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

2021 ◽  
Vol 10 (3) ◽  
pp. e45410313588
Author(s):  
Anne Karine Menezes Santos Batista ◽  
Tais Santana Barbosa ◽  
Phydel Palmeira Carvalho ◽  
Natasha Cordeiro dos Santos ◽  
Victor Durier Cavalcanti de Almeida ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Confusion Assessment ◽  
Status Score ◽  
Terapia Intensiva

Introdução: Os sedativos são fármacos utilizados como auxiliares terapêuticos em pacientes sob cuidados intensivos. Dentre os possíveis desfechos controversos ao seu uso, as alterações cognitivas são pontuadas na literatura, com a encefalopatia aguda ou delirium, sendo a mais descrita. Objetivos: Avaliar a associação entre o uso de fármacos com ação sedativa para o desenvolvimento de delirium e caracterizar o perfil funcional dos indivíduos com delirium. Material e métodos: Estudo longitudinal, realizado em um hospital público da rede estadual, durante os meses de junho de 2019 a outubro (primeira quinzena) de 2020, com indivíduos acima de 18 anos, internados em unidades de terapia intensiva e enfermarias, por meio de escalas para avaliação de sedação, delirium e funcionalidade (Richmond Agitation Sedation Scale - RASS, Confusion Assessment Method for the Intensive Care Unit - CAM-ICU e Status Score for the Intensive Care Unit - FSS, respectivamente), com capacidade de verbalização e sem admissão via transferência externa. Resultados: Inclusos 104 pacientes com idade média de 59,7 ± 15,3 anos, sendo 53,2% do sexo masculino, com 49% sendo hipertensos e 79,8% negando tabagismo. Não houve significância estatística entre os fármacos sedativos para o desencadeamento de delirium. A maioria dos pacientes com delirium estavam no intervalo da FSS entre 0-15 no ambiente intensivo e 16-25 nas enfermarias. Considerações finais: Não há associação entre o uso de fármacos com ação sedativa e delirium. Houve alteração do perfil funcional, com os pacientes tornando-se dependentes moderados a máximos nas unidades intensivas e dependentes mínimos ou independentes nas enfermarias.

scholarly journals Διερεύνηση των παθοφυσιολογικών μηχανισμών εγκατάστασης μετεγχειρητικής διέγερσης σε βαριατρικούς ασθενείς μονάδων μεταναισθητικής φροντίδας

2018 ◽  
Author(s):  
Κωνσταντινιά Μαμούρα
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Pain Scale ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Confusion Assessment ◽  
Behavioral Pain Scale

