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[PMID]:29444392
[Au] Autor:Momeni M; Gaudin A
[Ti] Título:Intraoperative cerebral hypoperfusion and electroencephalogram suppression resulting in neurological complications after cardiac surgery : the need for an in depth investigation.
[So] Source:Acta Anaesthesiol Belg;67(2):73-79, 2016.
[Is] ISSN:0001-5164
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:Reports on the demographic profile of older populations estimate that, in 2050, 19 countries will have at least 10% of their population aged 80 years or more. Many high risk elderly patients undergo cardiac surgery. In addition, advanced age has been shown to be a strong predictor of adverse neurological outcome. Despite sig- nificant improvements achieved in the perioperative care of cardiac surgical patients, neurological complications remain a global health issue. Recent findings have pointed out that cerebral hypoperfusion and too deep levels of anesthesia are major sources of adverse neurological outcomes. Cerebral near-in-frared spectroscopy provides information about cerebral perfusion non-invasively, and is increasingly used. Depth of anesthesia is evaluated using monitors that are based on processed electroencephalogram. This non-systematic review focuses on the results of studies performed with each monitor separately, and the need for a combined evaluation of their utility and eventual impact on neurological outcomes. The use of a combined cerebral monitoring strategy based on the two aforementioned monitors is proposed in order to optimize cerebral outcomes.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Cardíacos/efeitos adversos
Transtornos Cerebrovasculares/etiologia
Eletroencefalografia
Monitorização Intraoperatória
Complicações Pós-Operatórias/etiologia
[Mh] Termos MeSH secundário: Disfunção Cognitiva/etiologia
Delírio/etiologia
Seres Humanos
Espectroscopia de Luz Próxima ao Infravermelho
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE


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[PMID]:28452902
[Au] Autor:Fan KY; Liu HC
[Ad] Endereço:*Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital; and †Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan.
[Ti] Título:Delirium Associated With Fluoxetine Discontinuation: A Case Report.
[So] Source:Clin Neuropharmacol;40(3):152-153, 2017 May/Jun.
[Is] ISSN:1537-162X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Withdrawal symptoms on selective serotonin reuptake inhibitor (SSRI) discontinuation have raised clinical attention increasingly. However, delirium is rarely reported in the SSRI discontinuation syndrome. CASE: We report a case of delirium developing after fluoxetine discontinuation in a 65-year-old female patient with major depressive disorder. She experienced psychotic depression with limited response to treatment of fluoxetine 40 mg/d and quetiapine 100 mg/d for 3 months. After admission, we tapered fluoxetine gradually in 5 days because of its limited effect. However, delirious pictures developed 2 days after we stopped fluoxetine. Three days later, we added back fluoxetine 10 mg/d. Her delirious features gradually improved, and the clinical presentation turned into previous psychotic depression state. We gradually increased the medication to fluoxetine 60 mg/d and olanzapine 20 mg/d in the following 3 weeks. Her psychotic symptoms decreased, and there has been no delirious picture noted thereafter. CONCLUSIONS: Delirium associated with fluoxetine discontinuation is a much rarer complication in SSRI discontinuation syndrome. The symptoms of SSRI discontinuation syndrome may be attributable to a rapid decrease in serotonin availability. In general, the shorter the half-life of any medication, the greater the likelihood patients will experience discontinuation symptoms. Genetic vulnerability might be a potential factor to explain that SSRI discontinuation syndrome also occurred rapidly in people taking long-half-life fluoxetine. The genetic polymorphisms of both pharmacokinetic and pharmacodynamic pathways might be potentially associated with SSRI discontinuation syndrome.
[Mh] Termos MeSH primário: Antidepressivos de Segunda Geração/efeitos adversos
Delírio/etiologia
Fluoxetina/efeitos adversos
Inibidores da Captação de Serotonina/efeitos adversos
Síndrome de Abstinência a Substâncias/etiologia
[Mh] Termos MeSH secundário: Idoso
Antipsicóticos/uso terapêutico
Benzodiazepinas/uso terapêutico
Delírio/prevenção & controle
Transtorno Depressivo Maior/tratamento farmacológico
Monitoramento de Medicamentos
Resistência a Múltiplos Medicamentos
Quimioterapia Combinada
Feminino
Fluoxetina/uso terapêutico
Seres Humanos
Inibidores da Captação de Serotonina/uso terapêutico
Síndrome de Abstinência a Substâncias/fisiopatologia
Síndrome de Abstinência a Substâncias/prevenção & controle
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antidepressive Agents, Second-Generation); 0 (Antipsychotic Agents); 0 (Serotonin Uptake Inhibitors); 01K63SUP8D (Fluoxetine); 12794-10-4 (Benzodiazepines); N7U69T4SZR (olanzapine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1097/WNF.0000000000000214


