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Authors
Abstract(s)
O delirium é definido essencialmente por um distúrbio agudo dos níveis de
atenção e consciência, acompanhado por uma alteração do nível cognitivo basal, que se
desenvolvem num curto espaço de tempo e apresentam um carater flutuante. O seu
desenvolvimento envolve um conjunto de elementos que se correlacionam de forma
complexa entre os diversos fatores predisponentes que tornam a pessoa mais vulnerável
e o grau de exposição ao fator agressor ou precipitante.
É tipicamente dividido em três subtipos de acordo com o modo de apresentação:
delirium hiperativo, quando surge associado a hiperatividade psicomotora, labilidade
emocional e agitação; delirium hipoativo, quando se apresenta por níveis reduzidos de
atividade psicomotora, lentificação e letargia; e o tipo misto, que apresenta
manifestações clínicas de ambos os subtipos anteriormente referidos.
O diagnóstico é realizado através do conjunto de manifestações clínicas
associadas a esta patologia, tendo sido desenvolvidas recentemente um conjunto de
ferramentas e escalas que auxiliam os profissionais de saúde a alcançar um diagnóstico
mais correto e célere do delirium.
A prevenção é a intervenção disponível mais eficaz para diminuir a ocorrência do
delirium e o conjunto de consequências associadas a esta patologia, nomeadamente
através de medidas não farmacológicas. O tratamento é essencialmente realizado com
recurso a terapêuticas não farmacológicas, não existindo atualmente orientações ou
evidência que suporte o recurso a terapêuticas farmacológicas.
O delirium atinge diversas populações hospitalares, sendo mais prevalente na
população idosa. Pode surgir em contexto de internamento na unidade de cuidados
intensivos, na enfermaria, em situações de pós-operatório ou na pediatria. Ainda,
correlaciona-se com diversas patologias, podendo ser consequência ou fator de risco para
o desenvolvimento de outras doenças.
Assim, esta revisão da literatura por palavras-chave pretende explorar e
aprofundar o atual estado da arte sobre o delirium, analisando à luz da evidência atual
os seus fatores de risco e apresentação clínica, bem como as técnicas de prevenção e
gestão do doente, particularmente em contexto hospitalar.
Delirium is essentially defined by an acute disturbance in levels of attention and consciousness, accompanied by an alteration of the baseline cognitive level, which develops rapidly and tends to fluctuate in severity during the course of the day. Its development involves a set of elements that correlate complexly among various predisposing factors that make the individual more vulnerable and the degree of exposure to the aggressive or precipitating factor. It is typically divided into three subtypes according to presentation mode: hyperactive delirium, when associated with psychomotor hyperactivity, emotional lability, and agitation; hypoactive delirium, when presenting with reduced levels of psychomotor activity, sluggishness and lethargy; and mixed type, which presents clinical manifestations of both aforementioned subtypes. Diagnosis is made through the set of clinical manifestations associated with this pathology, and recently a set of tools and scales has been developed to assist healthcare professionals in achieving a more accurate and prompt diagnosis of delirium. Prevention is the most effective available intervention to reduce the occurrence of delirium and the set of associated consequences of this pathology, namely through non-pharmacological measures. Treatment is essentially carried out using nonpharmacological therapies, with currently no guidelines or evidence supporting the use of pharmacological therapies. Delirium affects various hospital populations, being more prevalent in the elderly population. It can occur in the context of admission to the intensive care unit, in the ward, in post-operative situations, or in pediatrics. Furthermore, it correlates with various pathologies and can be a consequence or risk factor for the development of other diseases. Thus, this literature review by keywords aims to explore and deepen the current state of the art on delirium, analyzing its risk factors and clinical presentation in light of current evidence, as well as prevention and patient management techniques, particularly in a hospital setting.
Delirium is essentially defined by an acute disturbance in levels of attention and consciousness, accompanied by an alteration of the baseline cognitive level, which develops rapidly and tends to fluctuate in severity during the course of the day. Its development involves a set of elements that correlate complexly among various predisposing factors that make the individual more vulnerable and the degree of exposure to the aggressive or precipitating factor. It is typically divided into three subtypes according to presentation mode: hyperactive delirium, when associated with psychomotor hyperactivity, emotional lability, and agitation; hypoactive delirium, when presenting with reduced levels of psychomotor activity, sluggishness and lethargy; and mixed type, which presents clinical manifestations of both aforementioned subtypes. Diagnosis is made through the set of clinical manifestations associated with this pathology, and recently a set of tools and scales has been developed to assist healthcare professionals in achieving a more accurate and prompt diagnosis of delirium. Prevention is the most effective available intervention to reduce the occurrence of delirium and the set of associated consequences of this pathology, namely through non-pharmacological measures. Treatment is essentially carried out using nonpharmacological therapies, with currently no guidelines or evidence supporting the use of pharmacological therapies. Delirium affects various hospital populations, being more prevalent in the elderly population. It can occur in the context of admission to the intensive care unit, in the ward, in post-operative situations, or in pediatrics. Furthermore, it correlates with various pathologies and can be a consequence or risk factor for the development of other diseases. Thus, this literature review by keywords aims to explore and deepen the current state of the art on delirium, analyzing its risk factors and clinical presentation in light of current evidence, as well as prevention and patient management techniques, particularly in a hospital setting.
Description
Keywords
Delirium Delirium in the Hospital
Setting Delirium Management Risk Factors for Delirium