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      Delirium em CTI: ansiedade e depressão como possíveis fatores de risco na população idosa Translated title: Delirium in the ICU: anxiety and depression as possible risk factors in elderly patients

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          Abstract

          As doenças cardiovasculares, quando agravadas, podem requerer cuidados hospitalares específicos em Centro de Tratamento Intensivo (CTI). As características desta unidade podem potencializar o afastamento do paciente de sua subjetividade, aumentando a vulnerabilidade para desenvolvimento de delirium - uma das síndromes mais comuns no ambiente hospitalar, especialmente na população idosa. Frente a isso, foram avaliados 94 pacientes com idade igual ou superior a 60 anos, a fim de identificar se existe relação entre a ansiedade e depressão no momento da internação em CTI de um hospital cardiológico e o desenvolvimento de delirium nas 48 horas seguintes. Foram utilizadas a Escala Hospitalar de Ansiedade e Depressão (HADS) e a Confusional Assessment Method in Intensive Care Unit (CAM-ICU). Foi possível observar uma tendência de que pacientes com sintomas de ansiedade e, principalmente, de depressão têm maior probabilidade de desenvolver delirium. Entre os pacientes com depressão, 18.8% apresentaram delirium e, daqueles sem depressão, 4.2%. Em relação à ansiedade, 11.1% dos que apresentaram ansiedade tiveram também delirium, comparado a 4.1% entre aqueles sem ansiedade. Observa-se a importância de se identificar o impacto de sintomas psicológicos na evolução clínica do paciente, tendo em vista a associação de delirium a desfechos clínicos desfavoráveis.

          Translated abstract

          Cardiovascular diseases, when aggravated, may require special hospital care in Intensive Care Units (ICUs). The characteristics of this unit may potentialize the distancing of the patient from their subjectivity, increasing the vulnerability to the development of delirium - one of the most common syndromes at hospitals, especially in the elderly population. Considering that, 94 patients with ages equal or greater than 60 years old were evaluated with the aim of identifying whether there is a relation between anxiety and depression at the moment of admission into the ICU of a cardiovascular hospital and delirium in the following 48 hours. Both the Hospital Anxiety and Depression Scale (HADS) and the Confusional Assessment Method in Intensive Care Unit (CAM-ICU) were used for the evaluations. In the preliminary results, it was observed a trend that patients with symptoms of anxiety and, especially, depression have a higher probability of developing delirium. Amongst patients with depression, 18,8% presented with delirium, and between those without depression, 4,2%. As for anxiety, 11,1% of those with anxiety had delirium, compared to the 4,1% that did not have anxiety. It can be noted the impact of psychological symptoms on the clinical condition of the patient, considering the association between delirium and unfavorable outcomes.

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          Depression and postoperative complications: an overview

          Background The interaction of depression and anesthesia and surgery may result in significant increases in morbidity and mortality of patients. Major depressive disorder is a frequent complication of surgery, which may lead to further morbidity and mortality. Literature search Several electronic data bases, including PubMed, were searched pairing “depression” with surgery, postoperative complications, postoperative cognitive impairment, cognition disorder, intensive care unit, mild cognitive impairment and Alzheimer’s disease. Review of the literature The suppression of the immune system in depressive disorders may expose the patients to increased rates of postoperative infections and increased mortality from cancer. Depression is commonly associated with cognitive impairment, which may be exacerbated postoperatively. There is evidence that acute postoperative pain causes depression and depression lowers the threshold for pain. Depression is also a strong predictor and correlate of chronic post-surgical pain. Many studies have identified depression as an independent risk factor for development of postoperative delirium, which may be a cause for a long and incomplete recovery after surgery. Depression is also frequent in intensive care unit patients and is associated with a lower health-related quality of life and increased mortality. Depression and anxiety have been widely reported soon after coronary artery bypass surgery and remain evident one year after surgery. They may increase the likelihood for new coronary artery events, further hospitalizations and increased mortality. Morbidly obese patients who undergo bariatric surgery have an increased risk of depression. Postoperative depression may also be associated with less weight loss at one year and longer. The extent of preoperative depression in patients scheduled for lumbar discectomy is a predictor of functional outcome and patient’s dissatisfaction, especially after revision surgery. General postoperative mortality is increased. Conclusions Depression is a frequent cause of morbidity in surgery patients suffering from a wide range of conditions. Depression may be identified through the use of Patient Health Questionnaire-9 or similar instruments. Counseling interventions may be useful in ameliorating depression, but should be subject to clinical trials.
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            Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS Study.

