FISIOPATOLOGÍA Y MANEJO TERAPÉUTICO DEL DELIRIO: UNA REVISIÓN BIBLIOGRÁFICA
DOI:
https://doi.org/10.47820/recima21.v5i6.5261Palabras clave:
Delirio. Fisiopatología. Terapéutica.Resumen
El delirio es una condición neuropsiquiátrica aguda y multifacética que se manifiesta como una alteración de la conciencia y una reducción de la capacidad cognitiva. Objetivo: Analizar los mecanismos fisiopatológicos y abordajes terapéuticos del delirio, proporcionando una síntesis actualizada de la literatura científica. Metodología: Se trata de una revisión bibliográfica, utilizando artículos de las siguientes bases de datos: PubMed, Scopus y SciELO Se incluyeron artículos originales y revisiones sistemáticas en inglés y portugués publicados entre 2009 y 2024, que abarcan los mecanismos fisiopatológicos y los enfoques terapéuticos de la epilepsia de ausencia. Tras el análisis, se seleccionaron 36 artículos para esta revisión bibliográfica. Resultados y discusión: La fisiopatología del delirio es compleja y multifacética, e implica una interacción compleja entre factores neuroquímicos, neuroinflamatorios, neuroendocrinos y estructurales. Aunque aún no se comprende completamente su etiología exacta, se han propuesto varias teorías para explicar los mecanismos subyacentes a este síndrome neuropsiquiátrico. Los enfoques terapéuticos del delirio son multifacéticos e implican una combinación de intervenciones farmacológicas y no farmacológicas, destinadas a identificar y tratar los factores precipitantes, brindar apoyo sintomático al paciente y prevenir las complicaciones asociadas. Conclusión: La educación y capacitación continua de los profesionales de la salud es esencial para mejorar el reconocimiento temprano del delirio, facilitando intervenciones oportunas y efectivas.
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ALAM, Azeem et al. Surgery, neuroinflammation and cognitive impairment. EBio Medicine, v. 37, p. 547-556, 2018. DOI: https://doi.org/10.1016/j.ebiom.2018.10.021
BARON, Ralf et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015)–short version. GMS German Medical Science, v. 13, 2015.
BARR, Juliana et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical care medicine, v. 41, n. 1, p. 263-306, 2013. DOI: https://doi.org/10.1097/CCM.0b013e3182a167d7
DEVINNEY, Michael J. et al. Role of Blood–Brain Barrier Dysfunction in Delirium following Non‐cardiac Surgery in Older Adults. Annals of neurology, v. 94, n. 6, p. 1024-1035, 2023. DOI: https://doi.org/10.1002/ana.26771
FONG, Tamara G. et al. The interface between delirium and dementia in elderly adults. The Lancet Neurology, v. 14, n. 8, p. 823-832, 2015. DOI: https://doi.org/10.1016/S1474-4422(15)00101-5
FONG, Tamara G.; INOUYE, Sharon K. The inter-relationship between delirium and dementia: the importance of delirium prevention. Nature Reviews Neurology, v. 18, n. 10, p. 579-596, 2022. DOI: https://doi.org/10.1038/s41582-022-00698-7
FONG, Tamara G.; TULEBAEV, Samir R.; INOUYE, Sharon K. Delirium in elderly adults: diagnosis, prevention and treatment. Nature Reviews Neurology, v. 5, n. 4, p. 210-220, 2009. DOI: https://doi.org/10.1038/nrneurol.2009.24
HSHIEH, Tammy T.; INOUYE, Sharon K.; OH, Esther S. Delirium in the elderly. Clinics in geriatric medicine, v. 36, n. 2, p. 183-199, 2020. DOI: https://doi.org/10.1016/j.cger.2019.11.001
IGLSEDER, Bernhard; FRÜHWALD, Thomas; JAGSCH, Christian. Delirium in geriatric patients. Wiener Medizinische Wochenschrift, v. 172, n. 5, p. 114-121, 2022. DOI: https://doi.org/10.1007/s10354-021-00904-z
IVANISENKO, V. A. et al. Gene networks for use in metabolomic data analysis of blood plasma from patients with postoperative delirium. Vavilov Journal of Genetics and Breeding, v. 27, n. 7, p. 768, 2023. DOI: https://doi.org/10.18699/VJGB-23-89
JANSSEN, T. L. et al. Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis. Clinical interventions in aging, p. 1095-1117, 2019. DOI: https://doi.org/10.2147/CIA.S201323
JIN, Zhaosheng; HU, Jie; MA, Daqing. Postoperative delirium: perioperative assessment, risk reduction, and management. British journal of anaesthesia, v. 125, n. 4, p. 492-504, 2020. DOI: https://doi.org/10.1016/j.bja.2020.06.063
KAPPENSCHNEIDER, Tobias et al. Delirium-an interdisciplinary challenge. Der Orthopade, v. 51, n. 2, p. 106-115, 2022. DOI: https://doi.org/10.1007/s00132-021-04209-2
KAŹMIERSKI, Jakub et al. Oxidative stress and soluble receptor for advanced glycation end-products play a role in the pathophysiology of delirium after cardiac surgery. Scientific reports, v. 11, n. 1, p. 23646, 2021. DOI: https://doi.org/10.1038/s41598-021-03007-2
