Cuidados para el manejo de delirio en Unidades de Paciente Crítico: una revisión integrativa

Gabriela Flores Oñate; Paula Andrea Ceballos Vasquez; Rocio Mejias Parada

doi:10.14198/cuid.2021.59.15

Autores/as

Gabriela Flores Oñate Hospital Base de Curico, Chile
Paula Andrea Ceballos Vasquez Universidad Católica del Maule, Chile https://orcid.org/0000-0002-3804-5146
Rocio Mejias Parada Hospital Regional de Talca, Chile

DOI:

https://doi.org/10.14198/cuid.2021.59.15

Palabras clave:

Delirio, Enfermería, Cuidados Críticos, Unidades de Cuidados Intensivos

Resumen

Objetivo: analizar en la evidencia bibliográfica los aspectos que influyen en el desarrollo del delirio, manejo, evaluación objetiva para su pesquisa y los cuidados relacionados a la promoción y prevención de éste en los usuarios hospitalizados en unidades críticas. Metodología: Se realizó una revisión integrativa, en bases de datos CINAHL; SCOPUS y Scielo. Fueron seleccionados 19 artículos limitados por año (2016-2017). Resultado: Se identificaron cuatro factores que impactan en el delirio: la fisiopatología/factores de riesgo, la prevención y promoción, la evaluación objetiva y el manejo en unidades críticas. Conclusión: La Gestión del Cuidado se encuentra a cargo de Enfermería, por ende, es fundamental no dejar esta temática de lado debido a que su incidencia aumentará los días de hospitalización, días de ventilación mecánica y mortalidad, impactando negativamente en la calidad de los cuidados.

Financiación

Universidad Católica del Maule, Especialización en Cuidados Críticos del Adulto, Hospital Regional de Talca

Citas

Barr, J., Fraser, GL., Puntillo, K., Ely, EW., Gélinas, C., Dasta, JF., Davidson, JE., Devlin, JW..., y Jaeschke, R. (2013). Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine. 41(1), 263-306.

Boettger, S., Nuñez, D., Meyer, R., Richter, A, Fernández, S., Rudiger, A., Schubert, M., y Jenewein, J. (2017). Delirium in the intensive care setting and the Richmond Agitation and Sedation Scale (RASS): Drowsiness increases the risk and is subthreshold for delirium. Journal of Psychosomatic Research, 103,133–39.

Bui, L., Pham, V., Shirkey, B., y Swan, J. (2017). Effect of delirium motoric subtypes on administrative documentation of delirium in the surgical intensive care unit. Journal of clinical monitoring and computing, 31, 631-40.

Carrasco, M., y Zalaquett, M. (2017). Delirium: una epidemia desde el servicio de urgencia a la unidad de paciente crítico. Revista Médica de Clínica las Condes, 28 (2), 301-10.

Ceballos, P., Jara, A., Stiepovich, J. Aguilera, P. y Vílchez, V. (2015). La gestión del cuidado: una función social y legal de la enfermería chilena. Revista de Enfermería Actual en Costa Rica, 29, 1-12. doi: http://dx.doi.org/10.15517/revenf.v0i29.19733.

Da Silva, R., Ribeiro, M., Pires, E., Meira, L., Lepre, D., y De Oliveira, N. (2017). Nurses’ training in the use of a delirium-screening tool. Revista Gaúcha de Enfermagem, 38 (1). doi: 10.1590/1983-1447.2017.01.64484.

Darbyshire, J., Greig, P., Vollam, S., Young, D., y Hinton, L. (2016). I Can Remember Sort of Vivid People . . . but to Me They Were Plasticine. Delusions on the Intensive Care Unit: What Do Patients Think Is Going On? PLOS ONE 11 (4). doi:10.1371/journal.pone.0153775.

Dittrich, T., Tschudin-Sutter, S., Widmer, A., Rúegg, S., Marsch, S., y Sutter, R. (2016). Risk factors for new-onset delirium in patients with bloodstream infections: independent and quantitative effect of catheters and drainages- a four- year cohort study. Annals of intensive care, 6 (1), 104.

Ely, E., Shintani, A., Truman, B., Speroff, T., Gordon, S., Harrell, F., Inouye, S… y Dittus, R. (2004). Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit. Journal of the American Medical Association. 291(14), 1753-62.