Εισαγωγή: Η διέγερση είναι μια κατάσταση που μπορεί να εμφανιστεί σε μετεγχειρητικούς ασθενείς και βαρέως πάσχοντες, και συνδέεται με δυνητικά επικίνδυνες επιπλοκές. Ωστόσο, τα επίπεδα πόνου, stress, φεντανύλης, αναισθητικών φαρμάκων και άλλων διεγχειρητικών παραμέτρων, σε σχέση με τη διέγερση, δεν έχουν αξιολογηθεί εστιασμένα σε βαριατρικούς ασθενείς.Σκοπός: Η διερεύνηση της σχέσης των επιπέδων μετεγχειρητικού πόνου stress, φεντανύλης, αναισθητικών φαρμάκων και άλλων διεγχειρητικών παραμέτρων με την εγκατάσταση μετεγχειρητικής διέγερσης σε βαριατρικούς ασθενείς, με απώτερο στόχο την πρόληψή της.Μεθοδολογία: Πραγματοποιήθηκε συγχρονική κλινική μελέτη συσχέτισης, σε Μονάδα Μεταναισθητικής Φροντίδας ιδιωτικού νοσοκομείου των Αθηνών για χρονικό διάστημα δεκατεσσάρων μηνών, με δείγμα 76 βαριατρικών ασθενών. Για τη συλλογή των δεδομένων χρησιμοποιήθηκαν: α) Φύλλο δημογραφικών και κλινικών δεδομένων, β) Κλίμακες αξιολόγησης διέγερσης, CAM-ICU (Confusion Assessment Method for the Intensive Care Unit), ICDSC (Intensive Care Delirium Screening Checklist) και RASS (Richmond Agitation-Sedation Scale), γ) Εργαλεία αξιολόγησης πόνου, CPOT (Critical-Care Pain Observation Tool), BPS (Behavioral Pain Scale) και NRS (0-10). Οι μεταβλητές ελέγχθηκαν για την κανονικότητα της κατανομής τους και ανάλογα εφαρμόστηκαν είτε παραμετρικές είτε μη παραμετρικές δοκιμασίες. Πραγματοποιήθηκε περιγραφική στατιστική, μελέτη εσωτερικής συνοχής κλιμάκων (Cronbach’s α), μελέτη συσχετίσεων (Pearson, Kendall’s tau, Spearman’s rho), έλεγχος μέσων και διαμέσων (T-test, Mann Whitney U test) και μελέτη παλινδρομήσεων με το SPSS 22.0 (p≤0,05). Αποτελέσματα: Οι συμμετέχοντες ήταν 46,1% άντρες, με μέση ηλικία 37,7(±10,2) έτη. Ο Δείκτης Μάζας Σώματος (ΔΜΣ/BMI), κυμαινόταν από 24,2 έως 67,6, με μέσο 46,3(±6,1). Οι βαθμολογίες στις κλίμακες ICDSC και RASS ήταν μέτριες ωστόσο μετεγχειρητική διέγερση, με βάση την κλίμακα CAM-ICU, καταγράφηκε στο 50% των ασθενών. Ο Cronbach’s α ήταν ≥0,726για όλες της κλίμακες. Επίσης τα επίπεδα πόνου ήταν χαμηλά προς μέτρια. Οι κλίμακες πόνου συσχετίσθηκαν μεταξύ τους (0,77≤rho≤0.958, p<0,001). O μετεγχειρητικός πόνος που αξιολογήθηκε με όλες τις κλίμακες συσχετίσθηκε στατιστικά σημαντικά θετικά, με όλες τις κλίμακες διέγερσης (0,622≤rho≤0.838, p<0,001). Άλλοι παράγοντες που συσχετίσθηκαν στατιστικά σημαντικά θετικά με την εμφάνιση διέγερσης ήταν τα επίπεδα κορτιζόλης ορού το πρωί του χειρουργείου (p<0,001), οι χορηγούμενες ποσότητες μιδαζολάμης και προποφόλης (p<0,001), ο μεγαλύτερος χρόνος διασωλήνωσης (p<0,001) και χειρουργείου (p<0,001), η οξέωση (p=0,005), το ιστορικό προηγούμενων χειρουργικών επεμβάσεων (p=0,004) και ο αριθμός ατόμων που συγκατοικούν με τον ασθενή (p=0,011). Αρνητικά συσχετίσθηκαν με την εμφάνιση διέγερσης τα υψηλότερα επίπεδα φεντανύλης ούρων (p<0,001), τα επίπεδα ACTH το πρωί του χειρουργείου(p=0,023) και η μεγαλύτερη ηλικία (p=0,04). Το 77,1% της διακύμανσης της CAM-ICU επεξηγήθηκε από την συνολική ποσότητα χορηγούμενης φεντανύλης, και η αλλαγή στα επίπεδα φεντανύλης ούρων κατά 1 μονάδα (ng/ml) μείωσε την διέγερση κατά 0,927 φορές. Επίσης αλλαγή στα επίπεδα Κορτιζόλης το πρωί του χειρουργείου κατά μία μονάδα (μg/dl) αυξάνει τη διέγερση κατά 1,244 φορές, ενώ 1 μονάδα Προποφόλης αυξάνει τη διέγερση κατά 1,041φορές. Συμπέρασμα: Ο μετεγχειρητικός πόνος, το στρες, τα αναισθητικά φάρμακα και άλλοι διεγχειρητικοί παράγοντες φαίνεται να αυξάνουν την πιθανότητα εμφάνισης διέγερσης σε βαριατρικούς ασθενείς. Απαιτείται η χρήση κατάλληλων εργαλείων αξιολόγησης πόνου και διέγερσης στη μονάδα μεταναισθητικής φροντίδας, και κατάλληλη τιτλοποίηση της αναλγητικής αγωγής ώστε να μειωθεί σημαντικά η εγκατάσταση διέγερσης. Η διαχείριση του προεγχειρητικού στρες, από τον νοσηλευτή, είναι δυνατό να περιορίσει την εμφάνιση μετεγχειρητικής διέγερσης. Τέλος, προσοχή πρέπει να δίνεται στους ασθενείς που υποβάλλονται σε επέμβαση μεγαλύτερης χρονικής διάρκειας και σε αυτούς που εμφανίζουν διαταραχές της οξεοβασικής ισορροπίας.

