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1.
Medicine (Baltimore) ; 100(8): e24394, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663052

RESUMO

RATIONALES: Cholinergic modification by anticholinergic medication can produce adverse effects in central nervous system (CNS) and cyclopentolate is an antimuscarinic agent widely used for ophthalmologic management. We demonstrate a rare case of hyperactive delirium caused by topical administration of cyclopentolate in a patient with amnestic mild cognitive impairment (MCI) due to Alzheimer's disease (AD). PATIENT CONCERNS: A 74-year-old man showed acute confusion after preparation for cataract operation in day surgery clinic. The patient became confused and agitated after instillation of topical cyclopentolate drop into the eye and the symptoms persisted over several hours. DIAGNOSIS: Previously the patient had been diagnosed with amnestic MCI with the finding of bilateral medial temporal atrophy on brain magnetic resonance imaging. 18F-flutemetamol positron emission tomography scan demonstrated multifocal amyloid deposition in the brain. INTERVENTIONS: The patient was closely observed with the supportive management. OUTCOMES: The patient began to recover 5 h after the onset of symptoms and the cognitive function was reverted to previous state within 24 h. LESSONS: It is well known that several drugs with anticholinergic effects used in perioperative periods make the patients susceptible to delirium, but even the topical administration of cyclopentolate for cataract surgery also produce adverse CNS effects in a vulnerable patient who is diagnosed with MCI due to AD in this case.


Assuntos
Doença de Alzheimer/complicações , Disfunção Cognitiva/complicações , Ciclopentolato/efeitos adversos , Delírio/induzido quimicamente , Delírio/complicações , Administração Tópica , Idoso , Extração de Catarata/métodos , Ciclopentolato/administração & dosagem , Humanos , Masculino
2.
Crit Care Clin ; 37(1): 175-190, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33190768

RESUMO

Older adults are particularly vulnerable during the Coronavirus disease 2019 (COVID-19) pandemic, because higher age increases risk for both delirium and COVID-19-related death. Despite the health care system limitations and the clinical challenges of the pandemic, delirium screening and management remains an evidence-based cornerstone of critical care. This article discusses practical recommendations for delirium screening in the COVID-19 pandemic era, tips for training health care workers in delirium screening, validated tools for detecting delirium in critically ill older adults, and approaches to special populations of older adults (eg, sensory impairment, dementia, acute neurologic injury).


Assuntos
Infecções por Coronavirus/complicações , Delírio/complicações , Delírio/diagnóstico , Demência/complicações , Pneumonia Viral/complicações , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Delírio/prevenção & controle , Perda Auditiva/complicações , Humanos , Unidades de Terapia Intensiva , Pandemias , Equipe de Assistência ao Paciente , Transtornos da Visão/complicações
4.
Cir. Esp. (Ed. impr.) ; 98(8): 450-455, oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199048

RESUMO

INTRODUCCIÓN: El delirium es una complicación frecuente en pacientes ancianos intervenidos de cirugía abdominal urgente. MÉTODOS: Estudio prospectivo que incluye pacientes consecutivos ≥ 65 años intervenidos de cirugía abdominal urgente entre 2017 y 2019. Se registró: edad, sexo, ASA, estado fisiológico, deterioro cognitivo, fragilidad (escala de Frail), dependencia funcional (escala de Barthel), calidad de vida (Euroqol-5D-EVA), estado nutricional (MNA-SF), diagnóstico preoperatorio, tipo de cirugía (clasificación BUPA), vía de abordaje y diagnóstico de delirium postoperatorio (Confusion Assessment Method). Se realizó un análisis univariante y multivariante para analizar la relación de estas variables con el delirium. RESULTADOS: El estudio incluye 446 pacientes con una mediana de edad de 78 años; el 63,6% eran ASA ≥ III y el 8% presentaban un deterioro cognitivo previo. El 13,2% eran frágiles y el 5,4% de los pacientes tenían un grado de dependencia grave o total. Un 13,6% desarrollaron delirium en el postoperatorio. En el análisis univariante todas las variables son estadísticamente significativas salvo el sexo, el tipo de cirugía (BUPA) y la duración. En el análisis multivariante los factores asociados fueron: la edad (p < 0,001; OR: 1,08 [IC 95%: 1,038-1,139]), el ASA (p = 0,026; OR: 3,15 [IC 95%: 1,149-8,668]), la alteración fisiológica (p < 0,001; OR: 5,8 [IC 95%: 2,176 15,457]), el diagnóstico (p = 0,006) y el deterioro cognitivo (p < 0,001; OR: 5,8 [IC 95%: 2,391-14,069]). CONCLUSIÓN: Los factores asociados al delirium son la edad, el ASA, la alteración fisiológica a su llegada a urgencias, el diagnóstico preoperatorio y el deterioro cognitivo previo


