Tratamento do Delirium em Doentes Hospitalizados com Necessidades Paliativas: Revisão Sistemática da Literatura

Autores

  • Teresa Tavares 1.Escola Superior de Saúde Dr. Lopes Dias - Instituto Politécnico de Castelo Branco Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos, 2.Matosinhos, Portugal

DOI:

https://doi.org/10.24950/rspmi.826

Palavras-chave:

Cuidados Paliativos, Delírio/psicologia, Delírio/ tratamento

Resumo

O delirium é uma alteração aguda e flutuante do estado cognitivo
e da atenção com uma causa subjacente. Nos doentes
hospitalizados com necessidades paliativas é um problema
frequente e com impacto importante. O objetivo desta revisão
sistemática foi analisar a evidência na literatura publicada
entre Abril de 2011 e Agosto de 2015, acerca do tratamento
do delirium nesta população. Foram encontradas 2539 referências,
das quais 9 cumpriram os critérios de inclusão. Dois
estudos avaliaram medidas não farmacológicas em idosos
vulneráveis. Encontrou-se apenas um estudo comparativo,
que não mostrou diferenças entre o haloperidol e o aripiprazole,
mas registou mais efeitos adversos com o primeiro. O
aripiprazole parece ser menos eficaz no delirium hiperativo.
Estão em estudo novos fármacos, como os análogos da melatonina.
As orientações publicadas derivam essencialmente
da opinião de peritos ou da extrapolação de dados de outros
contextos. São necessários estudos prospetivos comparativos
com grupo placebo, duplamente cegos e randomizados
e com tempo de seguimento mais prolongado. Nos doentes
com necessidades paliativas que desenvolvem delirium é
premente avaliar o potencial de reversibilidade do episódio,
garantir o suporte aos cuidadores e adoptar medidas farmacológicas
ou não farmacológicas que privilegiem a qualidade
de vida e os objetivos do doente e da família.

Downloads

Não há dados estatísticos.

Referências

Lawlor P, Davis D, Ansari M, Hosie A, Kanji S, Momoli F, et al. An AnalyticalnFramework for Delirium Research in Palliative Care Settings: Integrated Epidemiologic, Clinician-Researcher, and Knowledge User Perspectives. J Pain Symptom Manage. 2014;48:159-75.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Philadelphia: APA; 2013.

Milisen K, Lemiengre J, Braes T, Foreman MD. Multicomponent intervention strategies for managing delirium in hospitalized older people; systematic review. J Adv Nurs. 2005; 52:79–90.

Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The confusion assessment method: a systematic review of current usage. J Am Geriatr Soc. 2008; 56:823–30.

Spiller JA, Keen JC. Hypoactive delirium: assessing the extent of the problem for inpatient specialist palliative care. Palliat Med. 2006; 20:17–23.

Hosie A, Davidson P, Agar M, Sanderson C, Phillips J. Delirium prevalence, incidence, and implications for screening in specialist palliative

care inpatient settings: a systematic review. Palliat Med. 2013;27:486-98.

Lawlor G, Fainsinger L, Bruera D. Delirium at the end of life: critical issues in clinical practice and research. JAMA. 2000; 284: 2427-9.

Candy B, Jackson K, Jones L, Leurent B, Tookman A, King M. Drug therapy for delirium in terminally ill adult patients. Cochrane Database Syst

Rev. 2012. [consultado em Jan 2016] Disponível em: www.update-software.com/pdf/CD004770.pdf.

Bruera E, Bush S, Willey J, Paraskevopoulos T, Li Z, Palmer JL, et al. Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer. 2009;115:2004-12.

Bush S, Bruera E, Lawlor P, Kanji S, Davis D, Agar M. Clinical Practice Guidelines for Delirium Management: Potential Application in Palliative Care. J Pain Symptom Manage. 2014;48:249-58.

Ford A, Almeida O. Pharmacological interventions for preventing delirium in the elderly. Maturitas. 2015;81:287-92.

Lawlor P, Gagnon B, Mancini I Pereira J, Hanson J, Suarez-Almazor M, et al. Occurrence causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med. 2000;160:786–94.

Gagnon P, Allard P, Gagnon B, Merette C, Tardif F. Delirium prevention in terminal cancer: assessment of a multi-component intervention. Psycooncology. 2012;21:187-94.