            Delirium after cardiac surgery is a serious complication that results in higher morbidity and mortality rates, and prolongs hospitalisation. However, the knowledge base regarding the issue of postoperative delirium is still limited. Therefore, in the current study, we evaluated the incidence and independent perioperative risk factors of delirium after cardiac surgery. The IPDACS Study recruited 563 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass. The subjects were preoperatively examined by psychiatrists using the Mini-Mental State Examination and the Mini International Neuropsychiatric Interview to assess psychiatric comorbidity. Additionally, other variables connected to the patients' medical condition and surgical and anaesthetic procedures were evaluated. A diagnosis of delirium following surgical intervention was based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The incidence of postoperative delirium according to DSM-IV criteria was 16.3% (95% confidence interval: 13.5-19.6). Multivariate stepwise logistic regression analysis revealed that advanced age, preoperative cognitive impairment, an ongoing episode of major depression, anaemia, atrial fibrillation, prolonged intubation and postoperative hypoxia were independently associated with delirium after cardiac surgery. According to the current analysis, the aforementioned conditions independently predispose to delirium following cardiac surgery. Since some of these factors can be successfully treated and eliminated preoperatively and postoperatively, this study should be helpful in reducing the risk of delirium and in improving the medical care of patients undergoing cardiac surgery (Clinical Trials Identifier: NCT00784576). Copyright 2010 Elsevier Inc. All rights reserved.
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              A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients - a cohort study

              Background Delirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. However, in many other settings its prevalence and clinical consequences are understudied. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk or not at risk for delirium; (2) To compare these two groups according to defined indicators; and (3) To compare delirious with non-delirious patients regarding hospital mortality, ICU and hospital length of stay, nursing hours and cost per case. Methods This cohort study was performed in a Swiss university hospital following implementation of a delirium management guideline. After excluding patients aged < 18 years or with a length of stay (LOS) < 1 day, 29′278 patients hospitalized in the study hospital in 2014 were included. Delirium period prevalence was calculated based on a Delirium Observation Scale (DOS) score ≥ 3 and / or Intensive Care Delirium Screening Checklist (ICDSC) scores ≥4. Results Of 10′906 patients admitted, DOS / ICDSC scores indicated delirium in 28.4%. Delirium was most prevalent (36.2–40.5%) in cardiac surgery, neurosurgery, trauma, radiotherapy and neurology patients. It was also common in geriatrics, internal medicine, visceral surgery, reconstructive plastic surgery and cranio-maxillo-facial surgery patients (prevalence 21.6–28.6%). In the unadjusted and adjusted models, delirious patients had a significantly higher risk of inpatient mortality, stayed significantly longer in the ICU and hospital, needed significantly more nursing hours and generated significantly higher costs per case. For the seven most common ICD-10 diagnoses, each diagnostic group’s delirious patients had worse outcomes compared to those with no delirium. Conclusions The results indicate a high number of patients at risk for delirium, with high delirium prevalence across all patient groups. Delirious patients showed significantly worse clinical outcomes and generated higher costs. Subgroup analyses highlighted striking variations in delirium period-prevalence across patient groups. Due to the high prevalence of delirium in patients treated in care centers for radiotherapy, visceral surgery, reconstructive plastic surgery, cranio-maxillofacial surgery and oral surgery, it is recommended to expand the current focus of delirium management to these patient groups. Electronic supplementary material The online version of this article (10.1186/s12913-018-3345-x) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                cclin
                Contextos Clínicos
                Contextos Clínic
                UNISINOS - Universidade do Vale do Rio dos Sinos (São Leopoldo, RS, Brazil )
                1983-3482
                April 2021
                : 14
                : 1
                : 170-185
                Affiliations
                [1] orgnameInstituto de Cardiologia do RS orgdiv1Fundação Universitária de Cardiologia
                Article
                S1983-34822021000100009 S1983-3482(21)01400100009
                cf2240f3-b02b-4ecc-96e1-11d502e59f10

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 26 June 2020
                : 19 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 16
                Product

                SciELO Periódicos Eletrônicos em Psicologia

                Categories
                Editorial

                ansiedade,depressão,delírio,anxiety,depression,delirium
                ansiedade, depressão, delírio, anxiety, depression, delirium

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