INTRODUCTION: Delirium is a frequent complication in elderly patients after urgent abdominal surgery. METHODS: Prospective study of consecutive patients aged ≥ 65 years who had undergone urgent abdominal surgery from 2017-2019. The following variables were recorded: age, sex, ASA, physiological state, cognitive impairment, frailty (FRAIL Scale), functional dependence (Barthel Scale), quality of life (Euroqol-5D-VAS), nutritional status (MNA-SF), preoperative diagnosis, type of surgery (BUPA Classification), approach and diagnosis of postoperative delirium (Confusion Assessment Method). Univariate and multivariate analyses were performed to analyze the correlation of these variables with delirium. RESULTS: The study includes 446 patients with a median age of 78 years, 63.6% were ASA ≥ III and 8% had prior cognitive impairment. 13.2% were frail and 5.4% of the patients had a severe or total degree of dependence. 13.6% developed delirium in the postoperative period. In the univariate analysis, all the variables were statistically significant except for sex, type of surgery (BUPA) and duration. In the multivariate analysis the associated factors were: age (P < .001; OR: 1,08; 95% CI: 1,038-1,139), ASA (P = .026; OR: 3.15; 95% CI: 1.149-8.668), physiological state (P < .001; OR: 5.8; 95% CI: 2.176-15.457), diagnosis (P = .006) and cognitive impairment (P < .001; OR: 5.8; 95% CI: 2.391-14.069). CONCLUSION: The factors associated with delirium are age, ASA, physiological state in the emergency room, preoperative diagnosis and prior cognitive impairment


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Delírio/complicações , Complicações Pós-Operatórias/epidemiologia , Abdome/cirurgia , Delírio/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Disfunção Cognitiva , Qualidade de Vida , Análise Multivariada
5.
BMC Psychiatry ; 20(1): 343, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32611398

RESUMO

BACKGROUND: Postoperative delirium is a common complication following major surgeries, leading to a variety of adverse effects. However, there is a paucity of literatures studying the incidence and risk factors associated with delirium after primary elective total hip arthroplasty (THA) using a large-scale national database. METHODS: A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who underwent primary elective THA were included. Patient demographics, preoperative comorbidities, length of hospital stay (LOS), total charges, in-hospital mortality, and major and minor perioperative complications were evaluated. RESULTS: A total of 388,424 primary elective THAs were obtained from the NIS database, and the general incidence of delirium after THA was 0.90%. Patients with delirium after THA presented more preoperative comorbidities, longer LOS, extra hospital charges, and higher in-hospital mortality rate (P < 0.001). Delirium following THA was associated with major complications during hospitalization including acute renal failure and pneumonia. Preoperative risk factors associated with postoperative delirium included advanced age, alcohol or drug abuse, depression, neurological disorders, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency anemia, coagulopathy, hypertension, congestive heart failure, valvular disease, pulmonary circulation disorders, peripheral vascular disorders, and renal failure. Both female and obesity were detected to be protective factors. CONCLUSIONS: The results of our study identified a relatively low incidence of delirium after primary elective THA, which is as reported in the NIS and not necessarily the surgical population as a whole. Postoperative delirium of THA was associated with increased preoperative comorbidities, LOS, total charges, in-hospital mortality, and major perioperative complications including acute renal failure and pneumonia. It is of benefit to study risk factors associated with postoperative delirium to moderate its consequences.


