Prevalência de delirium induzido por medicamentos em idosos hospitalizados em unidade de terapia intensiva: uma revisão sistemática
DOI:
https://doi.org/10.30968/rbfhss.2024.151.1094Resumo
Objetivo: estimar a prevalência de delirium induzido por medicamentos e problemas relacionados a farmacoterapia (PRF) em idosos hospitalizados em unidade de terapia intensiva (UTI). Métodos: Revisão sistemática foi conduzida nas bases de dados PubMed, EMBASE, LILACS, Ageline, Web of Science e Cochrane (até março de 2023). Foram incluídos ensaios clínicos e estudos observacionais que investigaram a contribuição do medicamento na ocorrência de delirium e compararam com pacientes idosos gravemente enfermos (idade ≥65 anos) sem a síndrome. Foram excluídos unidades de emergência, enfermarias gerais, níveis de atenção primária e secundária, pacientes com delirium tremens; encefalopatia metabólica; demência; cuidados paliativos; e metástase cerebral. As referências foram inseridas no Rayyan QCRI. Duas duplas de revisores selecionaram os artigos, extraíram os dados e avaliaram o risco de viés (ROBINS-I). Resultados: Dos 12.492 estudos recuperados, após exclusão de duplicação (n=6.025), título/resumo (n=6.467) e leitura completa (n=286), dois atenderam aos critérios de inclusão. Ambos foram observacionais (coorte), desenvolvidos em países de alta renda, com alto nível de risco de viés (geral). As frequências de delirium e delirium subsindrômico foram de 15,8% a 33,9%. Fatores de risco independentes foram exposição a opioides e uso de corticosteróides. O delirium aumentou o tempo de internação na UTI e de ventilação mecânica. Conclusão: Mais estudos são necessários para compreender os PRF e as características da farmacoterapia associadas ao delirium em idosos gravemente enfermos. As reações adversas aos medicamentos e a carga deliriogênica parecem contribuir para a ocorrência da síndrome.
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