KOTEKAR, Nalini; SHENKAR, Anshul; NAGARAJ, Ravishankar. Postoperative cognitive dysfunction–current preventive strategies. Clinical interventions in aging, p. 2267-2273, 2018. DOI: https://doi.org/10.2147/CIA.S133896
LAURETANI, Fulvio et al. Treatment of delirium in older persons: what we should not do!. International journal of molecular sciences, v. 21, n. 7, p. 2397, 2020. DOI: https://doi.org/10.3390/ijms21072397
LEE, Yoonyoung et al. Non-pharmacological nursing interventions for prevention and treatment of delirium in hospitalized adult patients: systematic review of randomized controlled trials. International Journal of Environmental Research and Public Health, v. 18, n. 16, p. 8853, 2021. DOI: https://doi.org/10.3390/ijerph18168853
MALDONADO, José R. Acute brain failure: pathophysiology, diagnosis, management, and sequelae of delirium. Critical care clinics, v. 33, n. 3, p. 461-519, 2017. DOI: https://doi.org/10.1016/j.ccc.2017.03.013
MALDONADO, José R. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. The American Journal of Geriatric Psychiatry, v. 21, n. 12, p. 1190-1222, 2013. DOI: https://doi.org/10.1016/j.jagp.2013.09.005
MATTISON, Melissa LP. Delirium. Annals of internal medicine, v. 173, n. 7, p. ITC49-ITC64, 2020. DOI: https://doi.org/10.7326/AITC202010060
ORMSETH, Cora H. et al. Predisposing and precipitating factors associated with delirium: a systematic review. JAMA Network Open, v. 6, n. 1, p. e2249950-e2249950, 2023. DOI: https://doi.org/10.1001/jamanetworkopen.2022.49950
PANG, Yi et al. Effects of inflammation and oxidative stress on postoperative delirium in cardiac surgery. Frontiers in Cardiovascular Medicine, v. 9, p. 1049600, 2022. DOI: https://doi.org/10.3389/fcvm.2022.1049600
PAYNE, Lauren E. et al. Cefepime-induced neurotoxicity: a systematic review. Critical care, v. 21, p. 1-8, 2017. DOI: https://doi.org/10.1186/s13054-017-1856-1
PRENDERGAST, Niall T.; TIBERIO, Perry J.; GIRARD, Timothy D. Treatment of delirium during critical illness. Annual review of medicine, v. 73, p. 407-421, 2022. DOI: https://doi.org/10.1146/annurev-med-042220-013015
RENNER, Caroline et al. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Critical Care, v. 27, n. 1, p. 301, 2023. DOI: https://doi.org/10.1186/s13054-023-04569-5
RUMP, Katharina; ADAMZIK, Michael. Epigenetic mechanisms of postoperative cognitive impairment induced by anesthesia and neuroinflammation. Cells, v. 11, n. 19, p. 2954, 2022. DOI: https://doi.org/10.3390/cells11192954
SKROBIK, Yoanna. Delirium prevention and treatment. Anesthesiology clinics, v. 29, n. 4, p. 721-727, 2011. DOI: https://doi.org/10.1016/j.anclin.2011.09.010
SMITH, Heidi A. B. et al. 2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatric Critical Care Medicine, v. 23, n. 2, p. e74-e110, 2022. DOI: https://doi.org/10.1097/PCC.0000000000002873
STOLLINGS, Joanna L. et al. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive care medicine, v. 47, n. 10, p. 1089-1103, 2021. DOI: https://doi.org/10.1007/s00134-021-06503-1
TAUBER, Simone C. et al. Sepsis-associated encephalopathy and septic encephalitis: an update. Expert review of anti-infective therapy, v. 19, n. 2, p. 215-231, 2021. DOI: https://doi.org/10.1080/14787210.2020.1812384
TAYLOR, Jennifer et al. Postoperative delirium and changes in the blood–brain barrier, neuroinflammation, and cerebrospinal fluid lactate: a prospective cohort study. British Journal of Anaesthesia, v. 129, n. 2, p. 219-230, 2022. DOI: https://doi.org/10.1016/j.bja.2022.01.005
WANG, Ping et al. Neurovascular and immune mechanisms that regulate postoperative delirium superimposed on dementia. Alzheimer's & Dementia, v. 16, n. 5, p. 734-749, 2020. DOI: https://doi.org/10.1002/alz.12064
WANG, Yiru; SHEN, Xia. Postoperative delirium in the elderly: the potential neuropathogenesis. Aging Clinical and Experimental Research, v. 30, p. 1287-1295, 2018. DOI: https://doi.org/10.1007/s40520-018-1008-8
WILSON, Jo Ellen et al. Delirium. Nature Reviews Disease Primers, v. 6, n. 1, p. 90, 2020. DOI: https://doi.org/10.1038/s41572-020-00223-4
YANG, Jian-Bing; WANG, Long-Fei; CAO, Yun-Fei. Advances in the prevention and treatment of postoperative delirium by acupuncture: A review. Medicine, v. 102, n. 14, p. e33473, 2023. DOI: https://doi.org/10.1097/MD.0000000000033473
YOUNG, James W. S. The network model of delirium. Medical hypotheses, v. 104, p. 80-85, 2017. DOI: https://doi.org/10.1016/j.mehy.2017.05.027
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