| Autor: |
Serafim RB; Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro 22281-100, Brazil.; Hospital Copa D'Or, Rio de Janeiro 22031-011, Brazil.; Hospital Universitário Clementino Fraga Filho/Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil., Dal-Pizzol F; Laboratório de Fisiopatologia experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil., Souza-Dantas V; Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro 22281-100, Brazil., Soares M; Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro 22281-100, Brazil.; Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil., Bozza FA; Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro 22281-100, Brazil., Póvoa P; Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, 1150-199 Lisboa, Portugal.; NOVA Medical School, CEDOC, Universidade Nova de Lisboa, 1150-082 Lisboa, Portugal.; Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, C 5000 Odense, Denmark., Luiz RR; Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil.; Instituto de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-592, Brazil., Lapa E Silva JR; Hospital Universitário Clementino Fraga Filho/Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil.; Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil., Salluh JIF; Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro 22281-100, Brazil.; Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil. |
| Abstrakt: |
Despite recent advances in the field, the association between subsyndromal delirium (SSD) in the ICU and poor outcomes is not entirely clear. We performed a retrospective multicentric observational study analyzing mental status during the first 72 h of ICU stay. Of the 681 patients included, SSD occurred in 22.7%. Considering the worst cognitive assessment during the first 72 h, 233 (34%) patients had normal mental status, 124 (18%) patients had SSD and 324 (48%) patients had delirium or coma. SSD was not independently associated with an increased risk of death when compared with normal mental status (OR 95%IC 1.0 vs. 1.35 [0.73−1.49], p = 0.340), but was associated with a longer ICU LOS (7.0 (4−12) vs. 4 (3−8) days, p < 0.001). SSD patients who deteriorated to delirium or coma (21%) had a longer ICU LOS in comparison with those who improved or maintained mental status (8 (5−11) vs. 6 (4−8) days, p = 0.025), but did not have an increase in mortality. The main factors associated with the progression from SSD to delirium or coma were the use of mechanical ventilation, the use of intravenous benzodiazepines and a baseline APACHE II score > 23 points. Our findings support the association of SSD with increased ICU LOS, but not with ICU mortality. Monitoring the trajectory of SSD early at ICU admission can help to identify patients with increased risk of conversion from SSD to delirium or coma. |
