LAMIB marcando presença no 7th International Symposium on Itensive Care and Emergency Medicine For Latin America! Confira!
A LAMIB marcou ilustre presença no 7th International Symposium on Itensive Care and Emergency Medicine For Latin America, que ocorreu nos dias 19 a 22 de junho de 2013, em São Paulo (Mais informações sobre o evento)
Os membros da liga apresentaram três trabalhos inéditos no simpósio, fruto da linha de pesquisa em Delirium desenvolvida em grupode pesquisa orientado pelo Professor Dimitri Gusmão Flores, Médico intensivista e preceptor do programa de Residência de Clínica Médica do Hospital Universtário Professor Edgar Santos (HUPES) e coordenador médico da UTI Geral desta instituição. A linha de pesquisa ‘Delirium em pacientes graves’ é desenvolvida na UTI do Hospital Universitário Professor Edgard Santos.
Segue o abstracts dos trabalhos apresentados no congresso e publicados na critical care.
Pharmacological treatment of hypoactive delirium in critically ill patients: a systematic review
Joao Pedro LM Carvalho1*, Ricardo Alvim1*, Juliana Martins1, Cesar Bouza1, Paula Zenaide2, Ricardo Zantieff1, Bruno Pondé1, Daniele Amorim1, Lucas C Quarantini3, Dimitri Gusmao-Flores3
¹Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, 40025-010, Brazil
²Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, 40285-001, Brazil
³ University Hospital Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, 40110-060, Brazil
* These authors contributed equally to this work
Correspondence to: Joao Pedro LM Carvalho, email: joaopedro.lmc@gmail.com
Background: Delirium is generally managed by treating its underlying causes. However, symptomatic treatment may also be indicated. Although hypoactive delirium in critically ill patients is the most prevalent subtype of delirium, the effects of treatment with drugs specifically for this group are not well defined. The aim of this systematic review is to evaluate the role of pharmacological treatment in critically ill patients with hypoactive delirium.
Methods: A systematic review was conducted, based on the PRISMA criteria, to identify articles on the pharmacological approach to hypoactive delirium in critically ill patients. First, a MEDLINE and SciELO databases search was performed for articles published in the English language, involving patients in intensive care units in which pharmacological therapy was used to treat delirium. Second, these studies were reevaluated to identify subtypes of delirium and the impact of the treatment.
Results: The number of studies included in the qualitative synthesis was eighteen. Half of them were clinical trials and the others were either letters or comments. However, only one study specified the treatment of hypoactive subtype delirium. The design of this study was a post-hoc analysis of a double-blind, randomized, placebo-controlled study that used quetiapine as an adjuvant therapy of haloperidol. This study suggested that quetiapine appears to have more rapid resolution of many delirium symptoms, included hypoactive state. These results were not statistically significant. The other seventeen studies do not address the subtype.
Conclusions: There is poor evidence regarding the use of drugs for the management of hypoactive delirium. Not only the study design, but the number of patients studied in the single trial is very limited, which affects the power of evidence. Double-blind, randomized, placebo controlled trials must be done to guide the treatment and the management of hypoactive delirium.
There is no conflict of interest.
References:
1. Devlin et al.: Impact of quetiapine on resolution of individual delirium symptoms in critically ill patients with delirium: a post-hoc analysis of a double-blind, randomized, placebo-controlled study. Critical Care 2011 15:R215.
Comparison between consecutive versus non-consecutive episodes of delirium to predict outcome in critically ill patients
Juliana CS Martins¹*, Ricardo Zantieff¹, Paula Zenaide², Ricardo Alvim¹, Cesar Bouza¹, Bruno Pondé¹, Joao Pedro LM Carvalho¹, Daniele Amorim¹, Lucas C Quarantini3, Dimitri Gusmao-Flores4
¹Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, 40026-010, Brazil
²Escola Bahiana de Medicina e Saúde Pública, Salvador, 40285-001, Brazil
3Department of Neurosciences and Mental Health, University Hospital Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, 40110-910, Brazil
4Intensive Care Unit, University Hospital Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, 40110-910, Brazil
*Correspondence to: Juliana CS Martins, email: julianacsmartins@gmail.com
Background: Delirium is an acute confusional state associated with adverse outcomes. The primary aim of this study is to compare patients with the same number of episodes of delirium and identify whether different chronological patterns – consecutive or non-consecutive episodes of delirium – have an effect on mortality, Intensive Care Unit (ICU) length and duration of mechanical ventilation (MV).
