Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942012000400001
Brazilian Journal of Anesthesiology
Scientific Article

Delirium pós-operatório em pacientes críticos: fatores de risco e resultados

risk factors and outcome

Dalila Veiga; Clara Luis; Daniela Parente; Vera Fernandes; Miguela Botelho; Patricia Santos; Fernando Abelha

http://dx.doi.org/10.1590/S0034-70942012000400001 Braz J Anesthesiol, vol.62, n4, p.476-483, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: O delirium pós-operatório (DPO) em pacientes cirúrgicos em terapia intensiva é um resultado independente importante e determinante. O objetivo do nosso estudo foi avaliar a incidência e os determinantes do DPO. MÉTODOS: Estudo prospectivo de coorte realizado durante um período de 10 meses em uma unidade de recuperação pós-anestesia (URPA) com cinco leitos especializados em terapia intensiva. Todos os consecutivos pacientes adultos submetidos à cirurgia de grande porte foram incluídos. Os dados demográficos, as variáveis perioperatórias, o tempo de internação (TI) e a mortalidade na URPA, no hospital e nos 6 meses de acompanhamento foram registrados. Delirium pós-operatório foi avaliado utilizando o Checklist para triagem de delirium em terapia intensiva (Intensive Care Delirium Screening Checklist - ICDSC). Análises descritivas foram realizadas e o teste de Mann-Whitney, qui-quadrado ou teste exato de Fisher foram usados para comparações. Análise de regressão logística avaliou os fatores determinantes do DPO com o cálculo da razão de chances (RC) e seu intervalo de confiança de 95% (IC 95%). RESULTADOS: Houve admissão de 775 pacientes adultos na URPA e 95 pacientes não atenderam aos critérios de inclusão. Dos 680 pacientes restantes, 128 (18,8%) desenvolveram DPO. Os determinantes independentes de DPO identificados foram a idade, ASA-PS, cirurgia de emergência e a quantidade total de plasma fresco congelado (PFC) administrada durante a cirurgia. Os pacientes com delirium tiveram taxas mais elevadas de mortalidade, estavam mais gravemente doente e permaneceram mais tempo na URPA e no hospital. DPO foi um fator de risco independente para mortalidade hospitalar. DISCUSSÃO: A incidência de delirium foi elevada nos pacientes cirúrgicos em terapia intensiva. DPO foi associado a uma pior pontuação de gravidade da doença, tempo de permanencia mais longo no hospital e na URPA e a taxas mais elevadas de mortalidade. Os fatores de risco independentes para DPO foram a idade, ASA-PS, cirurgia de emergência e quantidade de plasma administrado durante a cirurgia.

Palavras-chave

COMPLICAÇÕES, Pós-operatória, RECUPERAÇÃO PÓS-ANESTÉSICA

Abstract

BACKGROUND AND OBJECTIVES: Postoperative delirium (POD) in Surgical Intensive Care patients is an important independent outcome determinant. The purpose of our study was to evaluate the incidence and determinants of POD. METHODS: Prospective cohort study conducted during a period of 10 months in a Post-Anesthesia Care Unit (PACU) with five intensive care beds. All consecutive adult patients submitted to major surgery were enrolled. Demographic data, perioperative variables, length of stay (LOS) and the mortality at PACU, hospital and at 6-months follow-up were recorded. Postoperative delirium was evaluated using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive analyses were conducted and the Mann-Whitney test, Chi-square test or Fisher's exact test were used for comparisons. Logistic regression analysis evaluated the determinants of POD with calculation of odds ratio (OR) and its confidence interval 95% (95% CI). RESULTS: There were 775 adult PACU admissions and 95 patients had exclusion criteria. Of the remaining 680 patients, 128 (18.8%) developed POD. Independent determinants of POD identified were age, ASA-PS, emergency surgery and total amount of fresh frozen plasma administered during surgery. Patients with delirium had higher mortality rates, were more severely ill and stayed longer at the PACU and in the hospital. POD was an independent risk factor for hospital mortality DISCUSSION: There was a high incidence of delirium had a high incidence in intensive care surgical patients. POD was associated with worse severity of disease scores, longer LOS in hospital, and in PACU and higher mortality rates. The independent risk factors for POD were age, ASA-PS, emergency surgery and the amount of plasma administered during surgery.