Sánchez-Román S, Zavala C, Solares A, Chiquete E. Delirium in adult patients receiving palliative care: A systematic review of the literature.

Rev Psiquiatr Salud Ment. 2014;7:48-58.

Bellelli G, Morandi A, Zanetti E, Bozzini M, Lucchi E, Terrasi M, et al. Recognition and management of delirium among doctors, nurses, physiotherapists, and psychologists: an Italian survey. Int Psychogeriatr. 2014;26:2093–102.

Rainsford S, Rosenberg J, Bullen T. Delirium in advanced cancer: screening for the incidence on admission to an inpatient hospice unit. J Palliat Med. 2014;17:1045–8.

Sato K, Inoue Y, Umeda M, Ishigamori I, Igarashi A, Togashi S, et al. A Japanese region-wide survey of the knowledge, difficulties and self-

reported palliative care practices among nurses. Jpn J Clin Oncol. 2014;44:718–28.

Morita T, Tei Y, Tsunoda J, Inoue S, Chihara S. Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. J Pain Symptom Manage. 2001; 22:997–1006.

Thomas K. The Gold Standards Framework Centre In End of Life Care. Prognostic Indicator Guidance (PIG) 4th ed.London: PIG; 2011.

Kham B, Zawahiri M, Campbell N, Fox G, Weinstein E, Nazir A, et al. Delirium in Hospitalized Patients: Implications of Current Evidence on Clinical Practice and Future Avenues for Research – A Systematic Evidence Review. J Hosp Med. 2012;7:580-9.

Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration 2011. [consultado em Jan 2016] Disponível em: http://handbook.cochrane.org.

Inouye S, van Dyck C, Alessi C, Balkin S, Siegal A, Horwitz R. Clarifying confusion: the confusion assessment method. A new method for detecting delirium. Ann Intern Med. 1990;113:941–8.

Yoo W, Seol H, Kim J, Yang M, Ryu S, Min D. Effects of hospitalist-directed interdisciplinary medicine floor service on hospital outcomes for

seniors with acute medical illness. Geriatr Gerontol Int. 2014;14:71-7.

Eeles E, Thompson L, McCrow J, Pandy S. Management of delirium in medicine: experience of a Close Observation Unit. Australas J Ageing.

;32:60-3.

Yoo W, Nakagawa S, Kim S. Delirium and transition to a nursing home of hospitalized older adults: a controlled trial of assessing the interdisciplinary team-based geriatric care and care coordination by non-geriatrics specialist physicians. Geriatr Gerontol Int. 2013;13:342-50.

Yoon J, Park M, Choi J, Choi H, Park Y, Kim J. Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of

delirium. BMC Psychiatry. 2013;13:240.

Yang J, Choi W, Ko H, Joe H, Han C, Kim K. Bright light therapy as an adjunctive treatment with risperidone in patients with delirium: a randomized, open, parallel group study. Gen Hosp Psychiatry. 2012;34:546-51.

Ohta T, Murao K, Miyake K, Takemoto K. Melatonin receptor agonists for treating delirium in elderly patients with acute stroke. J Stroke Cerebrovasc Dis. 2013;22:1107-10.

Zirker W, Dorokhine I, Knapp M, Patel N, Musuku M. Haloperidol overdosing in the treatment of agitated hospitalized older people with delirium: a retrospective chart review from a community teaching hospital. Drugs Aging. 2013;30:639-44.

Boettger S, Breitbart W. An open trial of aripiprazole for the treatment of delirium in hospitalized cancer patients. Palliat Support Care. 2011;9:351-7.

Boettger S, Passik S, Breitbart W. Treatment characteristics of delirium superimposed on dementia. Int Psychogeriatr. 2011;23:1671-6.

Boettger S, Friedlander M, Breitbart W, Passik S. Aripiprazole and haloperidol in the treatment of delirium. Aust N Z J Psychiatry. 2011;45:477-82.

Chong S, Tan T, Tay L, Wong M, Ancoli-Israel S. Bright light therapy as part of a multicomponent management program improves sleep and

functional outcomes in delirious older hospitalized adults. Clin Interv Aging. 2013;8:565-72.

Furuya M, Miyaoka T, Yasuda H, Yamashita S, Tanaka I, Otsuka S, et al. Marked improvement in delirium with ramelteon: five case reports. Psychogeriatrics. 2012; 12:259-62.

