Action of sedative drugs for the development of delirium and functional profile of patients admitted to intensive care units
DOI:
https://doi.org/10.33448/rsd-v10i3.13588Keywords:
Delirium; Sedatives; Cognitive Dysfunction; Mobility limitation.Abstract
Introduction: Sedatives are drugs used as therapeutic aid in patients under intensive care. Among the possible controversial outcomes for its use, cognitive changes are punctuated in the literature, with acute encephalopathy or delirium, being the most described. Objectives: To evaluate the association between the use of drugs with sedative action for the development of delirium and to characterize the functional profile of individuals with delirium. Material and Methods: Longitudinal study, carried out in a public hospital in the state network, from June 2019 to October (first half) of 2020, with individuals over 18 years old, admitted to intensive care units and infirmaries, for scales for assessing sedation, delirium and functionality (Richmond Agitation Sedation Scale - RASS, Confusion Assessment Method for the Intensive Care Unit - CAM-ICU and Status Score for the Intensive Care Unit - FSS, respectively), with verbalization and without admission via external transfer. Results: 104 patients with a mean age of 59.7 ± 15.3 years were included, 53.2% being male, with 49% being hypertensive and 79.8% denying smoking. There was not any statistical significance between sedative drugs for the onset of delirium. Most patients with delirium were in the FSS range between 0-15 in the intensive care unit setting and 16-25 in the infirmaries. Final considerations: There is no association between the use of drugs with sedative action and delirium. There was a change in the functional profile, with patients becoming moderate to maximum dependents in the intensive care units and minimize or independent dependents in the wards.
References
Balas, M. C., Weinhouse, G. L., Denery, L., Chanques, G., & Misak, C. J. (2018). Interpreting and Implementing the 2018 Pain, Agitation/Sedation, Delirium, Immobility and Sleep Disruption Clinical Practice Guideline. Crit Care Med, 46(9), 1464-1470.
Banerjee, A., Girard, T. D., & Pandharipande, P. (2011). The complex interplat between delirium, sedation, and early mobilitu during critical illness: Aplications in the trauma unit. Current Opinion in Anaesthesiology, 24(2), 195-201.
Bruton, L. L., Chabrer, B. A. (2012). As bases farmacológicas da terapêutica de Goodmam & Gilman. (12a ed): Artemed.
Burry, L. D., Williamson, D. R., Mehta, S., Perreault, M. M., & Mantas, I. (2017). Delirium and exposure to psychoactive medications in critically ill adults: A multi-centre observational study. J Crit Care, 42(1), 268-274.
Carvalho, J. P. L. K., Almeida, A. R. P., & Gusmão-Flores, D. (2013). Escalas de avaliação de delirium em pacientes graves: revisão sistemática da literatura. Rev Bras Ter Intensiva, 25(2), 148-154.
Cerveira, C. C. T., Pupo, C. C., Santos, S. S., & Santos, J. E. M. (2017). Delirium in the elderly A systematic review of pharmacological and non-pharmacological treatments. Dement. Neuropsychol, 11(3), 270-275.
Devlin, J. W., Skrobik, Y., Gelinas, C., Needhan, D. M., & Slooter, A. J. C. (2018). Diretrizes de Prática Clínica para a Prevenção e Tratamento da Dor, Agitação/Sedação, Delirium, Imobilidade e Interrupção do Sono em pacientes adultos na UTI. Crit Care Med, 46(9), 825-873.
Faria, R. S. B., & Moreno, R. P. (2013). Delirium na unidade de cuidados intensivos: uma realidade subdiagnosticada. Rev Bras Ter Intensiva, 25(2), 137-147.
Girard, T. D., Thompson, J. L., Pandharipande, P. P., Brummel, N. E., & Jackson, J. C. (2018). Clinical phenotypes of delirium during critical illness and severity of subsequente long-term cognitive impairment: a prospective cohort study. Lancet Respir Med. 2018, 6(3), 213-222.
Guimarães, H. P., Assunção, M. S. C., Carvalho, F. B., Japiassú, A. M., & Veras, K. N. (2014). Manual de Medicina Intensiva. (1ª ed.): Atheneu.
Gusmão-Flores, D., Carvalho, J. P. L. M., & Quarantini, L. C. (2013). Benzodiazepinicos e Delirium: a melhor opção para o paciente certo. Crit Care Med, 41(10), 56-57.
Haenggi, M., Blum, S., Brechbuehl, R., Brunello, A., & Jakob, S. M. (2013). Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC. Intensive Care Med, 39(12), 2171-2179.
Huang, M., Chan, K. S., Zanni, J. M., Parry, S. M., Saint-Clair Neto, G. B., & Silva, V. Z. M. (2016). Functional Status Score for the ICU: an international clinimetric analysis of validity, responsiveness, and minimal important difference. Crit Care Med, 44(12), 1155-1164.