Methods: Prospective study in the Intensive Care Unit (ICU) of the University Hospital Professor Edgard Santos (HUPES), Salvador, Brazil during the period of January to March, 2013. Patients were assessed twice daily for detection of delirium with the Confusion Assessment Method for the ICU (CAM-ICU). Those who had been less than 48 hours in the ICU were excluded. Data such as age, comorbidities, reason and length of hospitalization, mechanical ventilation, and clinical outcome were also collected. SPSS 21 for Windows was used for statistical analysis.
Results: Among the 45 patients included in the study, 16 (35,6%) presented at least one episode of delirium. The delirium subgroup presented a mean age of 59,2 year old, a mean ICU length of 13,63 (± 9,56) days and the most common admission diagnosis was sepsis (46,7%). Of these, 10 patients presented 2 or more episodes of delirium. Only four patients had the same number of delirium episodes, two episodes each. Six patients have different numbers and could not be compared. The group in which delirium presentation was consecutive (n=2) presented a mean ICU length of 6,5 days and 100% mortality, in contrast to 24,5 days in those with non-consecutive presentation (p=0,333) and 100% survival (p=0,333). The APACHE 2 and SAPS 3 showed no statistical difference between the two groups. Lastly, the consecutive delirium subgroup presented mean MV lenght of 3,5 days, compared to 12,5 days presented by the other group (p=0,667).
Conclusions: Even though the comparison was not statistically significant, the patients with consecutive days of delirium had better prognoses than the other group in most of the outcomes. This is a pilot study, still in progress, with the limitation being the small number of patients.
Evaluation of new variables to predict delirium outcome
Joao Pedro LM Carvalho1*, Ricardo Alvim1, Juliana CS Martins1, Cesar Bouza1, Paula Zenaide2, Ricardo Zantieff1, Bruno Pondé1, Daniele Amorim1, Lucas C Quarantini3, Dimitri Gusmao-Flores4
¹Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, 40025-010, Brazil
²Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, 40285-001, Brazil
³Department of Neurosciences and Mental Health, University Hospital Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, 40110-910, Brazil
4Intensive Care Unit, University Hospital Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, 40110-910, Brazil
*Correspondence to: Joao Pedro LM Carvalho, email: joaopedro.lmc@gmail.com
Introduction: Delirium assessment is already a well-established practice in intensive care units (ICU). Usually, these evaluations are represented in delirium incidence or delirium free days without coma. We propose four derived variables to predict the outcome in delirium patients in order to identify the most accurate data.
Methods: Prospective study took place at the ICU of the University Hospital Professor Edgard Santos (HUPES), Salvador, Brazil during the period of January to March 2013. Adult patients were assessed twice daily for detection of delirium with the Confusion Assessment Method for the ICU (CAM-ICU). Those patients with less than 48 hours in the ICU were excluded. The derived variables were classified in four groups: group 1 - days of delirium, group 2 - delirium episodes; group 3 - maximum time of consecutive positive delirium; group 4 - delirium density (days of consecutive positive delirium / days of delirium). These variables were compared with the outcome – mortality – of patients with positive delirium during the ICU stay. SPSS 21 for Windows was used for statistical analyses.
Results: Forty-five patients were analyzed, sixteen of whom presented delirium. The mortality of delirium patients was 60%. Group 1: one day with delirium was associated with mortality of 60% compared with 50% with two or more days. Group 2: patients who had just one episode had 67% mortality compared with 50% mortality if they have two or more episodes. Group 3: mortality with a density of 0,5 or more was 57% versus 50% mortality in the subgroup less than 0,5. And finally, group 4: comparing the patients who died with the survival patients, we found 1,75 days of consecutive positive evaluation in the patients who died and 4 days in those who survived. None of the differences between these results for any of the four groups were statistically significant.
Conclusion: Due to the small population analyzed we could not conclude which was the best variable to predict delirium outcomes. None of the variables analyzed affected outcome when compared with just one positive evaluation during the ICU stay. New studies with a larger population are needed to identify the best variable.