Gonçalves F, Almeida A, Pereira S. A Protocol for the Control of Agitation in Palliative Care. Am J Hosp Palliat Care. 2015 (in press)

Hayakawa K, Kato T, Kohjiro M, Monji A, Kanba S. Minocycline, a microglial inhibitor, diminishes terminal patients´ delirium? Am J Geriatr

Psychiatry. 2014;22:314-5.

Kishi Y, Kato M, Okuyama T, Thurber S. Treatment of delirium with risperidone in cancer patients. Psychiatry Clin Neurosci. 2012;66:411-7.

Bee L, Chew P, Sian M. Functional improvement in hospitalized older adults is independent of dementia diagnosis: experience of a specialized delirium management unit. J Hosp Med. 2013; 8:321-7.

Breitbart W, Marotta R, Platt M, Weisman H, Derevenco M, Grau C, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry. 1996;153:231-7.

Hui D, Bush S, Gallo L, Palmer J, Yennurajalingam S, Bruera E. Neuroleptic Dose in the Management of Delirium in Patients with Advanced

Cancer. J Pain Symptom Manage. 2010;39:186-96.

Prommer E. Role of Haloperidol in Palliative Medicine: An Update. Am J Hosp Palliat Care. 2012;29 295-301.

Lindqvist O, Lundquist G, Dickman A, Bükki J, Lunder U, Hagelin CL, et al. OPCARE9. Four essential drugs needed for quality care of the dying: a Delphi-study based international expert consensus opinion. J Palliat Med. 2013;16:38–43.

DeLeon A, Patel C, Crismon L. Aripiprazole: A comprehensive review of its pharmacology, clinical efficacy, and tolerability. Clinical Therapeutics. 2004;26:649–66.

Vella-Brincat J, Macleod A. Haloperidol in palliative care. Palliat Med. 2004;18:195-201.

Chakraborti D, Tampi D, Tampi R. Melatonin and Melatonin Agonist for Delirium in the Elderly Patients. Am J Alzheimers Dis Other Demen.

;30:119-29.

Simpson D, Curran P. Ramelteon: a review of its use in insomnia. Drugs. 2008;68:1901-19.

Agar M. Oral risperidone, oral haloperidol, and oral placebo in the management of delirium in palliative care. 2013. [consultado em Jan 2016] Disponível em: http://apps.who.int/trialsearch/trial.aspx?trialid1⁄4ACTRN12607000562471.

Khan B, Zawahiri M, Campbell N, Fox G, Weinstein E, Nazir A, et al. Delirium in Hospitalized Patients: Implications of Current Evidence on Clinical Practice and Future Avenues for Research - A Systematic Evidence Review. J Hosp Med. 2012; 7: 580–9.

Bush S, Kanji S, Pereira J, Davis D, Currow D, Meagher D, et al. Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development. J Pain Symptom Manage. 2014 ; 48: 231–48.

Irwin S, Pirrello R, Hirst J, Buckholz G, Ferris F. Clarifying delirium management: practical, evidenced-based, expert recommendations for clinical practice. J Palliat Med. 2013;16:423–35.

Zimmerman K, Rudolph J, Salow N, Skarf L. Delirium in Palliative Care Patients: Focus on Pharmacotherapy. Am J Hosp Palliat Care. 2011;28:501-10.

Bush S, Leonard M, Agar M, Spiller J, Hosie A, Wright D. End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase. J Pain Symptom Manage. 2014;48:215-30.

de Graeff A, Dean M. Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med. 2007; 10:67–85.

Gagnon P, Charbonneau C, Allard P, Soulard C, Dumont S, Fillion L. Delirium in advanced cancer: A psychoeducational intervention for family caregivers. J Palliat Care. 2002;18:253–61.

Rosenbloom-Brunton D, Henneman E, Inouye S. Feasibility of family participation in a delirium prevention program for hospitalized older adults. J Gerontol Nurs. 2010;36:22–33.

Ficheiros Adicionais

Publicado

30-09-2016

Como Citar

1.
Tavares T. Tratamento do Delirium em Doentes Hospitalizados com Necessidades Paliativas: Revisão Sistemática da Literatura. RPMI [Internet]. 30 de Setembro de 2016 [citado 14 de Dezembro de 2024];23(3):52-6. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/826

Edição

Secção

Artigos de Revisão