scholarly journals Delirium in intensive care: use of the ‘Confusion Assessment Method for the Intensive Care Unit’ by the nurse / Delirium em terapia intensiva: utilização do Confusion Assessment Method for the Intensive Care Unit pelo enfermeiro

2018 ◽  
Vol 10 (1) ◽  
pp. 2 ◽  
Author(s):  
Isabel Cristina Gomes de Oliveira Tostes ◽  
Sandra Regina Maciqueira Pereira ◽  
Luana Ferreira De Almeida ◽  
Manasses Moura Dos Santos
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment ◽  
Terapia Intensiva

Objetivo: compreender o conhecimento dos enfermeiros sobre o delirium no paciente crítico e a utilização do Confusion Assessment Method for the Intensive Care Unit. Métodos: Estudo exploratório-descritivo, prospectivo, com abordagem mista. Teve-se como população os enfermeiros de uma unidade de terapia intensiva, a amostra constituiu-se de 16 enfermeiros que aceitaram participar de todas as etapas da pesquisa. Realizou-se um pré e pós-teste aplicando-se o instrumento de coleta de dados constituído de 1 pergunta discursiva e 8 objetivas, para análise usou-se análise e conteúdo e estatística básica. A pesquisa foi aprovada pelo comitê de ética em pesquisa do Hospital Universitário Pedro Ernesto, sob o parecer de nº1.360.441. Resultados: Num comparativo entre o pré e pós-teste, o grupo se mostrou mais preparado para identificar o delirium e com maior grau de conhecimento acerca da temática. Conclusão: atualização mostrou-se como uma ferramenta de transformação da prática clínica. Destacando-se a importância da educação permanente para garantir a qualidade na assistência de enfermagem. Descritores: Terapia Intensiva, Enfermagem, Transtornos Cognitivos.   

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

2020 ◽  
Vol 9 (1) ◽  
pp. 16
Author(s):  
Mariana Santos Lago ◽  
Tássia Nery Faustino ◽  
Magno Conceição das Mercês ◽  
Douglas De Souza E Silva ◽  
Larissa Simões Da Cruz Pessoa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment ◽  
Terapia Intensiva

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<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.

scholarly journals AVALIAÇÃO DA PREVALÊNCIA DE DELIRIUM EM UMA UNIDADE DE TERAPIA INTENSIVA PÚBLICA

2019 ◽  
Vol 10 (3) ◽  
Author(s):  
Juliana Bessa Martins ◽  
Adriana Alves Dos Santos ◽  
Luís Joeci Jaques De Macedo Júnior ◽  
Carolina Chitolina Eberle
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Signs And Symptoms ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Porto Alegre ◽  
Cross Sectional ◽  
Care Clinic ◽  
Confusion Assessment ◽  
Terapia Intensiva

