FISIOPATOLOGIA E CONDUTA TERAPÊUTICA DO DELIRIUM: UMA REVISÃO BIBLIOGRÁFICA
DOI:
https://doi.org/10.47820/recima21.v5i6.5261Palavras-chave:
Delirium. Fisiopatologia. Terapêutica.Resumo
O delirium é uma condição neuropsiquiátrica aguda e multifacetada que se manifesta por uma perturbação da consciência e uma redução da capacidade cognitiva. Objetivo: Analisar os mecanismos fisiopatológicos e condutas terapêuticas do delirium, fornecendo uma síntese atualizada da literatura científica. Metodologia: Trata-se de uma revisão bibliográfica, utilizando artigos presentes nas seguintes bases de dados: PubMed, Scopus e SciELO Foram incluídos artigos originais e revisões sistemáticas em inglês e português publicadas entre 2009 e 2024, que abordam sobre mecanismos fisiopatológicos e condutas terapêuticas da epilepsia do tipo ausência. Após a análise, foram selecionados 36 artigos para a confecção dessa revisão bibliográfica. Resultados e Discussão: A fisiopatologia do delirium é complexa e multifacetada, envolvendo uma interação complexa entre fatores neuroquímicos, neuroinflamatórios, neuroendócrinos e estruturais. Embora sua etiologia exata ainda não seja completamente compreendida, várias teorias têm sido propostas para explicar os mecanismos subjacentes a essa síndrome neuropsiquiátrica. As abordagens terapêuticas do delirium são multifacetadas e envolvem uma combinação de intervenções não farmacológicas e farmacológicas, direcionadas para identificar e tratar os fatores precipitantes, fornecer suporte sintomático ao paciente e prevenir complicações associadas. Conclusão: A educação e treinamento contínuos de profissionais de saúde são essenciais para melhorar o reconhecimento precoce do delirium, facilitando intervenções oportunas e eficazes.
Downloads
Referências
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
Downloads
Publicado
Como Citar
Licença
Direitos de Autor (c) 2024 RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Os direitos autorais dos artigos/resenhas/TCCs publicados pertecem à revista RECIMA21, e seguem o padrão Creative Commons (CC BY 4.0), permitindo a cópia ou reprodução, desde que cite a fonte e respeite os direitos dos autores e contenham menção aos mesmos nos créditos. Toda e qualquer obra publicada na revista, seu conteúdo é de responsabilidade dos autores, cabendo a RECIMA21 apenas ser o veículo de divulgação, seguindo os padrões nacionais e internacionais de publicação.