Assuntos
Artroplastia de Quadril/efeitos adversos , Delírio/complicações , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Pacientes Internados/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Idoso , Artroplastia de Quadril/estatística & dados numéricos , Delírio/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
6.
Anesth Analg ; 130(6): 1516-1523, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32384341

RESUMO

BACKGROUND: Postoperative cognitive dysfunction (POCD) and delirium are the most common perioperative cognitive complications in older adults undergoing surgery. A recent study of cardiac surgery patients suggests that physical frailty is a risk factor for both complications. We sought to examine the relationship between preoperative frailty and postoperative delirium and preoperative frailty and POCD after major noncardiac surgery. METHODS: We performed a prospective cohort study of patients >65 years old having major elective noncardiac surgery with general anesthesia. Exclusion criteria were preexisting dementia, inability to consent, cardiac, intracranial, or emergency surgery. Preoperative frailty was determined using the FRAIL scale, a simple questionnaire that categorizes patients as robust, prefrail, or frail. Delirium was assessed with the Confusion Assessment Method for the intensive care unit (CAM-ICU) twice daily, starting in the recovery room until hospital discharge. All patients were assessed with neuropsychological tests (California Verbal Learning Test II, Trail Making Test, subtests from the Wechsler Adult Intelligence Scale, Logical Memory Story A, Immediate and Delayed Recall, Animal and Vegetable verbal fluency, Boston Naming Test, and the Mini-Mental Status Examination) before surgery and at 3 months afterward. RESULTS: A total of 178 patients met inclusion criteria; 167 underwent major surgery and 150 were available for follow-up 3 months after surgery. The median age was 70 years old. Thirty-one patients (18.6%) tested as frail, and 72 (43.1%) prefrail before surgery. After adjustment for baseline cognitive score, age, education, surgery duration, American Society of Anesthesiologists (ASA) physical status, type of surgery, and sex, patients who tested frail or prefrail had an estimated 2.7 times the odds of delirium (97.5% confidence interval, 1.0-7.3) when compared to patients who were robust. There was no significant difference between the proportion of POCD between patients who tested as frail, prefrail, or robust. CONCLUSIONS: After adjustment for baseline cognition, testing as frail or prefrail with the FRAIL scale is associated with increased odds of postoperative delirium, but not POCD after noncardiac surgery.


Assuntos
Transtornos Cognitivos/prevenção & controle , Delírio/complicações , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Fragilidade/complicações , Complicações Cognitivas Pós-Operatórias , Idoso , Cognição , Interpretação Estatística de Dados , Eletroencefalografia , Feminino , Seguimentos , Idoso Fragilizado , Avaliação Geriátrica , Humanos , Masculino , Rememoração Mental , Testes Neuropsicológicos , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários
9.
Crit Care ; 24(1): 161, 2020 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-32312288