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[PMID]:29406640
[Au] Autor:Porter S; Holly C; Echevarria M
[Ti] Título:Infants with Delirium: A Primer on Prevention, Recognition, and Management.
[So] Source:Pediatr Nurs;42(5):223-9, 2016 Sep-Oct.
[Is] ISSN:0097-9805
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Delirium is a serious neuropsychiatric condition that emerges acutely in all age groups, including infants, children, and adolescents. Delirium serves as an urgent signal of distress that a young child's brain is in trouble. Prevention, recognition, and management of infants with delirium is often especially challenging due to their pre-verbal status and still immature cognitive development. This article presents an overview of delirium in infants, offers details regarding the presentation of delirium in infants, discusses the challenges to screening and identification of infants with delirium, and provides evidence-based suggestions for pediatric nurses to optimize nursing care for infants at risk for or exhibiting delirium.
[Mh] Termos MeSH primário: Delírio/diagnóstico
Delírio/enfermagem
Enfermagem Pediátrica/educação
Enfermagem Pediátrica/normas
Guias de Prática Clínica como Assunto
[Mh] Termos MeSH secundário: Delírio/prevenção & controle
Educação Continuada em Enfermagem
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:180207
[St] Status:MEDLINE


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[PMID]:28459497
[Au] Autor:Smith JM; Van Aman MN; Schneiderhahn ME; Edelman R; Ercole PM
[Ti] Título:Assessment of Delirium in Intensive Care Unit Patients: Educational Strategies.
[So] Source:J Contin Educ Nurs;48(5):239-244, 2017 May 01.
[Is] ISSN:1938-2472
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Delirium is an acute brain dysfunction associated with poor outcomes in intensive care unit (ICU) patients. Critical care nurses play an important role in the prevention, detection, and management of delirium, but they must be able to accurately assess for it. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument is a reliable and valid method to assess for delirium, but research reveals most nurses need practice to use it proficiently. METHOD: A pretest-posttest design was used to evaluate the success of a multimodal educational strategy (i.e., online learning module coupled with standardized patient simulation experience) on critical care nurses' knowledge and confidence to assess and manage delirium using the CAM-ICU. RESULTS: Participants (N = 34) showed a significant increase (p < .001) in confidence in their ability to assess and manage delirium following the multimodal education. No statistical change in knowledge of delirium existed following the education. CONCLUSION: A multimodal educational strategy, which included simulation, significantly added confidence in critical care nurses' performance using the CAM-ICU. J Contin Nurs Educ. 2017;48(5):239-244.
[Mh] Termos MeSH primário: Competência Clínica
Enfermagem de Cuidados Críticos/educação
Delírio/diagnóstico
Delírio/enfermagem
Educação Continuada em Enfermagem/organização & administração
Avaliação Educacional/métodos
Recursos Humanos de Enfermagem no Hospital/educação
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Cuidados Críticos/métodos
Feminino
Seres Humanos
Unidades de Terapia Intensiva/organização & administração
Masculino
Meia-Idade
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.3928/00220124-20170418-09


