensive Care Delirium Screening Checklist for delirium. The T test and Chi-square test were applied for statistical analysis. Results: The prevalence of delirium was 22.3%, and 49.7% of the subsyndrome. Associations of the use of midazolam with the presence of delirium (p=0.05) and subsyndromal delirium (p<0.01), use of clonidine with the appearance of delirium (p<0.01) and of fentanyl with subsyndromal delirium (p=0.09). There were no significant differences between the mortality of patients with delirium (p=0.40) and subsyndromal delirium (p=0.86), as well as association with the mortality score. Conclusion: The use of sedoanalgesia is associated with the presence of delirium and subsyndromal delirium. No significant statistical associations were found between the severity and mortality scores.

Effect of Perioperative Dexmedetomidine Infusion on Postoperative Delirium in Elderly Patients Undergoing Oral and Maxillofacial Surgery: A Randomized Controlled Clinical Trial

“…Midazolam is a short-acting benzodiazepine, often used to induce anesthesia, which has been reported to increase the risk of delirium. 28 …”

Construção e Validação de um Protocolo de Cuidados para Pacientes Críticos com Câncer em Delirium

“…Esse destaque foi dado porque a dor oncológica é caracterizada por sensações simultâneas de dor aguda e crônica associadas à disseminação de células tumorais no corpo, ou por ser consequência de uma modalidade de tratamento do câncer, ou por ter sido provocada por outras condições relacionadas à doença, como ferida tumoral, por exemplo 14 . Sendo assim, é imprescindível que profissionais atuantes em UTI oncológica considerem a avaliação da dor porque, além de ela ser um fator desencadeante de delirium, quando negligenciada 15 , é descrita como sensação intensa e insuportável acompanhada por dificuldade para dormir e irritabilidade 14 .…”

Occurrence of Delirium and Length of Stay of Patients in the Intensive Care Unit

“…Currently, the most accepted theory of the pathophysiology of delirium is that the decrease in cholinergic activity associated with dopaminergic increase, corroborated by the lack of attention caused by anticholinergic medications, causes such symptoms. From a neuroscience perspective, it is believed that delirium is related to an imbalance in the synthesis, release and inactivation of neurotransmitters, modulating the control of cognitive function, behavior and mood [3].…”

“…Other neurotransmitters dopamine and GABA and neurobiological factors such as cytokines, hormones and free radicals will need further study to define their participation in the genesis of delirium. Future studies focused on the pathophysiology of delirium may lead to better prevention and treatment strategies [3].…”