RESUMO

BACKGROUND: While delirium prevalence and duration are each associated with increased 30-day, 6-month, and 1-year mortality, the association between incident ICU delirium and mortality remains unclear. We evaluated the association between both incident ICU delirium and days spent with delirium in the 28 days after ICU admission and mortality within 28 and 90 days. METHODS: Secondary cohort analysis of a randomized, double-blind, placebo-controlled trial conducted among 1495 delirium-free, critically ill adults in 14 Dutch ICUs with an expected ICU stay ≥2 days where all delirium assessments were completed. In the 28 days after ICU admission, patients were evaluated for delirium and coma 3x daily; each day was coded as a delirium day [≥1 positive Confusion Assessment Method for the ICU (CAM-ICU)], a coma day [no delirium and ≥ 1 Richmond Agitation Sedation Scale (RASS) score ≤ - 4], or neither. Four Cox-regression models were constructed for 28-day mortality and 90-day mortality; each accounted for potential confounders (i.e., age, APACHE-II score, sepsis, use of mechanical ventilation, ICU length of stay, and haloperidol dose) and: 1) delirium occurrence, 2) days spent with delirium, 3) days spent in coma, and 4) days spent with delirium and/or coma. RESULTS: Among the 1495 patients, 28 day mortality was 17% and 90 day mortality was 21%. Neither incident delirium (28 day mortality hazard ratio [HR] = 1.02, 95%CI = 0.75-1.39; 90 day mortality HR = 1.05, 95%CI = 0.79-1.38) nor days spent with delirium (28 day mortality HR = 1.00, 95%CI = 0.95-1.05; 90 day mortality HR = 1.02, 95%CI = 0.98-1.07) were significantly associated with mortality. However, both days spent with coma (28 day mortality HR = 1.05, 95%CI = 1.02-1.08; 90 day mortality HR = 1.05, 95%CI = 1.02-1.08) and days spent with delirium or coma (28 day mortality HR = 1.03, 95%CI = 1.00-1.05; 90 day mortality HR = 1.03, 95%CI = 1.01-1.06) were significantly associated with mortality. CONCLUSIONS: This analysis suggests neither incident delirium nor days spent with delirium are associated with short-term mortality after ICU admission. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier NCT01785290 Registered 7 February 2013.


Assuntos
Delírio/complicações , Mortalidade/tendências , Idoso , Estudos de Coortes , Estado Terminal/epidemiologia , Estado Terminal/mortalidade , Delírio/epidemiologia , Delírio/mortalidade , Método Duplo-Cego , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Modelos de Riscos Proporcionais
10.
Nervenarzt ; 91(5): 391-397, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32246170

RESUMO

BACKGROUND: The aim of palliative care is to optimize the quality of life of patients with incurable advanced diseases. Adequate psychotherapeutic and psychiatric care is essential in this context. OBJECTIVE: This article presents the recommendations of the S3 guideline on palliative care for patients with incurable cancer with regard to psychotherapeutic and psychiatric contents. MATERIAL AND METHODS: The guideline was developed under the leadership of the German Society for Palliative Medicine (DGP) within the methodological framework of the German Guideline Program in Oncology. Systematic literature reviews were carried out to identify relevant publications in the databases Medline, Cochrane Library, PsycInfo and Embase. Based on the publications included and clinical experience, representatives of 61 professional associations developed and agreed on evidence-based and consensus-based recommendations. RESULTS: Out of the total of 15 chapters in the guidelines, four have a special reference to psychiatry or psychotherapy; they cover the topics depression, anxiety, delirium in the dying phase and dealing with the desire to die. These chapters contain a total of 71 recommendations, almost one third of which are evidence-based. In view of the regularly undetected psychological symptoms in patients with incurable cancer, an early assessment is recommended. Optimal control of physical symptoms and support in social and existential matters are general measures that should be provided in addition to non-pharmacological and pharmacological procedures. CONCLUSION: The guideline on palliative care deals with important mental issues that should be considered by all disciplines and professions. The need for research in palliative care remains high.


Assuntos
Ansiedade , Atitude Frente a Morte , Delírio , Depressão , Neoplasias , Cuidados Paliativos , Ansiedade/complicações , Ansiedade/terapia , Delírio/complicações , Delírio/terapia , Depressão/complicações , Depressão/terapia , Humanos , Neoplasias/complicações , Neoplasias/psicologia , Cuidados Paliativos/psicologia , Qualidade de Vida
11.
Intensive Crit Care Nurs ; 59: 102851, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32223922

