A influência do delirium no tempo de ventilação mecânica em pacientes críticos: uma revisão sistemática / The influence of delirium in the time of mechanical ventilation in critical patients: a systematic review

O delirium consiste em um estado confusional agudo e de curso flutuante representando uma manifestação da disfunção cerebral que pode estar associado com diferentes manifestações clínicas. Os pacientes com delirium têm sido estudados, pois tem apresentado maior tempo de ventilação mecânica e de internação em unidade de terapia intensiva. O objetivo do estudo foi realizar uma revisão de literatura acerca da influência do delirium no tempo de ventilação mecânica, sedação e na mortalidade de pacientes internados em unidade de terapia intensiva. Foi realizada uma busca por estudos nas bases de dados PubMed e Embase, com os descritores delirium, intensive care unit and mechanical ventilation. Nos resultados foram incluídos oito artigos, um recebeu graduação A e sete receberam graduação B na escala de Oxford. Os principais resultados foram: Os pacientes com delirium apresentaram maior gravidade, maior tempo de ventilação mecânica, maior tempo de sedação e maior mortalidade. Conclui-se que o delirium parece estar associado ao maior tempo da ventilação mecânica, maior dosagem de sedação e de mortalidade nestes pacientes.

Delirium consists of an acute, fluctuating, confusional state, representing a manifestation of cerebral dysfunction that can occur with different clinical manifestations. Patients with delirium have been studied because they have had longer time of mechanical ventilation and hospitalization in the intensive care unit. The objective of the study was to perform a literature review about the influence of delirium on the time of mechanical ventilation, sedation and on the mortality of patients admitted in intensive care units. A search for studies with the keywords delirium, intensive care unit and mechanical ventilation was performed in PubMed and Embase databases. As result eight articles were included, one received level A and seven received level B on the Oxford scale. The main results were: Patients with delirium presented greater severity, longer time of mechanical ventilation, longer sedation time and higher mortality. It is concluded that delirium appears to be associated with longer mechanical ventilation, greater sedation and mortality rates in these patients.

Characteristics and Outcomes of Intensive Care Unit Survivors: Experience of a Multidisciplinary Outpatient Clinic in a Teaching Hospital

OBJECTIVES: To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. METHODS: Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. RESULTS: A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. CONCLUSIONS: A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

Networks of Life: a Jungian reading about aging and death / Redes da vida: uma leitura junguiana sobre o envelhecimento e a morte

This work aims at proposing an approach of the stages of aging and dying within the individuation process, starting from the symbolic amplification of images of these phases of life in light of Analytical Psychology. For the purpose of correlating these images with the stages of human development, particularly with the phases of the end of maturity and closing of the life cycle, a study on imagery and bibliography of aging and dying was conducted based on the theoretical framework of Analytical Psychology and of Post-Jungian authors. To that effect, the symbolic amplification of images taken from the plastic arts, literature, religion and mythology was made. The results of the study indicated that the death-related images bear a relationship with the individuation process, which points out to the need to explore this topic – which is a taboo in contemporary society – in a creative and significant manner; something that was synthesized by Jung himself in the expression “to die with life”.

O presente trabalho se propõe a abordar as fases do envelhecimento e morte dentro do processo de individuação a partir da amplificação simbólica de imagens destas etapas da vida à luz da Psicologia Analítica. Com o objetivo de relacionar tais imagens às etapas do desenvolvimento humano, notadamente às fases de fim da maturidade e encerramento do ciclo vital, realizou-se um estudo imagético e bibliográfico do envelhecimento e da morte a partir do referencial teórico da Psicologia Analítica e dos autores pós-junguianos. Para tanto, foi realizada a amplificação simbólica de imagens oriundas das artes plásticas, literatura, religião e mitologia. Os resultados do estudo indicam que as imagens relacionadas à morte guardam relação com o processo de individuação, sinalizando a necessidade de que este tema – que constitui um tabu na sociedade contemporânea – seja vivenciado de forma criativa e significativa.

