Delirium numa enfermaria de Medicina Interna - impacto na prática clínica
DOI:
https://doi.org/10.11606/issn.1679-9836.v99i4p357-365Palavras-chave:
Delírio, Medicina interna, Idoso, MortalidadeResumo
Introdução: O delirium é frequente nos doentes idosos internados. Define-se como uma alteração aguda e flutuante ao nível da cognição, atenção e consciência, geralmente reversível e de etiologia multifactorial, com aumento da morbimortalidade e dos custos, mas que permanece sub-diagnosticada. Neste sentido, avaliou-se a ocorrência de delirium numa enfermaria de Medicina Interna, os principais factores de risco e o impacto no episódio de internamento e após 3 meses. Materiais e Métodos: estudo prospectivo observacional de 3 meses num serviço de um hospital terciário, com aplicação da escala de sedação e agitação de Richmond adaptada e do Método de Avaliação da Confusão para o rastreio e diagnóstico de delirium, confirmadas pelos critérios do Diagnostic and Statistical Manual of Mental Disorders, 5ª edição. Avaliaram-se os principais factores de risco, segundo as guidelines, e o impacto no internamento e sobrevida aos 3 meses. Resultados/Discussão: Numa amostra de 297 doentes, a ocorrência de delirium foi de 26%, na sua maioria à admissão (73%) e na forma hiperactiva (50%). Estes doentes eram mais idosos, com mais comorbilidades, nomeadamente demência, e menos autonomia. Identificou-se a contenção física, a limitação da autonomia e as alterações do potássio como factores independentes para a ocorrência de delirium. Este associou-se a maior mortalidade no internamento e aos 3 meses, com maior sobrecarga dos profissionais de saúde. A aplicação das escalas permitiu um maior reconhecimento desta patologia (12% para 26%), nomeadamente as formas hipoactivas. Conclusão: O delirium foi frequente e com elevado impacto nos doentes e profissionais de saúde.
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