RESUMO

BACKGROUND: Depression is common in patients with cardiac disease. Depression is a risk factor for developing postoperative delirium, a common and serious complication to cardiac surgery. OBJECTIVES: The aim was to evaluate if screening tools for depression can be used to predict postoperative delirium after cardiac surgery. METHODS: This was a prospective population-based pilot study including 26 patients between 23 and 80 years of age undergoing cardiac surgery in Sweden during 2018. The day before surgery the participants filled out the depression screening instruments Hospital Anxiety and Depression Scale and Patient Health Questionnaire. After discharge the patient charts were examined for documentation of symptoms of delirium. RESULTS: Five (20%) patients screened positive regarding depression using the Hospital Anxiety and Depression Scale and 7 patients (27%) screened positive using The Patient Health Questionnaire. Four (22%) patients showed symptoms of postoperative delirium, none of them screened positive for depression prior to surgery. CONCLUSION: We found no difference between the questionnaires PHQ-9 and HADS regarding identifying depressive symptoms. Moreover, we found that post-operative delirium, to a certain extent, can be detected by reading the patient́s charts postoperatively. However, this pilot study showed that screening tools for delirium need to be better implemented.


Assuntos
Ansiedade/classificação , Delírio/complicações , Transtorno Depressivo/classificação , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Delírio/fisiopatologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Questionário de Saúde do Paciente/estatística & dados numéricos , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Psicometria/instrumentação , Psicometria/métodos , Fatores de Risco , Inquéritos e Questionários , Suécia
12.
J Clin Nurs ; 29(13-14): 2083-2092, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32065410

RESUMO

AIMS: To examine the delirium point prevalence studies conducted in different inpatient settings and to discuss the implication of the findings for delirium screening, assessment, prevention and management. BACKGROUND: Delirium-a common and distressing condition manifesting as an acute decline of attention and cognition-is frequently overlooked, misdiagnosed or treated inappropriately. This neuropsychiatric syndrome manifests as changes in attention, cognition and awareness, with resultant impact on behaviour, function and emotions. Delirium is recognised as a patient management challenge in the inpatient setting, and there is a need to understand the current point prevalence and assessment practices of delirium. DESIGN: A systematic review and meta-analysis. METHODS: A systematic review of published delirium prevalence studies in inpatient settings was conducted and the implications of findings for delirium screening, assessment, prevention and management identified. The random-effects meta-analysis was conducted among studies measuring delirium point prevalence. The PRISMA statement was used to report systematic review and meta-analysis. RESULTS: Nine studies were included in the review, with sample sizes ranging from 47-1867. Delirium point prevalence ranged from 9%-32%. Hypoactive delirium was the most common subtype, ranging from 23%-78%. Fifteen delirium screening tools or assessment or diagnostic methods were used. Comorbid dementia was present in up to 50% of inpatients. CONCLUSIONS: Gaining a consensus on effective delirium instruments, the time windows for assessment and measurement will be crucial in driving benchmarking and quality improvement studies. RELEVANCE TO CLINICAL PRACTICE: Consistent identification of high-risk patients and treatment settings with elevated risk, accompanied by the implementation of effective preventive and management strategies, are critical to addressing delirium-a frequent and burdensome condition, that adversely affects patient outcomes.


Assuntos
Delírio/diagnóstico , Estudos Transversais , Delírio/complicações , Delírio/enfermagem , Demência/complicações , Demência/diagnóstico , Demência/enfermagem , Humanos , Programas de Rastreamento/métodos , Melhoria de Qualidade
13.
N Engl J Med ; 382(12): 1103-1111, 2020 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-32068366

