Delirio en unidades de cuidados intensivos
DOI:
https://doi.org/10.30445/rear.v6i4.220Keywords:
delirio, Dexmedetomidina, haloperidol, neurológicoAbstract
Según el DSM-IV el delirio es una alteración aguda de la conciencia acompañada de inatención, desorganización del pensamiento y alteraciones de la percepción que fluctúan en breve periodo de tiempo. Presenta una incidencia que varía entre el 15-80% de los pacientes ingresados en Unidades de Cuidados Intensivos (UCI) dependiendo de los criterios diagnósticos y de la población estudiada. La importancia clínica del delirio en nuestras unidades a menudo es infraestimada a pesar de que el impacto negativo sobre el paciente está extensamente documentado desde hace años:
- Prolonga la duración de la ventilación mecánica y de la estancia en UCI y hospitalaria.
- Aumenta el riesgo de disfunción cognitiva a largo plazo. Gerard et al en Crit Care Med 2010 demostraron que el delirio es un factor de riesgo independiente de deterioro cognitivo a 3 meses (6).
- También se ha asociado a aumento de mortalidad. De hecho cada día que el paciente permanece con delirio aumenta la probabilidad de morir un 10%.
References
1.- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text revision. Washington, DC: American Psychiatric Press; 2000.
2.- Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA. 2001;286:2703–2710.
3.- Pandharipande P, Cotton BA, Shintani A, et al. Prevalenceand risk factors for the development of delirium in surgical and trauma intensive care unit patients. J Trauma. 2008;65:34–41.
4.- Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care. 2008;12(suppl 3):S3.
5.- Ely EW, Shintani A,Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291:1753–1762.
6.- Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38:1513–1520.
7.- Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180(11):1092-7.
8.- Banerjee A, Ely EW, Pandharipande PP Agitation and delirium. En Vincent JL Texbook of critical care. 6 Ed Elsevier.
9.- Barr J, Fraser GL, Puntillo K Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit Crit Care Med. 2013;41:263–306.
10.- Bergeron N, Dubois MJ Intensive Care Delirium Screening Checklist: Evaluation of a new screening tool. Intensive Care Med. 2001;27:859–864.
11.- Ely EW, Stephens RK, Jackson J, et al. Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med. 2004;32:106–112.
12.- Wang W, Li HL, Wang DX Haloperidol prophylaxis decreases delirium incidence in elderly patients after non cardiac surgery: A randomized controlled trial. Crit Care Med. 2012;40:731–739.
13.- Skrobik YK, Bergeron N, Dumont M, et al. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med. 2004;30:444–449.
14.- Girard TD, Pandharipande PP, Carson SS, et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med. 2010;38:428–437.
15.- Devlin JW, Roberts RJ, Fong JJ, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo- controlled pilot study. Crit Care Med. 2010;38:419–427.
16.- Riker RR, Shehabi Y, Bokesch PM et al. Dexmedetomidine vs midazolam for seda-tion of critically ill patients. A randomized trial. JAMA. 2009;301:489-99.
17.- Pandharipande PP, Sanders RD, Girard TD et al. Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: An apriori-designed analysis of the MENDS randomized controlledtrial. Crit Care. 2010;14:R38.41.
18.- Maldonado JR, Wysong A, van der Starre PJA, Block T,Miller C, Reitz BA. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics. 2009;50:206-17.
19.- Arpino PA, Kalafatas K, Thompson BT. Feasibility of dexmede-tomidine in facilitating extubation in the intensive care unit. JClin Pharm Ther. 2008;33:25-30.
20.- Shehabi Y, Nakae H, Hammond N, Bass F, Nicholson L, Chen J.The effect of dexmedetomidine on agitation during weaning of mechanical ventilation in critically ill patients. Anaesth Intensive Care. 2010;38:82-90.
2.- Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA. 2001;286:2703–2710.
3.- Pandharipande P, Cotton BA, Shintani A, et al. Prevalenceand risk factors for the development of delirium in surgical and trauma intensive care unit patients. J Trauma. 2008;65:34–41.
4.- Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care. 2008;12(suppl 3):S3.
5.- Ely EW, Shintani A,Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291:1753–1762.
6.- Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38:1513–1520.
7.- Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180(11):1092-7.
8.- Banerjee A, Ely EW, Pandharipande PP Agitation and delirium. En Vincent JL Texbook of critical care. 6 Ed Elsevier.
9.- Barr J, Fraser GL, Puntillo K Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit Crit Care Med. 2013;41:263–306.
10.- Bergeron N, Dubois MJ Intensive Care Delirium Screening Checklist: Evaluation of a new screening tool. Intensive Care Med. 2001;27:859–864.
11.- Ely EW, Stephens RK, Jackson J, et al. Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med. 2004;32:106–112.
12.- Wang W, Li HL, Wang DX Haloperidol prophylaxis decreases delirium incidence in elderly patients after non cardiac surgery: A randomized controlled trial. Crit Care Med. 2012;40:731–739.
13.- Skrobik YK, Bergeron N, Dumont M, et al. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med. 2004;30:444–449.
14.- Girard TD, Pandharipande PP, Carson SS, et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med. 2010;38:428–437.
15.- Devlin JW, Roberts RJ, Fong JJ, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo- controlled pilot study. Crit Care Med. 2010;38:419–427.
16.- Riker RR, Shehabi Y, Bokesch PM et al. Dexmedetomidine vs midazolam for seda-tion of critically ill patients. A randomized trial. JAMA. 2009;301:489-99.
17.- Pandharipande PP, Sanders RD, Girard TD et al. Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: An apriori-designed analysis of the MENDS randomized controlledtrial. Crit Care. 2010;14:R38.41.
18.- Maldonado JR, Wysong A, van der Starre PJA, Block T,Miller C, Reitz BA. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics. 2009;50:206-17.
19.- Arpino PA, Kalafatas K, Thompson BT. Feasibility of dexmede-tomidine in facilitating extubation in the intensive care unit. JClin Pharm Ther. 2008;33:25-30.
20.- Shehabi Y, Nakae H, Hammond N, Bass F, Nicholson L, Chen J.The effect of dexmedetomidine on agitation during weaning of mechanical ventilation in critically ill patients. Anaesth Intensive Care. 2010;38:82-90.
Published
2014-04-30
How to Cite
Paz Martín, D. (2014). Delirio en unidades de cuidados intensivos. Revista Electrónica AnestesiaR, 6(4), 1. https://doi.org/10.30445/rear.v6i4.220
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Section
Review articles
Revista Electrónica AnestesiaR by 