Keywords

Anesthesia Recovery Period, Delirium, Postoperative Complications, Risk factors

References

Ely EW, Shintani A, Truman B. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Jama. 2004;291(14):1753-1762.

Leslie DL, Zhang Y, Holford TR, Bogardus ST, Leo-Summers LS, Inouye SK. Premature death associated with delirium at 1-year follow-up. Arch Intern Med. 2005;165(14):1657-1662.

Olin K, Eriksdotter-Jönhagen M, Jansson A, Herrington MK, Kristiansson M, Permert J. Postoperative delirium in elderly patients after major abdominal surgery. Br J Surg. 2005;92(12):1559-1564.

Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care. 2005;9(4):R375-381.

Zakriya K, Sieber FE, Christmas C, Wenz JF Sr, Franckowiak S. Brief postoperative delirium in hip fracture patients affects functional outcome at three months. Anesth Analg. 2004;98(6):1798-1802.

Aakerlund LP, Rosenberg J. Postoperative delirium: treatment with supplementary oxygen. Br J Anaesth. 1994;72(3):286-290.

Whitlock EL VA, Avidan MS. Postoperative delirium. Minerva Anestesiol. 2011;77(4):448-456.

Girard TD PP, Ely EW. Delirium in the intensive care unit. Crit Care. 2008;12(^s3).

Jacobi J, Fraser GL, Coursin DB. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30(1):119-141.

Johnson J. Identifying and recognizing delirium. Dement Geriatr Cogn Disord. 1999;10(5):353-358.

Milisen K, Foreman MD, Abraham IL. A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. J Am Geriatr Soc. 2001;49(5):523-532.

Lundstrom M, Edlund A, Karlsson S, Brannstrom B, Bucht G, Gustafson Y. A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc. 2005;53(4):622-628.

Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859-864.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-829.

Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957-2963.

Lee TH, Marcantonio ER, Mangione CM. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-1049.

Parikh SSMC. Frances FRCPC: Postoperative Delirium in the Elderly. Anesth Analg. 1995;80(6):1223-1232.

Marcantonio ER, Goldman L, Mangione CM. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271(2):134-139.

Marcantonio ER, Goldman L, Orav EJ, Cook EF, Lee TH. The association of intraoperative factors with the development of postoperative delirium. Am J Med. 1998;105:380-384.

McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med. 2002;162(4):457-463.

Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes?: A three-site epidemiologic study. J Gen Intern Med. 1998;13(4):234-242.

Brouquet A, Cudennec T, Benoist S. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg. 2010;251(4):759-765.

Litaker D, Locala J, Franco K, Bronson DL, Tannous Z. Preoperative risk factors for postoperative delirium. Gen Hosp Psychiatry. 2001;23(2):84-89.

Radtke FM, Franck M, MacGuill M. Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol. 2010;27(5):411-416.

Dasgupta M, Dumbrell AC. Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc. 2006;54(10):1578-1589.

Bucerius J, Gummert JF, Borger MA. Predictors of delirium after cardiac surgery delirium: effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg. 2004;127(1):57-64.

Burkhart CS, Dell-Kuster S, Gamberini M. Modifiable and nonmodifiable risk factors for postoperative delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2010;24(4):555-559.

Ansaloni L, Catena F, Chattat R. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg. 2010;97(2):273-280.

James G, Kenneth R. Dehydration and Delirium: Not a Simple Relationship. J Gerontol A Biol Sci Med Sci. 2004;59(8):M811-M811.

Vaurio LE, Sands LP, Wang Y, Mullen EA, Leung JM. Postoperative delirium: the importance of pain and pain management. Anesth Analg. 2006;102(4):1267-1273.

Bryson GL, Wyand A. Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth. 2006;53(7):669-677.

Ansaloni L, Catena F, Chattat R. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg. 2010;97(2):273-280.

Milbrandt EB, Deppen S, Harrisson PL. Costs associated with delirium in mechanically ventilated patients. Crit Care Med. 2004;32(4):955-962.

Fricchione GL, Nejad SH, Esses JA. Postoperative delirium. Am J Psychiatry. 2008;165(7):803-812.

Warshaw G, Mechlin M. Prevention and management of postoperative delirium. Int Anesthesiol Clin. 2009;47(4):137-149.

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