RESUMO

BACKGROUND: In critically ill, mechanically ventilated patients, daily interruption of sedation has been shown to reduce the time on ventilation and the length of stay in the intensive care unit (ICU). Data on whether a plan of no sedation, as compared with a plan of light sedation, has an effect on mortality are lacking. METHODS: In a multicenter, randomized, controlled trial, we assigned, in a 1:1 ratio, mechanically ventilated ICU patients to a plan of no sedation (nonsedation group) or to a plan of light sedation (i.e., to a level at which the patient was arousable, defined as a score of -2 to -3 on the Richmond Agitation and Sedation Scale [RASS], on which scores range from -5 [unresponsive] to +4 [combative]) (sedation group) with daily interruption. The primary outcome was mortality at 90 days. Secondary outcomes were the number of major thromboembolic events, the number of days free from coma or delirium, acute kidney injury according to severity, the number of ICU-free days, and the number of ventilator-free days. Between-group differences were calculated as the value in the nonsedation group minus the value in the sedation group. RESULTS: A total of 710 patients underwent randomization, and 700 were included in the modified intention-to-treat analysis. The characteristics of the patients at baseline were similar in the two trial groups, except for the score on the Acute Physiology and Chronic Health Evaluation (APACHE) II, which was 1 point higher in the nonsedation group than in the sedation group, indicating a greater chance of in-hospital death. The mean RASS score in the nonsedation group increased from -1.3 on day 1 to -0.8 on day 7 and, in the sedation group, from -2.3 on day 1 to -1.8 on day 7. Mortality at 90 days was 42.4% in the nonsedation group and 37.0% in the sedated group (difference, 5.4 percentage points; 95% confidence interval [CI], -2.2 to 12.2; P = 0.65). The number of ICU-free days and of ventilator-free days did not differ significantly between the trial groups. The patients in the nonsedation group had a median of 27 days free from coma or delirium, and those in the sedation group had a median of 26 days free from coma or delirium. A major thromboembolic event occurred in 1 patient (0.3%) in the nonsedation group and in 10 patients (2.8%) in the sedation group (difference, -2.5 percentage points; 95% CI, -4.8 to -0.7 [unadjusted for multiple comparisons]). CONCLUSIONS: Among mechanically ventilated ICU patients, mortality at 90 days did not differ significantly between those assigned to a plan of no sedation and those assigned to a plan of light sedation with daily interruption. (Funded by the Danish Medical Research Council and others; NONSEDA ClinicalTrials.gov number, NCT01967680.).


Assuntos
Sedação Consciente , Estado Terminal/terapia , Hipnóticos e Sedativos/administração & dosagem , Respiração Artificial , Idoso , Idoso de 80 Anos ou mais , Coma/complicações , Sedação Consciente/métodos , Estado Terminal/mortalidade , Delírio/complicações , Feminino , Humanos , Infusões Intravenosas , Unidades de Terapia Intensiva , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Midazolam/administração & dosagem , Pessoa de Meia-Idade , Propofol/administração & dosagem , Respiração Artificial/efeitos adversos , Tromboembolia/etiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-32102286

RESUMO

Recent data indicate that acute kidney damage leads to inflammation in the brain and other distant organs. The purpose of this study was to investigate the effect of acute kidney injury (AKI) according to the Kidney Disease Improving Global Outcome (KDIGO) criteria on the occurrence of postoperative delirium in patients undergoing coronary artery bypass grafting (CABG). We performed a retrospective cohort analysis that included all consecutive patients undergoing elective CABG. The CAM-ICU (Confusion Assessment Method for Intensive Care Unit) was used for delirium assessment. Patients were divided into four groups, depending on the occurrence of AKI in the perioperative period according to KDIGO criteria. Overall, 902 patients were included in the final analysis, the mean age was 65.95 ± 8.01 years, and 76.83% were males (693/957). The majority of patients presented with normal kidney function-baseline creatinine level of 0.91 ± 0.21 (mg/dL). The incidence of AKI in the perioperative setting was 22.17% (200/902). Postoperative delirium was diagnosed in 115/902 patients (12.75%). Compared with no AKI, the odds of developing POD were increased for KDIGO stage 1 (OR 2.401 (95% confidence interval 1.484-3.884), p < 0.001); KDIGO stage 2 (OR 3.387 (95% confidence interval 1.459-7.866), p = 0.005); and highest for KDIGO stage 3 (OR equal to 9.729 (95% confidence interval 2.675-35.382), p = 0.001). Acute kidney injury, based on AKI staging, should be regarded as an independent risk factor for postoperative delirium after cardiac surgery.