Objetivo: Conhecer a prevalência do delirium em uma Unidade de Terapia Intensiva Clínica e Cirúrgica pública. Métodos: Abordagem quantitativa descritiva de corte transversal, com pacientes de 18 anos ou mais internados em um hospital público de Porto Alegre-RS, com utilização da escala Confusion Assessment Method in a Intensive Care Unit (CAM-ICU). Resultados: A prevalência do delirium foi 36%. Apresentaram relação com o delirium, com significância estatística: média de idade dos pacientes, a mediana de dias de internação hospitalar e em UTI, tipo de UTI, motivo de internação, doença neurológica anterior, uso de sedação, ventilação mecânica e utilização de haloperidol. Conclusões: Este estudo conclui que o delirium apresentou prevalência de 36%, demonstrando que esta síndrome apresenta prevalência significante em Unidade de Terapia Intensiva, portanto, o reconhecimento de seus sinais e sintomas é fundamental para a sua prevenção, aliada a aplicação de escalas de rastreio.Descritores: Delirium, Unidades de Terapia Intensiva, Enfermagem. EVALUATION OF THE PREVALENCE OF DELIRIUM IN AN PUBLIC INTENSIVE CARE UNITObjective: To know the prevalence of delirium in a Public Intensive Care Clinic and Surgical Unit. Methodology: Descriptive quantitative cross-sectional approach with patients aged 18 years or more admitted to a public hospital in Porto Alegre, Brazil, using the Confusion Assessment Method in the Intensive Care Unit (CAM-ICU). Results: The prevalence of delirium was 36%, in a sample of 335 patients interviewed. The mean age of the patients, median days of hospital stay and ICU, type of ICU, reason for hospitalization, previous neurological disease, use of sedation, mechanical ventilation and use of haloperidol were statistically significant. Conclusions: This study concludes that delirium presented a prevalence of 36%, demonstrating that this syndrome presents a significant prevalence in the Intensive Care Unit, therefore, the recognition of its signs and symptoms is fundamental for its prevention, allied to the application of screening scales.Descriptors: Delirium; Intensive Care Units; Nursing. EVALUACIÓN DE LA PREVALENCIA DE DELIRIUM EN UNA UNIDAD DE TERAPIA INTENSIVA PÚBLICAObjetivo: Conocer la prevalencia del delirium en una Unidad de Terapia Intensiva Clínica y Quirúrgica pública. Metodologia: En el presente trabajo se analizaron los resultados obtenidos en el análisis de los resultados obtenidos en el estudio. Resultados: La prevalencia del delirium fue del 36%, en una muestra de 335 pacientes entrevistados. En la mayoría de los casos, se observó un aumento en la incidencia de la enfermedad de Chagas en el momento de la intervención, Conclusiones: Este estudio concluye que el delirium presentó prevalencia del 36%, demostrando que este síndrome presenta prevalencia significante en Unidad de Terapia Intensiva, por lo tanto, el reconocimiento de sus signos y síntomas es fundamental para su prevención, aliada a la aplicación de escalas de rastreo.Descriptores: Delirium; Unidades de Terapia Intensiva; Enfermería.

scholarly journals Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

2021 ◽  
Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

Confusion Assessment Method for the Intensive Care Unit

2001 ◽  
Author(s):  
E. Wesley Ely ◽  
Sharon K. Inouye ◽  
Gordon R. Bernard ◽  
Joseph Francis ◽  
Lisa May ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment

Serum protein S100 as marker of postoperative delirium after off-pump coronary artery bypass surgery: secondary analysis of two prospective randomized controlled trials

2016 ◽  
Vol 54 (10) ◽  
Author(s):  
Layth Al Tmimi ◽  
Marc Van de Velde ◽  
Bart Meyns ◽  
Bart Meuris ◽  
Paul Sergeant ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Postoperative Delirium ◽  
Artery Bypass ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Off Pump ◽  
Confusion Assessment ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass

AbstractBackground:To investigate the predictive value of S100 (biochemical marker of neuroglial injury) for the occurrence of postoperative delirium (POD) in patients undergoing off-pump coronary artery bypass (OPCAB)-surgery.Methods:We enrolled 92 patients older than 18 years undergoing elective OPCAB-surgery. Serum-levels of S100 were determined at baseline (BL), end of surgery (EOS) and on the first postoperative day (PD1). Postoperatively, all-patients were evaluated daily until PD5 for the presence of POD using the confusion assessment method (CAM) or the confusion assessment method for the intensive care unit (CAM-ICU) for patients in the intensive care unit (ICU).Results:The overall incidence of POD was 21%. S100-values on PD1 significantly predicted the occurrence of POD during the later hospital stay [area under the curve (AUC)=0.724 (95% confidence interval (CI): 0.619–0.814); p=0.0001] with an optimal cut-off level of 123 pg mLConclusions:S100-levels <123 pg mL

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