Delirium em idosos na unidade de terapia intensiva e associação com contenção mecânica

Luiz Fernando de Andrade Silva; Inácia Sátiro Xavier de França; Angélica de Godoy Torres Lima; Hugo Moura de Albuquerque Melo; Fábia Maria de Lima

doi:10.5294/aqui.2025.25.2.6

Authors

Luiz Fernando de Andrade Silva Author University of Pernambuco https://orcid.org/0000-0002-2564-3120
Inácia Sátiro Xavier de França Author State University of Paraíba https://orcid.org/0000-0002-2695-510X
Angélica de Godoy Torres Lima Author University of Pernambuco https://orcid.org/0000-0002-7432-0109
Hugo Moura de Albuquerque Melo Author Federal University of Pernambuco https://orcid.org/0000-0001-8072-337X
Fábia Maria de Lima Author University of Pernambuco https://orcid.org/0000-0001-9992-6556

DOI:

https://doi.org/10.5294/aqui.2025.25.2.6

Keywords:

Delirium, physical restraint, cross-sectional study, aged, intensive care unit

Abstract

Introduction: Advanced age is one of the most prevalent predisposing factors in cases of delirium, particularly in older patients hospitalized in intensive care units. Due to population aging and demographic transition, this study presents a specific sample analysis of a population subgroup. Objectives: To determine the prevalence of delirium in older patients hospitalized in the intensive care unit and to verify correlations with clinical and sociodemographic predictor variables. Materials and Methods: This is a cross-sectional study conducted in the countryside of the state of Pernambuco, Brazil, between July and November 2023. Older people aged 60 years or older (according to Brazilian law) and hospitalized for at least 24 hours were included. The Richmond Agitation-
Sedation Scale (RASS) was used to screen sedation levels, and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to assess delirium. Results: The sample consisted of 83 older patients hospitalized in the intensive care unit. The prevalence rate of delirium was 36.1 %, with a strong association with the predictor “use of mechanical restraint in bed”. Multivariate analysis showed that the use of mechanical restraint in bed increases the odds of delirium in older people by 21.5 times (OR = 21.542; 95 % CI: 6.663-69.641). Conclusions: Reducing the use of mechanical restraint, adequately monitoring sedation, and preventing delirium are essential strategies for reducing healthcare costs and providing a more humane experience for patients and their families.

Downloads

Download data is not yet available.

References

Han JH, Suyama J. Delirium and Dementia. Clinics in Geriatric Medicine. 2018;34(3):327-54. DOI: https://doi.org/10.1016/j.cger.2018.05.001

Ramírez Echeverría M de L, Schoo C, Paul M. Delirium [Internet]. StatPearls Publishing; 2022. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK470399/

Marcantonio ER. Delirium in hospitalized older adults. New England Journal of Medicine. 2017;377(15):1456-66. DOI: https://doi.org/10.1056/NEJMcp1605501

Bastos AS, Beccaria LM, Silva DC da, Barbosa TP. Prevalence of delirium in intensive care patients and association with sedoanalgesia, severity and mortality. Rev Gaúcha Enferm [Internet]. 2020;41:e20190068. DOI: https://doi.org/10.1590/1983-1447.2020.20190068

Li X, Zhang L, Gong F, Ai Y. Incidence and Risk Factors for Delirium in Older Patients Following Intensive Care Unit Admission: A Prospective Observational Study. J Nurs Res. 2020;28(4):e101. DOI: https://doi.org/10.1097/jnr.0000000000000384

Souza RC da S, Bersaneti MDR, Siqueira EMP, Meira L, Brumatti DL, Prado NR de O. Capacitação de enfermeiros na utilização de um instrumento de avaliação de delirium. Rev Gaúcha Enferm [Internet]. 2017;38(1):e64484. DOI: https://doi.org/10.1590/1983-1447.2017.01.64484

Krewulak KD, Rosgen BK, Ely EW, Stelfox HT, Fiest KM. The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients. PLoS One. 2020;15(11):e0242378. DOI: https://doi.org/10.1371/journal.pone.0242378

Carvalho JPLM, Almeida ARP de, Gusmao-Flores D. Escalas de avaliação de delirium em pacientes graves: revisão sistemática da literatura. Rev bras ter intensiva [Internet]. 2013;25(2):148-54. DOI: https://doi.org/10.5935/0103-507X.20130026

Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, Slooter AJC, Ely EW. Delirium. Nat Rev Dis Primers. 2020;6(1):90. DOI: https://doi.org/10.1038/s41572-020-00223-4

Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-22. DOI: https://doi.org/10.1016/S0140-6736(13)60688-1

Kotfis K, Diem-Zaal IV, Roberson SW, Sietnicki M, Boogaard MVD, Shehabi Y, et al. The future of intensive care: delirium should no longer be an issue. Crit Care. 2022;26(1):285. DOI: https://doi.org/10.1186/s13054-022-04128-4

Suliman M, Aloush S, Al-Awamreh K. Knowledge, attitude and practice of intensive care unit nurses about physical restraint. Nurs Crit Care. 2017;22(5):264-9. DOI: https://doi.org/10.1111/nicc.12303

Rosso LH, Gomes GA, Maronezi LFC, Lindemann IL, Riffel RT, Stobbe JC. Delirium em idosos internados via unidades de emergência: um estudo prospectivo. J bras psiquiatr. 2020;69(1):38-43. DOI: https://doi.org/10.1590/0047-2085000000261

Rudnicka E, Napierała P, Podfigurna A, Męczekalski B, Smolarczyk R, Grymowicz M. The World Health Organization (WHO) approach to healthy ageing. Maturitas. 2020;139:6-11. DOI: https://doi.org/10.1016/j.maturitas.2020.05.018