Assuntos
Lesão Renal Aguda , Delírio , Complicações Pós-Operatórias , Lesão Renal Aguda/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Ponte de Artéria Coronária , Delírio/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Estudos Retrospectivos , Fatores de Risco
16.
PLoS One ; 15(1): e0227471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978127

RESUMO

BACKGROUND: Delirium is a common and serious acute neuropsychiatric syndrome which is often missed in routine clinical care. Inattention is the core cognitive feature. Diagnostic test accuracy (including cut-points) of a smartphone Delirium App (DelApp) for assessing attention deficits was assessed in older hospital inpatients. METHODS: This was a case-control study of hospitalised patients aged ≥65 years with delirium (with or without pre-existing cognitive impairment), who were compared to patients with dementia without delirium, and patients without cognitive impairment. Reference standard delirium assessment, which included a neuropsychological test battery, was based on Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A separate blinded assessor administered the DelApp arousal assessment (score 0-4) and attention task (0-6) yielding an overall score of 0 to 10 (lower scores indicate poorer performance). Analyses included receiver operating characteristic curves and sensitivity and specificity. Optimal cut-points for delirium detection were determined using Youden's index. RESULTS: A total of 187 patients were recruited, mean age 83.8 (range 67-98) years, 152 (81%) women; n = 61 with delirium; n = 61 with dementia without delirium; and n = 65 without cognitive impairment. Patients with delirium performed poorly on the DelApp (median score = 4/10; inter-quartile range 3.0, 5.5) compared to patients with dementia (9.0; 5.5, 10.0) and those without cognitive impairment (10.0; 10.0, 10.0). Area under the curve for detecting delirium was 0.89 (95% Confidence Interval 0.84, 0.94). At an optimal cut-point of ≤8, sensitivity was 91.7% (84.7%, 98.7%) and specificity 74.2% (66.5%, 81.9%) for discriminating delirium from the other groups. Specificity was 68.3% (56.6%, 80.1%) for discriminating delirium from dementia (cut-point ≤6). CONCLUSION: Patients with delirium (with or without pre-existing cognitive impairment) perform poorly on the DelApp compared to patients with dementia and those without cognitive impairment. A cut-point of ≤8/10 is suggested as having optimal sensitivity and specificity. The DelApp is a promising tool for assessment of attention deficits associated with delirium in older hospitalised adults, many of whom have prior cognitive impairment, and should be further validated in representative patient cohorts.


Assuntos
Delírio/diagnóstico , Aplicativos Móveis , Testes Neuropsicológicos , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos de Casos e Controles , Disfunção Cognitiva/complicações , Disfunção Cognitiva/patologia , Delírio/complicações , Demência/complicações , Demência/patologia , Feminino , Hospitalização , Humanos , Masculino , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Smartphone
17.
Rev. Rol enferm ; 43(1,supl): 59-68, ene. 2020. tab
Artigo em Português | IBECS | ID: ibc-193163

RESUMO

In patients with impaired consciousness, pain self-assessment is impracticable and communication is compromised, therefore challenging assessment by health care professionals. This causes the use of valid and trustful scales to become fundamental. The present study aims to evaluate the clinical potential of the existent scales for the assessment of pain in patients with impaired consciousness. The literature review comprehends the time frame from January of 2005 to June of 2011 based on two search engines and three databases. A total of 654 abstracts and titles were analyzed, 16 papers wereselected for a full body revision of which 8 comprise within the present review. Three university archives were visualized and only 1 paper was included herein. Seven distinct assessments of pain scales were identified in patients presenting impaired consciousness. Only one of the scales took into account physiological and behavioral indicators, whereas the remaining others included solely behavioral indicators. The BPS scale obtained the highest rating, thus turning its implementation possible in these patients.More research, concerning the effects of the use of assessment of pain tools in clinics and their implications, is required


