RESUMEN
Este Relatório Final é o resultado formal da conclusão do Mestrado em Enfermagem na Pessoa em Situação Crítica sobre forma de relatório e revisão sistemática da literatura. O relatório é apresentado com método descritivo e argumentativo dos domínios de competência do enfermeiro especialista na pessoa em situação crítica da Ordem dos Enfermeiros, documentados no Regulamento 429/2018. Confronta a experiência de ensino clínico com documentos oficiais da DGS, OE, sociedades internacionais e evidência científica recente. Demonstra assim o percurso formativo de construção de um enfermeiro especialista e sintetiza o conhecimento que possui e as principais áreas de desenvolvimento, apresentando a reflexão contínua como um processo dinâmico, imprescindível à tomada de decisão. A revisão sistemática da literatura sobre "a eficácia das intervenções não farmacológicas na incidência e duração do delirium no adulto no pós-operatório" revela a síntese científica sobre um tema emergente da área cirúrgica, a nível investigativo e pouco evidente no contexto pratico, evidenciando a importância da intervenção de enfermagem na temática.
Asunto(s)
Pacientes , Vías Clínicas , Rol de la Enfermera , Educación en Enfermería , Atención de EnfermeríaRESUMEN
BACKGROUND: Postoperative delirium (POD) is a frequent post-surgical complication that is associated with increased mortality and poor patient outcomes. POD is a complex disorder with multiple risk factors such as pre-existing patient comorbidities and perioperative complications. The aim of this study was to evaluate the incidence of POD and to identify risk factors for the development of POD in a post-anesthesia care unit (PACU). METHODS: We enrolled 97 adult patients admitted to a PACU over a five-day period (start date September 6, 2010). Patient demographics and intraoperative and postoperative data were collected. Patients were followed for the development of delirium using the Intensive Care Delirium Screening Checklist. Descriptive analyses of variables were used to summarize data, and the Mann-Whitney U test was used to compare continuous variables; the chi-square or Fisher's exact test was used for comparisons. Univariate analysis was performed using simple binary logistic regression with odds ratios (OR) and 95% confidence intervals (95% CI). The significance level for multiple comparisons was controlled by applying the Bonferroni correction for multiple comparisons and variables were deemed significant if p≤0.0025. RESULTS: Six percent of patients developed POD. These patients were older and more likely to have higher American Society of Anesthesiologists (ASA) physical status (83 vs. 22% with ASA III/IV, p=0.004) as well as a higher frequency of congestive heart failure (50 vs. 3%, p=0.003) and a higher Revised Cardiac Risk Index (RCRI) score (33 vs. 6% with RCRI ≥2, p=0.039). The duration of anesthesia for patients with POD was also longer and they received a greater volume of crystalloids, colloids, and erythrocytes during surgery. Congestive heart disease was an independent risk factor for POD (OR 29.3, 95% CI 4.1-210.6; p<0.001). In addition, patients who developed POD had higher in-hospital mortality and longer PACU and hospital stays. CONCLUSIONS: Patients who developed POD had longer hospital and PACU stays and higher in-hospital mortality. Congestive heart disease was considered an independent risk factor for POD.