Garpestad, E., y Devlin, J. W. (2017). Polypharmacy and Delirium in Critically Ill Older Adults. Clinics in Geriatric Medicine, 33(2), 189–203.

Girard, T., Kress, J., Fuchs, B., Thomason, J., Schweickert, W., Pun, B., Taichman, D…..y Ely, E. (2008). Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. The Lancet, 371(9607), 126–34.

Girard, T., Ware, L., Bernard, G., Pandharipande, P., Thompson, J., Shintani, A., Jackson, J.C.., y Ely, E. (2012). Associations of markers of inflammation and coagulation with delirium during critical illness. Intensive Care Medicine, 38(12), 1965–1973.

Gofton, T., y Young, G. (2012). Sepsis-associated encephalopathy. Nature Reviews Neurology, 8:557. http://dx.doi.org/10.1038/nrneurol.2012.183.

Goulart, R., Tonietto, T., Barbosa, D., Gutierres, F., Ascoli, A., Cordeiro, L… y Teixeira, C. (2017). Effectiveness and Safety of an Extended ICU Visitation Model for Delirium Prevention: A Before and After Study. Critical Care Medicine, 45 (10), 1660–7.

Green, C., Hendry, K., Wilson, E., Walsh, T., Allerhand, M., MacLullich, A., y Tieges, Z. (2017). A Novel computerized Test for Detecting and Monitoring Visual Attentional Deficits and Delirium in the ICU. Critical Care Medicine, 45(7), 1224-31.

Hughes, C., Morandi, A., Girard, T., Riedel, B., Thompson, J., Shintani, A., Pun..., y Pandharipande, P. (2013). Association between Endothelial Dysfunction and Acute Brain Dysfunction during Critical Illness. Anesthesiology, 118(3), 631–39.

Kanji, S., MacPhee, H., Singh, A., Johanson, C., Fairbairn, J., Lloyd, T., MacLean, R. y Rosenberg, E. (2016). Validation of the Critical Care Pain Observation Tool in Critically Ill Patients with Delirium: A Prospective Cohort Study. Critical Care Medicine, 44(5), 943–7.

Khan, B., Perkins, A., Gao, S., Hui, S., Campbell, N., Farber, M.,… y Boustani, M. (2017). The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU. Critical Care Medicine, 45(5), 851–7.

Kim, M., Park, U., Kim, H., y Cho, W. (2016). Delirium Prediction Based on Hospital Information (Delphi) in General Surgery Patients. Medicine, 95 (12).

Morandi, A., Piva, S., Wesley, E., Myatra, S., Salluh, J., Amare, D., Azoulay, E., Bellelli…, y Latronico, N. (2017). Worlwide Survey of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/ Management, Early Exercise/ Mobility, and Family Empowerment” (ABCDEF) Bundle. Critical Care Medicine, 20 (30).

Morandi, A., Vasilevskis, EE., Pandharipande, PP., Girard, TD., Solberg, LM., Neal, EB., Koestner, T..., y Kripalani, S. (2011). Inappropriate medications in elderly ICU survivors: where to intervene? Archives of Internal Medicine, 171(11):1032–4.

Mori, S., Tsuchihashi Takeda, JR., Angotti Carrara, FS., Rizzo Cohrs, C., Viski Zanei, SS., y Yamaguchi Whitaker, I. (2016). Revista da Escola de Enfermagem USP, 50(4), pp. 585-91.

Oto, J., Yamamoto, K., Koike, S., Imanaka, H., y Nishimura, M. (2011). Effect of daily sedative interruption on sleep stages of mechanically ventilated patients receiving midazolam by infusion. Anaesthesia Intensive Care, 39, 392–400.

Pandharipande, P., Pun, B., Herr, D., Maze, M., Girard, T., Miller, R., Shintani, A…, Ely, E. (2007). Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA, 298(22), 2644-53.

Palencia, E., Romera, M., Silva, J., y grupo de trabajo de analgesia y sedación de la Semicyuc. (2008). Delirio en el paciente crítico. Medicina Intensiva, 32(1), 77-91.

Pereira, J., Dos Reis, F., Caetano, R., Pinto, M., Batista, M., Galhardas, M., y Santos, M. (2016). Delírium no doente crítico: fatores de risco modificáveis pelos enfermeiros. Revista de Enfermagem Referencia, 4(9),29-36.

