Abordaje del riesgo de delirium en una unidad de ortogeriatría / Aproach to the risk of delirium in an orthogeriatric unit

Introducción: El objetivo de este estudio es evaluar la eficacia de un cambio en la estrategia de manejo del riesgo de delirium en una unidad de ortogeriatría. Material y métodos: Estudio prospectivo, comparativo, no aleatorizado de 2 cohortes de pacientes. Una cohorte (grupo control) tratado con la terapia estándar con tramadol de rescate y diazepam, y otra cohorte (grupo experimental) tratado con morfina a dosis bajas de rescate junto con benzodiacepinas de vida media corta y tratamiento preventivo con neurolépticos, en los pacientes de alto riesgo. Resultados: Se ha incluido a 85 pacientes (42 en el grupo control y 43 en el grupo experimental). Edad media: 85 años (71-105). Un total de 29 pacientes (34%) han tenido un episodio de delirium durante el ingreso actual, 16 pacientes (38%) en el grupo control y 13 pacientes (30%) en el grupo experimental, respectivamente (p=0,498). La duración media del delirium en los 29 pacientes que lo presentaron fue de 5,3 días. Esta duración fue en el grupo control de 6,6 días y en el grupo experimental de 3,8 días, respectivamente (p=0,031). En el grupo de pacientes que tenían antecedente de delirium previo, se aprecia que hay una menor incidencia de delirium durante el ingreso actual en el grupo experimental (80% vs. 17%, p=0,036). Conclusiones: La terapia experimental ha resultado eficaz, ya que se ha podido observar una tendencia a disminuir la incidencia del delirium y en los casos que lo han presentado la terapia sirvió para disminuir su duración con diferencias estadísticamente significativas

Introduction: The objective of this study is to evaluate the efficacy of a change in the management of the risk of delirium in an orthogeriatric unit. Material and methods: Prospective, comparative, non-randomised study of two cohorts of patients. One cohort (control group) treated with standard therapy with tramadol rescue and diazepam and another cohort (experimental group) treated with rescue with morphine at low doses and short half-life benzodiazepines as well as preventive treatment with neuroleptics in patients at high risk. Results: Eighty-five patients were included (42 in the control group and 43 in the experimental group). Mean age: 85 (71-105). Twenty-nine patients (34%) had an episode of delirium during the current admission, 16 patients (38%) in the control group and 13 patients (30%) in the experimental group respectively (P=.498). The mean duration of delirium in the 29 patients who presented it was 5.3 days. This duration in the control group was 6.6 days and in the experimental group 3.8 days (P=.031). In the group of patients who had previous delirium, a lower incidence of delirium was seen during the current admission in the experimental group (80% vs 17% P=.036). Conclusions: Experimental treatment has been effective since a trend to a lower incidence of delirium has been observed. In the patients who have suffered an episode of delirium, the treatment served to decrease its duration with statistically significant differences

Aproach to the risk of delirium in an orthogeriatric unit. / Abordaje del riesgo de delirium en una unidad de ortogeriatría.

INTRODUCTION: The objective of this study is to evaluate the efficacy of a change in the management of the risk of delirium in an orthogeriatric unit. MATERIAL AND METHODS: Prospective, comparative, non-randomised study of two cohorts of patients. One cohort (control group) treated with standard therapy with tramadol rescue and diazepam and another cohort (experimental group) treated with rescue with morphine at low doses and short half-life benzodiazepines as well as preventive treatment with neuroleptics in patients at high risk. RESULTS: Eighty-five patients were included (42 in the control group and 43 in the experimental group). Mean age: 85 (71-105). Twenty-nine patients (34%) had an episode of delirium during the current admission, 16 patients (38%) in the control group and 13 patients (30%) in the experimental group respectively (P=.498). The mean duration of delirium in the 29 patients who presented it was 5.3 days. This duration in the control group was 6.6 days and in the experimental group 3.8 days (P=.031). In the group of patients who had previous delirium, a lower incidence of delirium was seen during the current admission in the experimental group (80% vs 17% P=.036). CONCLUSIONS: Experimental treatment has been effective since a trend to a lower incidence of delirium has been observed. In the patients who have suffered an episode of delirium, the treatment served to decrease its duration with statistically significant differences.

Prevention of irinotecan associated diarrhea by intestinal alkalization. A pilot study in gastrointestinal cancer patients.

AIM AND BACKGROUND: Intestinal alkalization could prevent irinotecan associated diarrhea modulating some chemical equilibria between irinotecan metabolites. The aim of this study was to evaluate the efficacy of this procedure in advanced gastrointestinal cancer patients (GICP). MATERIALS AND METHOD: In this prospective study advanced GICP, receiving irinotecan based chemotherapy regimens, were well trained to add sodium bicarbonate to the water intake in order to accomplish intestinal alkalization. RESULTS: A total of twenty four advanced GICP were enrolled. Grade III-IV diarrhea has been observed in four patients (16%), some of whom had several risk factors for diarrhea. Only one out of seventeen colorectal cancer patients, receiving the irinotecan combination as first line therapy, had grade III-IV diarrhea. No side effects of the procedure have been appreciated. CONCLUSIONS: Intestinal alkalization may be effective as a preventive treatment for irinotecan associated diarrhea in chemotherapy regimens used in GICP. This procedure deserves further investigation.

Prevention of irinotecan associated diarrhea by intestinal alkalization. A pilot study in gastrointestinal cancer patients

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Aim and background. Intestinal alkalization couldprevent irinotecan associated diarrhea modulatingsome chemical equilibria between irinotecan metabolites.The aim of this study was to evaluate the efficacyof this procedure in advanced gastrointestinalcancer patients (GICP).Materials and method. In this prospective studyadvanced GICP, receiving irinotecan based chemotherapyregimens, were well trained to add sodiumbicarbonate to the water intake in order to accomplishintestinal alkalization.Results. A total of twenty four advanced GICP wereenrolled. Grade III-IV diarrhea has been observedin four patients (16%), some of whom had severalrisk factors for diarrhea. Only one out of seventeencolorectal cancer patients, receiving the irinotecancombination as first line therapy, had grade III-IVdiarrhea. No side effects of the procedure have beenappreciated.Conclusions. Intestinal alkalization may be effectiveas a preventive treatment for irinotecan associateddiarrhea in chemotherapy regimens used in GICP.This procedure deserves further investigation