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Transcript

DR FRANK MERAZ

DELIRIUM

IDENTIFICACIÓN

2.Bowman EML, Cunningham EL, Page VJ, McAuley DF. Phenotypes and subphenotypes of delirium: a review of current categorisations and suggestions for progression. Critical Care. 2021 Sep 15;25(1).

CUADRO AGUDO EN DONDE HAY UNA DISMINUCIÓN EN LAS FUNCIONES MENTALES ( ATENCIÓN, PERCEPCIÓN, LENGUAJE, ETC ) SECUNDARIO A UNA ETIOLOGÍA A DETERMINAR

DEFINICIÓN

SUBFENOTIPOS

PERDIDA DE LA FUNCIONALIDAD

AUMENTA LA SUSCEPTIBILIDAD A LA DEMENCIA

Bowman EML, Cunningham EL, Page VJ, McAuley DF. Phenotypes and subphenotypes of delirium: a review of current categorisations and suggestions for progression. Critical Care. 2021 Sep 15;25(1)

AUMENTA LA MORTALIDAD A LOS 6 MESES

AUMENTA LA ESTANCIA INTRAHOSPITALARIA

IMPORTANCIA

INDEPENDENCIA

RESERVA COGNITIVA

MORBIMORTALIDAD

EIH

DEMENCIA

BAJA RESERVA COGNITIVA

DELIRIUM

INTERACCIÓN DSD

5.Fong TG, Inouye SK. The inter-relationship between delirium and dementia: the importance of delirium prevention. Nature Reviews Neurology [Internet]. 2022 Aug 26;18(18). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9415264/

ESQUEMATIZACIÓN

DIFERENCIACIÓN

FACTORES DE RIESGO

1.Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, et al. Delirium. Nature Reviews Disease Primers [Internet]. 2020;6(1):1–26. Available from: https://www.nature.com/articles/s41572-020-00223-4

.Ormseth CH, LaHue SC, Oldham MA, Josephson SA, Whitaker E, Douglas VC. Predisposing and Precipitating Factors Associated With Delirium. JAMA Network Open. 2023 Jan 6;6(1):e2249950.

FISIOPATOLOGÍA

1.Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, et al. Delirium. Nature Reviews Disease Primers [Internet]. 2020;6(1):1–26. Available from: https://www.nature.com/articles/s41572-020-00223-4

  • EXAMEN MENTAL
  • INTERROGATORIO

DIAGNÓSTICO

  • CAM ( CONFUSION ASSESSMENT METHOD)
  • NEWS ( NATIONAL EARLY WARNING SCORE)

1.Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, et al. Delirium. Nature Reviews Disease Primers [Internet]. 2020;6(1):1–26. Available from: https://www.nature.com/articles/s41572-020-00223-4

5.Fong TG, Inouye SK. The inter-relationship between delirium and dementia: the importance of delirium prevention. Nature Reviews Neurology [Internet]. 2022 Aug 26;18(18). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9415264/

DIVERSOS ESTUDIOS MUESTRAN RESULTADOS NO CONCLUYENTES.REALIZAR LABORATORIOS DE ACUERDO AL ENDOTIPO (ETIOLOGÍA ) SOSPECHADO

PARACLINICOS

4.Marquetand J, Bode L, Fuchs S, Hildenbrand F, Ernst J, von Känel R, et al. Risk Factors for Delirium Are Different in the Very Old: A Comparative One-Year Prospective Cohort Study of 5,831 Patients. Frontiers in Psychiatry. 2021 May 11;12.

ETAPIFICACIÓN

LOS PACIENTES > 80 AÑOS QUE CURSAN CON DELIRIUM TIENEN MÁS Y PEORES EFECTOS ADVERSOS QUE AQUELLOS PACIENTES CON MENOR EDAD.

1.Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, et al. Delirium. Nature Reviews Disease Primers [Internet]. 2020;6(1):1–26. Available from: https://www.nature.com/articles/s41572-020-00223-4

NO FARMACOLÓGICO

TRATAMIENTO

FARMACOLÓGICO

  • Bibliography1.Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, et al. Delirium. Nature Reviews Disease Primers [Internet]. 2020;6(1):1–26. Available from: https://www.nature.com/articles/s41572-020-00223-4
  • Bowman EML, Cunningham EL, Page VJ, McAuley DF. Phenotypes and subphenotypes of delirium: a review of current categorisations and suggestions for progression. Critical Care. 2021 Sep 15;25(1)
  • 3.Ormseth CH, LaHue SC, Oldham MA, Josephson SA, Whitaker E, Douglas VC. Predisposing and Precipitating Factors Associated With Delirium. JAMA Network Open. 2023 Jan 6;6(1):e2249950.
  • 4.Marquetand J, Bode L, Fuchs S, Hildenbrand F, Ernst J, von Känel R, et al. Risk Factors for Delirium Are Different in the Very Old: A Comparative One-Year Prospective Cohort Study of 5,831 Patients. Frontiers in Psychiatry. 2021 May 11;12.
  • 5.Fong TG, Inouye SK. The inter-relationship between delirium and dementia: the importance of delirium prevention. Nature Reviews Neurology [Internet]. 2022 Aug 26;18(18). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9415264/

REFERENCIAS

  • Incapacidad de mantener una demanda metabólica
  • Estados hipoxicos
  • Hipoglicemia sistémica
  • Disfunción microvascular secundario a edad y/o a otras patologías
INSUFICIENCIA METABOLICA CEREBRAL

No hay diferencia significativa al usar antipsicoticos comparados con placebo al evaluar duración de delirium y mejoría de sintomatología

Multiples modelos que se complementan , no son mutuamente excluyentes

  • Hospital elder life program ( help) abarca aspectos como deficiencias auditivas , visuales, inmovilidad, desorientación, insomnio y deshidratación. Equipo de voluntarios, medic@s , enfermer@ y voluntari@s
  • ABCDE bundle

ESTRATEGIAS NO FARMACOLÓGICAS

SE HA DEMOSTRADO QUE ESTA TERAPEUTICA HA REDUCIDO EL RIESGO DE PRESENTAR DELIRIUM EN UN 5 %