RESUMO
Delirium, a common neurocognitive disorder among hospitalized older adults, depends on an interrelationship between precipitating and predisposing factors. Adequate prevention, detection, and management are directly related to knowledge of these factors. Due to a lack of education, delirium is underdiagnosed and the time taken to identify and react to the condition is suboptimal. Based on an open review of the literature, the main precipitating factors were compiled into the acronym DELIRIUM, in Portuguese. A second acronym MAIS (meaning 'plus') was compiled from important behaviors for preventing and treating delirium. Thus, the mnemonic device DELIRUM+ stands for: Discomfort, Electrolytes/metabolism, Locale/environment, Infections, urinary/fecal Retention; and acute clinical complIcations; Uremia; Medications + (Mobility, Assistant/companion, Interactions, and Sleep/psychotropic substances]. This mnemonic device can encourage teaching and care aimed at the prevention, detection, and management of delirium. Ideally, the clinical impact of this mnemonic device should be tested in research to validate its implementation. (AU)
Delirium é um distúrbio neurocognitivo frequente entre idosos hospitalizados e depende da interrelação entre fatores precipitantes e predisponentes. Sua adequada prevenção, detecção e seu manejo estão diretamente relacionados ao conhecimento desses fatores. Devido à baixa disseminação de ensino nessa área, o delirium é subdiagnosticado e o tempo de identificação e instituição de condutas é subótimo. A partir de revisão aberta da literatura, os principais fatores precipitantes foram listados e compilados em categorias nominadas, em português, com as letras que compõem a palavra DELIRIUM. O símbolo de mais (+) foi acrescido para destacar condutas que deveriam ser mais bem observadas para a prevenção e o manejo do delirium, utilizando-se as letras que compõem a palavra MAIS. Resultados: Apresenta-se proposição do mnemônico DELIRIUM+: D or; E letrólitos/Metabólico; L ocal/ambiente; I nfecções/invasões; R etenção urinária/fecal; I ntercorrência clínica aguda; U remia; M edicamentos; + [M obilidade; A companhante; I nteração; S ono]. A proposição desse mnemônico tem potencial para favorecer o ensino e a assistência voltados à prevenção, à detecção e ao manejo do delirium. Idealmente, o real impacto clínico desse mnemônico deverá ser testado em delineamento de pesquisa para validar sua implementação. (AU)
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Delírio/prevenção & controle , Fatores de RiscoRESUMO
Central venous catheters (CVCs) are frequently used, but the rate of complications is high. This study evaluates the effects of a short training program for CVC insertion in a university-based teaching hospital. A sample of adults with CVCs inserted outside the intensive care unit was selected from two academic years: 2015, year without structured training, and 2016, year with structured training. Clinical and laboratory information, as well as the procedure's characteristics and complications (mechanical and infectious) were collected. The incidence of complications before and after the training was compared. A total of 1502 punctures were evaluated. Comparing the pre- and post-training period, there was an increase in the choice for jugular veins and the use of ultrasound. A numerical reduction in the rate of complications was identified (RR 0.732; 95% CI 0.48-1.12; P = 0.166). This difference was driven by a statistically significant lower rate of catheter-related infections (RR 0.78; 95% CI 0.64-0.95; P = 0.047). In the multivariate analysis, aspects regarding technique (ultrasound use, multiple punctures) and year of training were associated with outcomes. Structured training reduces the rate of complications related to CVC insertion, especially regarding infections.