No disponible


Assuntos
Humanos , Delírio/complicações , Transtornos da Consciência/complicações , Medição da Dor/instrumentação , Dor Crônica/diagnóstico , Inconsciência/complicações , Manejo da Dor/enfermagem , Cuidados Críticos/métodos , Saúde do Adulto , Respiração Artificial/enfermagem
18.
Nursing ; 50(1): 32-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31855984

RESUMO

Hospital-acquired delirium often goes unnoticed because the signs and symptoms resemble those of dementia and depression, making diagnosis difficult. This article explores the differences between delirium, dementia, and depression and discusses the role of nursing in patient assessment and education.


Assuntos
Delírio/enfermagem , Doença Iatrogênica/prevenção & controle , Delírio/complicações , Delírio/etiologia , Diagnóstico Diferencial , Humanos , Diagnóstico de Enfermagem , Educação de Pacientes como Assunto , Gestão de Riscos/métodos
19.
Arch Gerontol Geriatr ; 87: 103977, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31751902

RESUMO

BACKGROUND: Although a few trials have explored the relationship between postoperative delirium (POD) and incident dementia in patients with hip surgery, the numbers of participants in each study are relatively small. Thus, we performed a meta-analysis to examine whether POD after hip surgery is a risk factor for incident dementia. METHODS: Six prospective cohort studies investigating the development of incident dementia in patients with POD after hip surgery were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- and random- effect models. RESULTS: POD significantly increased the risk of incident dementia and cognitive decline (overall odds ratio [ORs] = 8.957; 95 % confidence interval [CI], 5.444-14.737; P <  0.001 in fixed-effects model; overall ORs = 8.962; 95 % CI, 5.344-15.029; P <  0.001 in random-effects model). A publication bias was not evident in this study. CONCLUSIONS: Our meta-analysis revealed that POD after hip surgery is a risk factor for incident dementia. Early identification of cognitive function should be needed after surgery and appropriate prevention and treatment for dementia will be required, especially in cases with POD.


Assuntos
Delírio/complicações , Demência/etiologia , Quadril/cirurgia , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco
20.
Cardiovasc Interv Ther ; 35(2): 168-176, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31154617

RESUMO

Post-operative delirium (POD) has been recognized as an independent risk factor for mortality. Recent studies suggest that POD is associated with higher mortality rates in patients undergoing transcatheter aortic valve replacement (TAVR). However, a systematic review and meta-analysis of the literature has not been performed. This study assessed the association between POD and TAVR by performing a systematic review and meta-analysis of the literature. We comprehensively searched the databases of MEDLINE and EMBASE from inception to April 2018. Included studies were prospective or retrospective cohort studies that compared mortality among patients undergoing TAVR both with and without POD. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Seven studies consisting of 20,086 subjects undergoing TAVR (1517 with POD and 18,569 without POD) were included in this meta-analysis. POD demonstrated a trend towards higher all-cause mortality (pooled odd ratio 1.52, 95% confidence interval 0.98-2.37, p = 0.062, I2 = 72%). POD was associated with a significant increased long-term mortality (pooled odd ratio 2.11, 95% confidence interval 1.21-3.68, p = 0.009, I2 = 62.5%). POD was associated with an increased risk of long-term all-cause mortality in patients undergoing TAVR. Our study suggests POD could be a potential risk factor of mortality among patients undergoing TAVR. Further studies implementing preventative and treatment strategies against delirium and its effect on POD and its associated mortality are needed.


Assuntos
Delírio/complicações , Mortalidade , Complicações Pós-Operatórias , Substituição da Valva Aórtica Transcateter , Estenose da Valva Aórtica/terapia , Humanos , Fatores de Risco
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