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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
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[PMID]:29466591
[Au] Autor:van den Boogaard M; Slooter AJC; Brüggemann RJM; Schoonhoven L; Beishuizen A; Vermeijden JW; Pretorius D; de Koning J; Simons KS; Dennesen PJW; Van der Voort PHJ; Houterman S; van der Hoeven JG; Pickkers P; REDUCE Study Investigators
[Ad] Endereço:Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
[Ti] Título:Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial.
[So] Source:JAMA;319(7):680-690, 2018 02 20.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Results of studies on use of prophylactic haloperidol in critically ill adults are inconclusive, especially in patients at high risk of delirium. Objective: To determine whether prophylactic use of haloperidol improves survival among critically ill adults at high risk of delirium, which was defined as an anticipated intensive care unit (ICU) stay of at least 2 days. Design, Setting, and Participants: Randomized, double-blind, placebo-controlled investigator-driven study involving 1789 critically ill adults treated at 21 ICUs, at which nonpharmacological interventions for delirium prevention are routinely used in the Netherlands. Patients without delirium whose expected ICU stay was at least a day were included. Recruitment was from July 2013 to December 2016 and follow-up was conducted at 90 days with the final follow-up on March 1, 2017. Interventions: Patients received prophylactic treatment 3 times daily intravenously either 1 mg (n = 350) or 2 mg (n = 732) of haloperidol or placebo (n = 707), consisting of 0.9% sodium chloride. Main Outcome and Measures: The primary outcome was the number of days that patients survived in 28 days. There were 15 secondary outcomes, including delirium incidence, 28-day delirium-free and coma-free days, duration of mechanical ventilation, and ICU and hospital length of stay. Results: All 1789 randomized patients (mean, age 66.6 years [SD, 12.6]; 1099 men [61.4%]) completed the study. The 1-mg haloperidol group was prematurely stopped because of futility. There was no difference in the median days patients survived in 28 days, 28 days in the 2-mg haloperidol group vs 28 days in the placebo group, for a difference of 0 days (95% CI, 0-0; P = .93) and a hazard ratio of 1.003 (95% CI, 0.78-1.30, P=.82). All of the 15 secondary outcomes were not statistically different. These included delirium incidence (mean difference, 1.5%, 95% CI, -3.6% to 6.7%), delirium-free and coma-free days (mean difference, 0 days, 95% CI, 0-0 days), and duration of mechanical ventilation, ICU, and hospital length of stay (mean difference, 0 days, 95% CI, 0-0 days for all 3 measures). The number of reported adverse effects did not differ between groups (2 [0.3%] for the 2-mg haloperidol group vs 1 [0.1%] for the placebo group). Conclusions and Relevance: Among critically ill adults at high risk of delirium, the use of prophylactic haloperidol compared with placebo did not improve survival at 28 days. These findings do not support the use of prophylactic haloperidol for reducing mortality in critically ill adults. Trial Registration: clinicaltrials.gov Identifier: NCT01785290.
[Mh] Termos MeSH primário: Antipsicóticos/administração & dosagem
Estado Terminal/mortalidade
Delírio/prevenção & controle
Haloperidol/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Antipsicóticos/efeitos adversos
Relação Dose-Resposta a Droga
Método Duplo-Cego
Feminino
Haloperidol/efeitos adversos
Seres Humanos
Unidades de Terapia Intensiva
Masculino
Meia-Idade
Modelos de Riscos Proporcionais
Fatores de Risco
Análise de Sobrevida
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antipsychotic Agents); J6292F8L3D (Haloperidol)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2018.0160


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[PMID]:29465603
[Au] Autor:Yu H; Shen X
[Ad] Endereço:Department of Otorhinolaryngology.
[Ti] Título:Postoperative delirium after partial laryngectomy in a middle-aged patient: A case report.
[So] Source:Medicine (Baltimore);97(8):e9988, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONAL: Postoperative delirium is a common occurrence in older patients. However, reports of postoperative delirium in middle-aged patients are limited, and the underlying mechanism of delirium in this patient population is not clear. PATIENT CONCERNS: A 45-year-old man who developed postoperative delirium on the second day after partial laryngectomy. Interviews of the surgical team, patient, and patient's spouse revealed that the patient was psychologically stressed, but had not been diagnosed or treated. The patient also suffered impairment in physiological functioning and sleep disturbance after surgery. DIAGNOSIS: Postoperative delirium. INTERVENTIONS: The postoperative delirium was treated with an antipsychotic drug. OUTCOMES: The patient recovered well. LESSONS: Preoperative psychological stress, which is often undiagnosed and untreated, can increase the risk of postoperative delirium in middle-aged patients undergoing laryngectomy. Therefore, screening for psychological stress and implementing strategies to prevent delirium should be considered for patients who undergo laryngectomy, even if they are not in high-risk older age groups.
[Mh] Termos MeSH primário: Delírio/etiologia
Laringectomia/efeitos adversos
Complicações Pós-Operatórias
[Mh] Termos MeSH secundário: Antipsicóticos/uso terapêutico
Delírio/tratamento farmacológico
Seres Humanos
Laringectomia/métodos
Masculino
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antipsychotic Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009988