Redes da vida: uma leitura junguiana sobre o envelhecimento e a morte / Life networks: a Jungian reading about aging and death

O presente trabalho se propõe a abordar as fases do envelhecimento e morte dentro do processo de individuação a partir da amplificação simbólica de imagens destas etapas da vida à luz da Psicologia Analítica. Com o objetivo de relacionar tais imagens às etapas do desenvolvimento humano, notadamente às fases de fim da maturidade e encerramento do ciclo vital, realizou-se um estudo imagético e bibliográfico do envelhecimento e da morte a partir do referencial teórico da Psicologia Analítica e dos autores pós-junguianos. Para tanto, foi realizada a amplificação simbólica de imagens oriundas das artes plásticas, literatura, religião e mitologia. Os resultados do estudo indicam que as imagens relacionadas à morte guardam relação com o processo de individuação, sinalizando a necessidade de que este tema – que constitui um tabu na sociedade contemporânea – seja vivenciado de forma criativa e significativa...

This paper proposes to address the stages of aging and death in the process of individuation starting from the symbolic amplification of images of these life stages in the light of Analytical Psychology. In order to relate these images to the stages of human development, especially to the phases of late maturity and life cycle termination, we carried out an imagistic and bibliographic study of aging and death based on the theoretical framework of Analytical Psychology and post-Jungian authors. Therefore, we performed a symbolic amplification of images coming from visual arts, literature, religion and mythology. The results of this study indicate that the images connected with death are related to the process of individuation, signaling the need for this issue - which is a taboo in contemporary society – to be experienced in a creative and meaningful way...

Fatores estressantes para familiares de pacientes criticamente enfermos de uma unidade de terapia intensiva / Stressful factors for families of critically ill patients of the intensive care unit

OBJETIVO: Identificar os principais estressores ambientais, conforme a percepção de familiares de pacientes internados em uma UTI-G de adultos de um hospital público universitário. MÉTODO: Estudo transversal descritivo com familiares de pacientes gravemente enfermos internados na UTI de um hospital escola. Para a coleta de dados, utilizou-se uma escala contendo 25 itens relacionados a eventos da referida UTI. Para análise dos resultados, as respostas foram classificadas como estressores ambientais, referentes à equipe, ao paciente e à visita. RESULTADOS: Participaram 53 familiares, 67,9 por cento mulheres, com média de idade de 39,7 anos. Os fatores relacionados ao paciente foram mais estressantes do que aqueles referentes à equipe e ao ambiente (p < 0,005). Os eventos mais estressantes para os familiares estiveram relacionados à insegurança e ao medo quanto ao estado clínico do paciente, dentre esses, o motivo e o tempo de internação e ver o paciente em coma. CONCLUSÃO: A internação de um parente próximo na UTI foi considerada pelos familiares que efetivamente participaram desse processo um evento estressante. Todos os participantes indicaram pelo menos um evento causador de estresse capaz de provocar diferentes reações emocionais. Conhecer tais eventos pode facilitar as estratégias de humanização hospitalar, propiciando alternativas para reduzir os níveis de estresse e alterações psiquiátricas subsequentes.

OBJECTIVE:To identify main environment stressors according to the perception of relatives of patients hospitalized in an adult ICU in a university public hospital. METHOD: It is a transversal descriptive study involving family members of critically ill patients hospitalized in an ICU of a school hospital. To collect data we used a 25-item scale related to the referred ICU. For result analysis, answers were classified as environmental stressors concerning the team, patients, and visits. RESULTS: There were 53 family-member participants where 67.9 percent were women averaging 39.7 years of age. Factors related to patients were more stressing than those concerning the hospital team and the environment (p < 0.005). The most stressed events for the family members were related to uncertainty and fear of the clinical state of the patient, among them reason and length of hospital stay, and witness the patients in a coma. CONCLUSION: Hospital ICU stay of a relative was considered by the close to kin, who actually participated in the process, a stressful event. All participants indicated at least one event that causes stress as capable of provoking diverse emotional reactions. Knowing such events can favor hospital humanization strategies thus providing alternatives to reduce stress levels and subsequent psychiatrical disorder.