A influência do Delirium no tempo de ventilação mecânica em pacientes críticos: uma revisão sistemática

Jessica Aline Krebs, Erica Fernanda Osaku, Claudia Rejane Lima de Macedo Costa, Suely Mariko Ogasawara, Jaquilene Barreto da Costa, Sheila Taba, Amaury Cezar Jorge, Pericles Almeida Delfino Duarte

Resumo


O delirium consiste em um estado confusional agudo e de curso flutuante representando uma manifestação da disfunção cerebral que pode estar associado com diferentes manifestações clínicas. Os pacientes com delirium têm sido estudados, pois tem apresentado maior tempo de ventilação mecânica e de internação em unidade de terapia intensiva. O objetivo do estudo foi realizar uma revisão de literatura acerca da influência do delirium no tempo de ventilação mecânica, sedação e na mortalidade de pacientes internados em unidade de terapia intensiva. Nos métodos foi realizada uma busca por estudos nas bases de dados: PubMed e Embase, com os descritores delirium, intensive care unit and mechanical ventilation. Nos resultados foram incluídos oito artigos, um recebeu graduação A e sete receberam graduação B na escala de Oxford. Os principais resultados foram: Os pacientes com delirium apresentaram maior gravidade, maior tempo de ventilação mecânica, maior tempo de sedação e maior mortalidade.  Conclui-se que o delirium parece estar associado ao maior tempo da ventilação mecânica, maior dosagem de sedação e de mortalidade nestes pacientes.


Palavras-chave


Delírio; unidade de terapia intensiva; respiração artificial

Texto completo:

PDF

Referências


Salluh JIF, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015;350:h2538.http://dx.doi.org/10.1136/bmi.h2538

Inouye SK, Bogardus Jr ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999: 340(9):669-76. https://dx.doi.org/10.1056/NEJM199903043400901

Aldemir M, Özen S, Kara IH, Sir A, Baç B. Predisposing factors for delirium in the surgical intensive care unit. Crit Care. 2001;5(5):265-70.https://dx.doi.org/10.1186/cc1044

Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-10.https://dx.doi.org/10.1001/jama.286.21.2703

Associação Psiquiátrica Americana. Manual diagnóstico e estatístico de transtornos mentais: DSM-4. 4ª ed. Porto Alegre: Artes Médicas, 2000.

Pandharipande P, Shintani A, Peterson J, Pun BT, Wilkinson GR, Dittus RS, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006;104(1):21-6.

Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell Jr FE, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753-62. https://dx.doi.org/10.1001/jama.291.14.1753

Kamdar BB, King LM, Collop NA, Sakamuri S, Colantuoni E, Neufeld KJ, et al. The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU. Crit Care Med. 2013;41(3):800-9.https://dx.doi.org/10.1097/CCM.0b013e3182746442

Colombo R, Corona A, Praga F, Minari C, Giannotti C, Castelli A, et al. A reorientation strategy for reducing delirium in the critically ill. Results of an interventional study. Minerva Anestesiol. 2012;78(9):1026-33.

Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536-42.https://dx.doi.org/10.1016/j.apmr.2010.01.002

Reade MC, Finfer S. Sedation and delirium in the intensive care unit. N Engl J Med. 2014;370:444-54.https://dx.doi.org/10.1056/NEJMra1208705

Wolfe KS, Patel BK, Pohlman AS, Hall JS, Kress JP. Delirium and sedative requirements in a trial of helmet versus facemask noninvasive ventilation in acute hypoxic respiratory failure. Am J Respir Crit Care Med. 2017;195:A3012.

Centre Evidence-Based Medicine (CEBM). Oxford Centre for Evidence-based Medicine: Levels of Evidence (March 2009). Disponível em: http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Acesso em: 11 set. 2017.

Jeon K, Jeong BH, Ko MG, Nam J, Yoo H, Chung CR, et al. Impact of delirium on weaning from mechanical ventilation in medical patients. Respirology. 2016;21(2):313-20. https://dx.doi.org/10.1111/resp.12673

Lin SM, Huang CD, Liu CY, Lin HC, Wang CH, Huang PY, et al. Risk factors for the development of early-onset delirium and the subsequent clinical outcome in mechanically ventilated patients. J Crit Care. 2008;23(3):372-9. https://dx.doi.org/10.1016/j.jcrc.2006.09.001

Lat I, McMillian W, Taylor S, Janzen JM, Papadopoulos S, Korth L, et al. The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med. 2009;37(6):1898-905.https://dx.doi.org/10.1097/CCM.0b013e31819ffe38

Micek ST, Anand NJ, Laible BR, Shannon WD, Kollef MH. Delirium as detected by the CAM-ICU predicts restraint use among mechanically ventilated medical patients. Crit Care Med. 2005;33(6):1260-5.https://dx.doi.org/10.1097/01.CCM.0000164540.58515.BF