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[PMID]:29194309
[Au] Autor:Davis KD; Nye C
[Ad] Endereço:About the Authors Kimberly D. Davis, MS, RN, CNE, is a clinical instructor, School of Nursing, Family and Community Health Nursing, Virginia Commonwealth University, Richmond. Carla Nye, DNP, CPNP-BC, CNE, CHSE, is a clinical associate professor, School of Nursing, and director, Clinical Learning Center, Virginia Commonwealth University, Richmond. For more information, contact Ms. Davis at daviskd5@vcu.edu.The author declares no conflict of interest.
[Ti] Título:Care of the Older Adult With Postoperative Delirium: An Interprofessional Simulation for Undergraduate Nursing Students.
[So] Source:Nurs Educ Perspect;38(2):103-105, 2017 Mar/Apr.
[Is] ISSN:1536-5026
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Because of the expanding older adult population, undergraduate nursing students need to be introduced to the unique challenges of taking care of older adults. Using simulation to demonstrate some of these challenges allows these entry-level students to learn in a nonthreatening environment. By focusing on an older adult patient who is experiencing postoperative delirium in a simulation, students can practice not only how to complete a safety assessment but also effective communication skills with the patient, family, and members of the interprofessional health care team.
[Mh] Termos MeSH primário: Delírio/enfermagem
Bacharelado em Enfermagem/métodos
Enfermagem Geriátrica/educação
Simulação de Paciente
[Mh] Termos MeSH secundário: Currículo
Avaliação Educacional
Seres Humanos
Avaliação de Programas e Projetos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1097/01.NEP.0000000000000105


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[PMID]:29385235
[Au] Autor:Eamer G; Taheri A; Chen SS; Daviduck Q; Chambers T; Shi X; Khadaroo RG
[Ad] Endereço:Department of Surgery, University of Alberta, Edmonton, Canada.
[Ti] Título:Comprehensive geriatric assessment for older people admitted to a surgical service.
[So] Source:Cochrane Database Syst Rev;1:CD012485, 2018 Jan 31.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Aging populations are at increased risk of postoperative complications. New methods to provide care for older people recovering from surgery may reduce surgery-related complications. Comprehensive geriatric assessment (CGA) has been shown to improve some outcomes for medical patients, such as enabling them to continue living at home, and has been proposed to have positive impacts for surgical patients. CGA is a coordinated, multidisciplinary collaboration that assesses the medical, psychosocial and functional capabilities and limitations of an older person, with the goal of establishing a treatment plan and long-term follow-up. OBJECTIVES: To assess the effectiveness of CGA interventions compared to standard care on the postoperative outcomes of older people admitted to hospital for surgical care. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two clinical trials registers on 13 January 2017. We also searched grey literature for additional citations. SELECTION CRITERIA: Randomized trials of people undergoing surgery aged 65 years and over comparing CGA with usual surgical care and reporting any of our primary (mortality and discharge to an increased level of care) or secondary (length of stay, re-admission, total cost and postoperative complication) outcomes. We excluded studies if the participants did not receive a complete CGA, did not undergo surgery, and if the study recruited participants aged less than 65 years or from a setting other than an acute care hospital. DATA COLLECTION AND ANALYSIS: Two review authors independently screened, assessed risk of bias, extracted data and assessed certainty of evidence from identified articles. We expressed dichotomous treatment effects as risk ratio (RR) with 95% confidence intervals and continuous outcomes as mean difference (MD). MAIN RESULTS: We included eight randomised trials, seven recruited people recovering from a hip fracture (N = 1583) and one elective surgical oncology trial (N = 260), conducted in North America and Europe. For two trials CGA was done pre-operatively and postoperatively for the remaining. Six trials had adequate randomization, five had low risk of performance bias and four had low risk of detection bias. Blinding of participants was not possible. All eight trials had low attrition rates and seven reported all expected outcomes.CGA probably reduces mortality in older people with hip fracture (RR 0.85, 95% CI 0.68 to 1.05; 5 trials, 1316 participants, I² = 0%; moderate-certainty evidence). The intervention reduces discharge to an increased level of care (RR 0.71, 95% CI 0.55 to 0.92; 5 trials, 941 participants, I² = 0%; high-certainty evidence).Length of stay was highly heterogeneous, with mean difference between participants allocated to the intervention and the control groups ranging between -12.8 and 8.3 days. CGA probably leads to slightly reduced length of stay (4 trials, 841 participants, moderate-certainty evidence). The intervention probably makes little or no difference in re-admission rates (RR 1.00, 95% CI 0.76 to 1.32; 3 trials, 741 participants, I² = 37%; moderate-certainty evidence).CGA probably slightly reduces total cost (1 trial, 397 participants, moderate-certainty evidence). The intervention may make little or no difference for major postoperative complications (2 trials, 579 participants, low-certainty evidence) and delirium rates (RR 0.75, 95% CI 0.60 to 0.94, 3 trials, 705 participants, I² = 0%; low-certainty evidence). AUTHORS' CONCLUSIONS: There is evidence that CGA can improve outcomes in people with hip fracture. There are not enough studies to determine when CGA is most effective in relation to surgical intervention or if CGA is effective in surgical patients presenting with conditions other than hip fracture.
[Mh] Termos MeSH primário: Avaliação Geriátrica
Fraturas do Quadril/cirurgia
Tempo de Internação
Neoplasias/cirurgia
[Mh] Termos MeSH secundário: Idoso
Delírio/epidemiologia
Procedimentos Cirúrgicos Eletivos/mortalidade
Fraturas do Quadril/mortalidade
Seres Humanos
Neoplasias/mortalidade
Readmissão do Paciente/estatística & dados numéricos
Complicações Pós-Operatórias/epidemiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012485.pub2