Pisani, M. A., Kong, S. Y. J., Kasl, S. V., Murphy, T. E., Araujo, K. L. B., y Van Ness, P. H. (2009). Days of Delirium Are Associated with 1-Year Mortality in an Older Intensive Care Unit Population. American Journal of Respiratory and Critical Care Medicine, 180(11), 1092–97.

Reade, M., Phil, D., y Finfer, S. (2014). Sedation and Delirium in the Intensive Care Unit. The New England Journal of Medicine. 370, 444-54.

Robinson, T., Raeburn, C., Tran, Z., Brenner, L., y Moss, M. (2011). Motor subtypes of postoperative delirium in older adults. The Archives of Surgery, 146(3), 295–300.

Salazar, N., Griñen, H., Jirón, M., Rojas, L., Escobar, L., Berasaín, M., y Romero, C. (2012). Impacto del cuidado multidisciplinario en los desenlaces clínicos de los pacientes Críticos. Revista Chilena de Medicina Intensiva, 27(1), 12-22.

Salluh, J.I., Soares, M., Teles, J.M., Ceraso, D., Raimondi, N., Nava, V.S., Blasquez, P., Ugarte, S…, y Rocha, M.G., Delirium Epidemiology in Critical Care Study Group. (2010). Delirium epidemiology in critical care (DECCA): an international study. Crit Care, 14(6), 210.

Salluh, J., Wang, H., Schneider, E., Nagaraja, N., Yenokyan, G., Damluji, A., Serafim, R., y Stevens, R. (2015). Outcome of delirium in critically ill patients: systematic review and meta-analysis. British medical journal. 350, h2538.

Severgnini, C., Dornelles, A., Bessel, M., Meira, J., Skrobik, Y., y Teixeira, C. (2017). Effectiveness and Safety of an Extended ICU Visitation Model for Delirium Prevention: A Before and After Study. Critical Care Medicine, 45(10), 1660-67.

Sharshar, T., Annane, D., de la Grandmaison, GL., Brouland, JP., Hopkinson, NS., y Françoise, G. (2004). The neuropathology of septic shock. Brain Pathology, 14(1): 21–33.

Shehabi, Y., Riker, R.R., Bokesch, P.M., Wisemandle, W., Shintani, A., y Ely, W. SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group. (2010). Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Critical Care Medicine, 38(12), 2311-18.

Sullinger, D., Gilmer, A., Jurado, L., Hall, L., Steelman, J., Gallagher, A., Dupre, T., y Acquista, E. (2016). Development, Implementation, and Outcome of a Delirium protocol in the Surgical Trauma Intensive Care Unit. Annals of Pharmacotherapy, 51(1), 5-12.

Swan, J. (2014). Decreasing inappropriate unable-to-assess ratings for the confusion assessment method for the intensive care unit. AJCC, 23(1):60–9.

Thomason, J., Shintani, A., Peterson, J., Pun, B., Jackson, J., y Ely, E. (2005). Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Critical Care, 9(4), 375.

Van den Boogaard, M., Schoonhoven L., Evers, A., Van der Hoeven, J., Van Achterberg, T., y Pickkers, P. (2012). Delirium in critically ill patients. Critical Care Medicine, 40 (1), 112-18.

Vitkovic, L., Konsman, JP, Bockaert, J., Dantzer, R., Homburger, V., y Jacque, C (2000).Cytokine signals propagate through the brain. Molecular Psychiatry, 5(6), 604–15.

Wood, M., Maslove, D., Muscedere, J., Day, A., y Gordon, J. (2017). Low brain tissue oxygenation contributes to the development of delirium in critically ill patients: A prospective observational study. Journal of Critical Care, 41, 289-95.

Wolters, A., Peelen, L., Welling, M., Kok, L., de Lange, D., Cremer, O., Van Dijk, D…, y Veldhuijzen, D. (2016). Long- Term Mental Health Problems after Delirium in the ICU. Critical Care Medicine, 44 (10), 1808-13.

Xing, J., Sun, Y., Jie, Y., Yuan, Z., y Liu, W. (2017). Perceptions, attitudes, and current practices regards delirium in China. Medicine, 96:39.

Yang, J., Zhou, Y., Kang, Y., Xu, B., Wang, P., Lv Y., y Wang Z. (2017). Risk Factors of Delirium in Sequential Sedation Patients in Intensive Care Units. Hindawi, 2017