Tsuruta R, Nakahara T, Miyauchi T, Kutsuna S, Ogino Y, Yamamoto T, et al. Prevalence and associated factors for delirium in critically ill patients at a Japanese intensive care unit. Gen Hosp Psychiatry. 2010 32(6):607-11. https://dx.doi.org/10.1016/j.genhosppsych.2010.09.001

Spronk PE, Riekerk B, Hofhuis J, Hommes JH. Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med. 2009;35(7):1276-80. https://dx.doi.org/10.1007/s00134-009-1466-8

Mehta S, Cook D, Devlin JW, Skrobik Y, Meade M, Fergusson D, et al. Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med. 2015;43(3):557-66.https://dx.doi.org/10.1097/CCM.0000000000000727

McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med. 2012;367(23):2233-9.https://dx.doi.org/10.1056/NEJMra1203367

Dessap AM, Roche-Campo F, Launay JM, Charles-Nelson A, Katsahian S, Brun-Buisson C, et al. Delirium and circadian rhythm of melatonin during weaning from mechanical ventilation: an ancillary study of a weaning trial. Chest. 2015;148(5):1231-41. https://dx.doi.org/10.1378/chest.15-0525

Ansaloni L, Catena F, Chattat R, Fortuna D, Franceschi C, Mascitti P, et al. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg. 2010;97(2):273-80. https://dx.doi.org/10.1002/bjs.6843

Reade MC, Eastwood GM, Bellomo R, Bailey M, Bersten A, Cheung B, et al. Effect of Dexmedetomidine added to standard care on ventilator-free time in patients with agitated delirium: a randomized clinical trial. JAMA. 2016;315(14):1460-8.https://dx.doi.org/10.1001/jama.2016.2707

Arias-Rivera S, Sánchez-Sánchez Mdel M, Santos-Díaz R, Gallardo-Murillo J, Sánchez-Izquierdo R, Frutos-Vivar F, et al. Effect of a nursing-implemented sedation protocol on weaning outcome. Crit Care Med. 2008;36(7):2054-60. https://dx.doi.org/10.1097/CCM.0b013e31817bfd60

Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342(20):1471-7.https://dx.doi.org/10.1056/NEJM200005183422002

Pisani MA, Murphy TE, Araujo KL, Slattum P, Van Ness PH, Inouye SK. Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. Crit Care Med. 2009;37(1):177-83.https://dx.doi.org/10.1097/CCM.0b013e318192fcf9

Agarwal V, O'Neill PJ, Cotton BA, Pun BT, Haney S, Thompson J, et al. Prevalence and risk factors for development of delirium in burn intensive care unit patients. J Burn Care Res. 2010;31(5):706-715.https://dx.doi.org/10.1097/BCR.0b013e3181eebee9

Mehta S, Burry L, Cook D, Fergusson D, Steinberg M, Granton J, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA. 2012;308(19):1985-92. https://dx.doi.org/10.1001/jama.2012.13872

Vasilevskis EE, Ely EW, Speroff T, Pun BT, Boehm L, Dittus RS. Reducing Iatrogenic Risks: ICU-acquired delirium and weakness crossing the quality chasm. Chest. 2010;138(5):1224-33.https://dx.doi.org/10.1378/chest.10-0466

Leite MA, Osaku EF, Costa CR, Cândia MF, Toccolini B, Covatti C, et al. Delirium during weaning from mechanical ventilation. Crit Care Res Pract. 2014;2014:546349. https://dx.doi.org/10.1155/2014/546349

Ruokonen E, Parviainen I, Jakob SM, Nunes S, Kaukonen M, Shepherd ST, et al. Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation. Intensive Care Med. 2009;35(2):282-90. https://dx.doi.org/10.1007/s00134-008-1296-0

Maldonado JR, Wysong A, van der Starre PJ, Block T, Miller C, Reitz BA. Dexmedetomidine and ther eduction of postoperative delirium after cardiac surgery. Psychosomatics. 2009;50(3):206-17.https://dx.doi.org/10.1176/appi.psy.50.3.206

Ho KM, Ng JY. The use of propofol for medium and long-term sedation in critically ill adult patients: A meta-analysis. Intensive Care Med. 2008;34(11):1969-79. https://dx.doi.org/10.1007/s00134-008-1186-5

Hopkins RO, Jackson JC. Assessing neurocognitive outcomes after critical illness: are delirium and long-term cognitive impairments related? Curr Opin Crit Care. 2006; 12(5):388-94. https://dx.doi.org/10.1097/01.ccx.0000244115.24000.f5




DOI: https://doi.org/10.7322/abcshs.v43i1.1028

Apontamentos

  • Não há apontamentos.


Direitos autorais 2018 Jessica Aline Krebs, Erica Fernanda Osaku, Claudia Rejane Lima de Macedo Costa, Suely Mariko Ogasawara, Jaquilene Barreto da Costa, Sheila Taba, Amaury Cezar Jorge, Pericles Almeida Delfino Duarte

Licença Creative Commons
Esta obra está licenciada sob uma licença Creative Commons Atribuição 4.0 Internacional.