Silva JBVB, Pedreira LC, Santos JLP, Barros CSMA, David RAR. Perfil clínico de longevos em uma unidade de terapia intensiva. Acta paul enferm. 2018;31(1):39-45. DOI: https://doi.org/10.1590/1982-0194201800007

Massaud-Ribeiro L, Barbosa MC de M, Panisset AG, Robaina JR, Lima-Setta F, Prata-Barbosa A et al. Adaptação transcultural para o Brasil da Richmond Agitation-Sedation Scale para avaliação da sedação em terapia intensiva pediátrica. Rev bras ter intensiva. 2021;33(1):102-10. DOI: https://doi.org/10.5935/0103-507X.20210011

Gusmao-Flores D, Salluh JIF, Dal-Pizzol F, Ritter C, Tomasi CD, Lima MASD de, et al. The validity and reliability of the Portuguese versions of three tools used to diagnose delirium in critically ill patients. Clinics. 2011;66(11):1917-22.

Mevorach L, Forookhi A, Farcomeni A, Romagnoli S, Bilotta F. Perioperative risk factors associated with increased incidence of postoperative delirium: systematic review, meta-analysis, and Grading of Recommendations Assessment, Development, and Evaluation system report of clinical literature. Br J Anaesth. 2023;130(2):e254-62. DOI: https://doi.org/10.1016/j.bja.2022.05.032

Ko RE, Kim S, Lee J, Park S, Bae D, Choi KH, et al. Clinical phenotypes of delirium in patients admitted to the cardiac intensive care unit. PLoS One. 2022;17(9):e0273965. DOI: https://doi.org/10.1371/journal.pone.0273965

Nomali M, Ayati A, Yadegari M, Nomali M, Modanloo M. Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran. Indian J Crit Care Med. 2022;26(2):192-8. DOI: https://doi.org/10.5005/jp-journals-10071-24103

Thomann S, Zwakhalen S, Richter D, Bauer S, Hahn S. Restraint use in the acute-care hospital setting: a cross-sectional multi-centre study. Int J Nurs Stud. 2021;114:103807. DOI: https://doi.org/10.1016/j.ijnurstu.2020.103807

Ji Y, Yang X, Wang J, Cai W, Gao F, Wang H. Factors Influencing the Physical Restraint of Patients in the Neurosurgical Intensive Care Unit. Clin Nurs Res. 2022;31(1):46-54. DOI: https://doi.org/10.1177/10547738211016874

Gu T, Wang X, Deng N, Weng W. Investigating influencing factors of physical restraint use in China intensive care units: A prospective, cross-sectional, observational study. Aust Crit Care. 2019;32(3):193-8. DOI: https://doi.org/10.1016/j.aucc.2018.05.002

Wang Y, Liu Y, Tian YL, Gu SL. A Nomogram for Predicting Physical Restraint of Patients in Intensive Care Unit. Emerg Med Int. 2023;6618366. DOI: https://doi.org/10.1155/2023/6618366

Zhang M, Zhang X, Gao L, Yue J, Jiang X. Incidence, predictors and health outcomes of delirium in very old hospitalized patients: a prospective cohort study. BMC Geriatr. 2022;22(1):262. DOI: https://doi.org/10.1186/s12877-022-02932-9

Gusmão-Flores D, Neto AC. Delirium no paciente grave. São Paulo: Atheneu; 2014.

Boncyk CS, Farrin E, Stollings JL, Rumbaugh K, Wilson JE, Marshall M et al. Pharmacologic Management of Intensive Care Unit Delirium: Clinical Prescribing Practices and Outcomes in More Than 8500 Patient Encounters. Anesth Analg. 2021;133(3):713-22. DOI: https://doi.org/10.1213/ANE.0000000000005365

Casault C, Soo A, Lee CH, Couillard P, Niven D, Stelfox T et al. Sedation strategy and ICU delirium: a multicentre, population-based propensity score-matched cohort study. BMJ Open. 2021;11(7):e045087. DOI: https://doi.org/10.1136/bmjopen-2020-045087

Kooken RWJ, van den Berg M, Slooter AJC, Pop-Purceleanu M, van den Boogaard M. Factors associated with a persistent delirium in the intensive care unit: a retrospective cohort study. J Crit Care. 2021;66:132-7. DOI: https://doi.org/10.1016/j.jcrc.2021.09.001

Limpawattana P, Panitchote A, Tangvoraphonkchai K, Suebsoh N, Eamma W, Chanthonglarng B et al. Delirium in critical care: a study of incidence, prevalence, and associated factors in the tertiary care hospital of older Thai adults. Aging Ment Health. 2016;20(1):74-80. DOI: https://doi.org/10.1080/13607863.2015.1035695

Carvalho LAC, Correia MDL, Ferreira RC, Botelho ML, Ribeiro E, Duran ECM. Accuracy of delirium risk factors in adult intensive care unit patients. Rev esc enferm USP [Internet]. 2022;56:e20210222. DOI: https://doi.org/10.1590/1980-220x-reeusp-2021-0222

Ormseth CH, LaHue SC, Oldham MA, Josephson SA, Whitaker E, Douglas VC. Predisposing and Precipitating Factors Associated with Delirium: a Systematic Review. JAMA Netw Open. 2023;6(1):e2249950. DOI: https://doi.org/10.1001/jamanetworkopen.2022.49950

Olsen HT, Nedergaard HK, Strøm T, Oxlund J, Wian KA, Ytrebø LM et al. Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients. N Engl J Med. 2020;382(12):1103-11. DOI: https://doi.org/10.1056/NEJMoa1906759