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Colegio de Medicina Interna de México.

2010, Número 2

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Med Int Mex 2010; 26 (2)


Delirium en el enfermo grave

Carrillo ER, Sosa GJO

Idioma: Español
Referencias bibliográficas: 70
Paginas: 130-139
Archivo PDF: 273.73 Kb.


RESUMEN

El delirium tiene una elevada incidencia en los enfermos graves internados en unidades de terapia intensiva. Es un factor de riesgo independiente de: mortalidad, estancia y ventilación mecánica prolongada, y deterioro cognitivo a mediano y largo plazo. La falta de protocolos de diagnóstico de este padecimiento en las unidades de terapia intensiva para su diagnóstico temprano y atención oportuna, repercute negativamente en la evolución y pronóstico del enfermo grave. El objetivo de este trabajo es revisar los conceptos actuales relacionados con el delirium y proponer a la comunidad médica que atiende enfermos graves la necesidad de implantar protocolos para su diagnóstico y tratamiento con la finalidad de mejorar la calidad y seguridad de atención en las unidades de terapia intensiva.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Bergeron N, Dubois MJ, Dumont M, et al. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 2001;27:859-864.

  2. McNicoll L, Pisani MA, Zhang Y, et al. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 2003;51:591-598.

  3. Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001;29:1370-1379.

  4. 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 (CAMICU). JAMA 2001;286:2703-2710.

  5. Lin SM, Liu CY, Wang CH, et al. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 2004;32:2254-2259.

  6. Pandharipande P, Costabile S, Cotton B, et al. Prevalence of delirium in surgical ICU patients [abstract]. Crit Care Med 2005;33:A45.

  7. Levkoff SE, Evans DA, Liptzin B, et al. Delirium: the occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 1992;152:334-340.

  8. 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.

  9. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001; 27:1892-1900.

  10. Jackson JC, Hart RP, Gordon SM, et al. Six-month neuropsychological outcome of medical intensive care unit patients. Crit Care Med 2003;31:1226-1234.

  11. Thomason JW, Shintani A, Peterson JF, et al. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non ventilated patients. Crit Care 2005; 9:R375-R381.

  12. Miller RR, Shintani A, Girard TD, et al. Delirium predicts extubation failure [abstract]. Proc Am Thorac Soc 2006;3:42.

  13. Ouimet S, Kavanagh BP, Gottfried SB, et al. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007; 33:66-73.

  14. Hopkins RO, Weaver LK, Pope D, et al. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 1999;160:50-56.

  15. Milbrandt EB, Deppen S, Harrison PL, et al. Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004;32:955-962.

  16. Marcantonio ER, Simon SE, Bergmann MA, et al. Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. J Am Geriatr Soc 2003;51:4-9.

  17. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington: American Psychiatric Pub 2000;p:135-137.

  18. Milisen K, Foreman MD, Godderis J, et al. Delirium in the hospitalized elderly: nursing assessment and management. Nurs Clin North Am 1998;33:417-436.

  19. Meagher DJ, Trzepacz PT. Motoric subtypes of delirium. Semin Clin Neuropsychiatry 2000;5:75-85.

  20. O’Keeffe ST, Lavan JN. Clinical significance of delirium subtypes in older people. Age Ageing 1999;28:115-119.

  21. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 1994;271:134-139.

  22. Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 1994;97:278- 288

  23. Peterson JF, Pun BT, Dittus RS, et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc 2006;54:479-484.

  24. Trzepacz PT, Mulsant BH, Dew MA, Pasternak R, Sweet RA, Zubenko GS. Is delirium different when it occurs in dementia? A study using the delirium rating scale. J Neuropsychiatry Clin Neurosci 1998;10:199-204.

  25. Perry VH, Andersson B, Gordon S. Macrophages and inflammation in the central nervous system. Trends Neurosci 1993;16:268-273.

  26. Rothwell NJ, Luheshi G, Toulmond S. Cytokines and their receptors in the central nervous system: physiology, pharmacology and pathology. Pharmacol Ther 1996; 69:85- 95.

  27. Czura CJ, Friedman SG, Tracey KJ. Neural inhibition of inflammation: the cholinergic anti-inflammatory pathway. J Endotoxin Res 2003;9:409-413.

  28. Munford RS, Tracey KJ. Is severe sepsis a neuroendocrine disease? Mol Med 2002; 8:437-442.

  29. Pavlov VA, Wang H, Czura CJ, et al. The cholinergic anti-inflammatory pathway: a missing link in neuroimmunomodulation. Mol Med 2003;9:125-134.

  30. Woiciechowsky C, Asudullah K, Nestler D, et al. Sympathetic activation triggers systemic interleukin-10 release in immunodepression induced brain injury. Nat Med 1998;4:808-813.

  31. Woiciechowsky C, Schoening B, Daberkow N, et al. Brain IL-1 beta induces local inflammation but systemic anti-inflammatory response through stimulation of both hypothalamic-pituitaryadrenal axis and sympathetic nervous system. Brain Res 1999;816:563-571.

  32. Nicholson TE, Renton KW. The role of cytokines in the depression of CYP1A activity using cultured astrocytes as an in vitro model of inflammation in the CNS. Drug Metab Dispos 2002;30:42-46.