Knobel, E., Capone, N. A., Ferraz, A. C., & Machado, F. S. (2003). Terapia Intensiva – Neurologia. (1ª ed.): Atheneu.
Lago, M. S., Faustino, T. N., Merces, M. C., Silva, D. S., Pessoa, L. S. C., & Oliveira, M. T. S. (2020). Delirium e fatores associados nas unidades de terapia intensiva: estudo piloto de coorte. Rev Enferm Contemp, 9(1), 16-23.
Lobo, R. R., Silva Filho, S. R. B., Lima, N. K. C., Ferriolli, E., & Moriguti, J. C. (2010). Delirium. Medicina (Ribeirão Preto), 43(3), 249-257.
Mehrholz, J., Muckel, S., Oehmichen, F., & Pohi, M. (2015). First results about recovery of walking function in patients with intensive care unit – acquired muscle weakness from the general weakness Syndrome Therapy (Gym NAST) Cohort study. BMJ Open, 5(12), 1-10.
Nunes, B. S., & Bastos, F. M. (2016). Efeitos colaterais atribuídos ao uso indevido e prolongado de benzodiazepínicos. Saúde & Ciência em Ação, 3(1), 71-82.
Patel, R. P., Grambell, M., Speroff, T., Scott, A., & Pun, B. T. (2009). Delirium and sedation in the intensive care unit: survey of behaviors and atitudes of 1,384 helthcare professionals. Crit Care Med, 37(3), 825-832.
Pessoa, R. F., & Nacul, F. E. (2006). Delirium em pacientes críticos. Rev Bras Ter Intensiva, 18(2), 190-195.
Pinheiro, A. R., & Christofoletti, G. (2012). Fisioterapia motora em pacientes internados na unidade de terapia intensiva: uma revisão sistemática. Rev Bras Ter Intensiva, 24(2), 188-196.
Pitrowsky, M. T., Shinotsuka, C. R., Soares, M., Lima, M. A. S. D., & Salluh, J. I. F. (2010) Importância da monitorização do delirium na unidade de terapia intensiva. Rev Bras Ter Intensiva, 22(3), 274-279.
Reade, M. C., & Finfer, S. (2014). Sedation and delirium in the intensive care unit. N Engl J Med, 370, 444-454.
Riker, R. R., Shehabi, Y., Bokesch, P. M., Ceraso, D., & Wisemandle, W. (2009). Dexmedetomidine versus midazolam for sedation of critically ill patients: a ramdomized trial. JAMA, 301(5), 489-499.
Shehabi, Y., Bellomo, R., Kadiman, S., Kah Ti, L., & Howe, B. (2018). Sedation intensive in the first 48 hours of mechanical ventilation and 180-day mortality: A multinational prospective longitudinal cohort study. Crit Care Med, 46(6), 850-859.
Shinotsuka, C. R., & Salluh, J. I. F. (2013). Percepções e práticas sobre delirium, sedação e analgesia em pacientes críticos: uma revisão narrativa. Rev Bras Ter Intensiva, 25(2), 155-161.
Silva, V. Z. M., Araujo Neto, J. A., Cipriano Júnior, G., Pinedo, M., & Needham, D. M. (2017). Versão brasileira da Escala de Estado Funcional em UTI: tradução e adaptação transcultural. Rev Bras Ter Intensiva, 29(1), 34-38.
Simone, S., Pucciarelli, G., Perrone, M., Tereza, R., & Gargiulo, G. (2018). Delirium in ICU patients following cardiac sugery: An observational study. J Clin Nurs, 27(9), 1994-2002.
Slooter, A. J. C., Van de Leur, R. R., & Zaal, I. J. (2007). Delirium in critically ill patients. Handb Clin Neurol, 141(3), 449-466.
Thrush, A., Rozek, M., & Dekerlegand, J. L. (2012). The Clinical Utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) at a Long-Term Acute Care Hospital: A prospective Cohort Study. Phys Ther, 92(12), 1536-1545.
Tymkew, H., Norris, T., Arroyo, C., & Schallom, M. (2020). The Use of Physical Therapy ICU Assessments to Predict Discharge Home. Crit Care Med, 48(9), 1312-1318.
Yang, J., Zhou, Y., Kang, Y., Xu, B., & Wang, P. (2017). Risck factors of delirium in sequential sedation patients in intensive care units. BioMed Research International, 3(1), 1-9.
Wacker, P., Nunes, P. V., & Forçenza, O. V. (2005). Delirium: uma perspectiva histórica. Rev Psiquiatr Clin, 32(3), 97-103.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Anne Karine Menezes Santos Batista; Tais Santana Barbosa; Phydel Palmeira Carvalho; Natasha Cordeiro dos Santos; Victor Durier Cavalcanti de Almeida; Fernanda Warken Rosa Camelier
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.