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[PMID]:29466573
[Au] Autor:Delaney A; Hammond N; Litton E
[Ad] Endereço:Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
[Ti] Título:Preventing Delirium in the Intensive Care Unit.
[So] Source:JAMA;319(7):659-660, 2018 02 20.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Delírio/prevenção & controle
Unidades de Terapia Intensiva
[Mh] Termos MeSH secundário: Cuidados Críticos
Seres Humanos
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2018.0159


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[PMID]:29381733
[Au] Autor:Avelino-Silva TJ; Campora F; Curiati JAE; Jacob-Filho W
[Ad] Endereço:Division of Geriatrics, Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
[Ti] Título:Prognostic effects of delirium motor subtypes in hospitalized older adults: A prospective cohort study.
[So] Source:PLoS One;13(1):e0191092, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To investigate the association between delirium motor subtypes and hospital mortality and 12-month mortality in hospitalized older adults. DESIGN: Prospective cohort study conducted from 2009 to 2015. SETTING: Geriatric ward of a university hospital in Sao Paulo, Brazil. PARTICIPANTS: We included 1,409 consecutive admissions of acutely ill patients aged 60 years and over. We excluded admissions for end-of-life care, with missing data on the main variables, length of stay shorter than 48 hours, or when consent to participate was not given. MAIN OUTCOMES AND MEASURES: Delirium was detected using the Confusion Assessment Method and categorized in hypoactive, hyperactive, or mixed delirium. Primary outcomes were time to death in the hospital, and time to death in 12 months (for the discharged sample). Comprehensive geriatric assessment was performed at admission and included socio-demographic, clinical, functional, cognitive, and laboratory variables. Further clinical data were documented upon death or discharge. Multivariate analyses used Cox proportional hazards models adjusted for possible confounders. RESULTS: We included 1,409 admissions, with a mean age of 80 years. The proportion of in-hospital deaths was 19%, with a cumulative mortality of 38% in 12 months. Delirium occurred in 47% of the admissions. Hypoactive delirium was the predominant motor subtype (53%), followed by mixed delirium (30%) and hyperactive delirium (17%). Hospital mortality rates were respectively 33%, 34% and 15%. We verified that hypoactive and mixed delirium were independently associated with hospital mortality, with respective hazard ratios of 2.43 (95%CI = 1.64-3.59) and 2.31 (95%CI = 1.53-3.50). Delirium motor subtypes were not independently predictive of 12-month mortality. CONCLUSIONS: One in three acutely ill hospitalized older adults who suffered hypoactive or mixed delirium died in the hospital. Clinicians should be aware that hypoactive symptoms of delirium, whether shown exclusively or in alternation with hyperactive symptoms, are indicative of a worse prognosis in this population.
[Mh] Termos MeSH primário: Delírio/fisiopatologia
Hospitalização
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Brasil
Feminino
Seres Humanos
Masculino
Prognóstico
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180131
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191092



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