  33. Justic M. Does ‘ICU psychosis’ really exist? Crit Care Nurse 2000;20:28-37.

  34. Webb JM, Carlton EF, Geeham DM. Delirium in the intensive care unit: are we helping the patient? Crit Care Nurs Q 2000;22:47-60.

  35. Crippen D. Treatment of agitation and its comorbidities in the intensive care unit. In: Hill NS, Levy MM, editors. Ventilator management strategies for critical care. New York: Marcel Dekker, 2001;p:243-284.

  36. Fulkerson W, MacIntyre N, Stamler J, Crapo J. Pathogenesis and treatment of the adult respiratory distress syndrome. Arch Intern Med 1996;156:29-38.

  37. Bellingan G. The pulmonary physician in critical care- 6: the pathogenesis of ALI/ARDS. Thorax 2002;57:540-546.

  38. Arvin B, Neville LF, Barone FC, Feurstein GZ. Brain injury and inflammation: a putative role for TNF-alpha. Ann N Y Acad Sci 1995;116:62-71.

  39. Fink MP, Evans TW. Mechanisms of organ dysfunction in critical illness: report from a round table conference held in Brussels. Intensive Care Med 2002;28:369-375.

  40. Abraham E. Coagulation abnormalities in acute lung injury and sepsis. Am J Respir Cell Mol Biol 2000;22:401-404.

  41. Suter PM. MV causes lung inflammation and systemic immune depression: a balance of fire and ice. Intensive Care Med 2002;28:383-385.

  42. Wrigge H, Zinserling J, Stuber F, et al. Effects of mechanical ventilation on release of cytokines into systemic circulation in patients with normal pulmonary function. Anesthesiology 2000; 93:1413-1417.

  43. Plotz FB, Vreugdenhil HAE, Slutsky AR, et al. Mechanical ventilation alters the immune response in children with lung pathology. Intensive Care Med 2002; 28:486-492.

  44. Eidelman LA, Putterman D, Putterman C, Sprung CL. The spectrum of septic encephalopathy: definitions, etiologies, and mortalities. JAMA 1996;275:470-473.

  45. Sprung CL, Peduzzi PN, Shatney CH, et al. The impact of encephalopathy on mortality in the sepsis syndrome. The Veteran’s Administration Systematic Sepsis Cooperative Study Group. Crit Care Med 1990;18:801-806.

  46. Dubois MJ, Bergeron N, Dumont M, et al. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 2001;27:1297-1304.

  47. Marcantonio ER, Juarez G, Goldman L, et al. The relationship of postoperative delirium with psychoactive medications. JAMA 1994;272:1518-1522.

  48. American Psychiatric Association. Practice guideline for the treatment of patients with delirium. Am J Psychiatry 1999; 156:1-20.

  49. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA 1996; 275:852-857.

  50. Inouye SK, Viscoli C, Horwitz RI, et al. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 1993; 119:474-481.

  51. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule fordelirium after elective noncardiac surgery. JAMA 1994;271:134-139.

  52. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001;27:1892-1900.

  53. Inouye SK, Schlesinger MJ, Lyndon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med 1999; 106:565-573.

  54. Pandharipande P, Shintani A, Peterson J, Ely EW. Sedative and analgesic medications are independent risk factors in ICU patients for transitioning into delirium. Crit Care Med 2004; 32:A19.

  55. Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 1993;119:474-481.

  56. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996;275:852- 857.

  57. Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 2001;27:1297-1304.

  58. Williams-Russo P, Urquhart BL, Sharrock NE, Charlson ME. Post-operative delirium: predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc 1992;40:759-767.

  59. Lynch EP, Lazor MA, Gellis JE, et al. The impact of postoperative pain on the development of postoperative delirium. Anesth Analg 1998;86:781-785.

  60. Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30:119-141.

  61. Ramsay M, Savege TM, Simpson ER, Goodwin R. Controlled sedation with alphaxalone-alphadolone. BMJ 1974;2:656-659.

  62. Ostermann ME, Keenan SP, Seiferling RA, Sibbald W. Sedation in the intensive care unit. JAMA 2000;283:1451-1459.

  63. Riker R, Picard JT, Fraser G. Prospective evaluation of the sedation-agitation scale for adult critically ill patients. Crit Care Med 1999;27:1325-1329.

  64. Sessler CN, Gosnell M, Grap MJ, et al. The Richmond Agitation- Sedation Scale: validity and reliability in adult intensive care patients. Am J Respir Crit Care Med 2002;166:1338-1344.

  65. Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003;289:2983-2991.

  66. Inouye SK, Bogardus ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340:669-676.

  67. Maldonado JR, van der Starre PJ,Wysong A. Post-operative sedation and the incidence of ICU delirium in cardiac surgery patients. Anesthesiology 2003, ASA Meeting Abstracts.

  68. Nelson LE, Lu J, Guo T, et al. The a2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology 2003; 98:428-436.

  69. Celis-Rodriguez E, Besso J, Birchenall C, et al. M. Guía de práctica clínica basada en la evidencia para el manejo de la sedo-analgesia en el paciente adulto críticamente enfermo. Med Intensiva 2007;31(8):428-471.

  70. Milbrandt EB, Kersten A, Kong L, et al. Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients. Crit Care Med 2005;33:226-229.




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