Setembro de 2011 - Vol 18 numero 3 - Sociedade Portuguesa de ...
Setembro de 2011 - Vol 18 numero 3 - Sociedade Portuguesa de ...
Setembro de 2011 - Vol 18 numero 3 - Sociedade Portuguesa de ...
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Rev Port Med Int <strong>2011</strong>; <strong>18</strong>(3)<br />
<strong>de</strong>tecção, sem que haja um diagnóstico<br />
complementar <strong>de</strong>terminado, sem tratamento<br />
efetivo. Estudar o <strong>de</strong>lirium é caminhar por<br />
“caminhos nunca (ou quase nunca) dantes<br />
navegados”. Com esta revisão, preten<strong>de</strong>u-se<br />
objetivar alguns pontos da fisiopatogenia do<br />
22<br />
<strong>de</strong>lirium, bem como sugerir diretrizes futuras<br />
(Tabela 2) no estudo <strong>de</strong> afecção fortemente<br />
prevalente nas unida<strong>de</strong>s <strong>de</strong> terapia intensiva e<br />
que é por nós, profissionais <strong>de</strong> saú<strong>de</strong>,<br />
imensamente negligenciada.<br />
1. Padronizar um termo para o <strong>de</strong>lirium em terapia intensiva. Propomos que, tal e qual os<br />
síndromes da resposta inflamatória aguda, da disfunção respiratória aguda, o <strong>de</strong>lirium <strong>de</strong>ve<br />
ser consi<strong>de</strong>rado como parte <strong>de</strong> uma síndrome da disfunção cerebral aguda.<br />
2. É mister estudar os fatores <strong>de</strong> risco associados à internação em UTI, particularmente a<br />
influência do ambiente no surgimento do <strong>de</strong>lirium, ruptura do ciclo sono-vigília, procedimentos<br />
invasivos, ausência <strong>de</strong> familiares, solidão, dor persistente, gravida<strong>de</strong> da doença <strong>de</strong> base.<br />
3. Não se sabe ao certo as razões <strong>de</strong> certos pacientes <strong>de</strong>senvolverem quadro hiperativo e<br />
outros, pelo contrário, apresentarem hipoativida<strong>de</strong>, tampouco o porquê <strong>de</strong> outros<br />
apresentarem variabilida<strong>de</strong> no <strong>de</strong>correr da internação, com períodos <strong>de</strong> hipervigilância e <strong>de</strong><br />
estado <strong>de</strong> alerta reduzido, sendo necessário estudar a fenomenologia mais acuradamente,<br />
tentando <strong>de</strong>terminar a fisiopatologia <strong>de</strong> tais subtipos.<br />
4. Os mo<strong>de</strong>los experimentais <strong>de</strong> <strong>de</strong>lirium em animais <strong>de</strong>ixam a <strong>de</strong>sejar no sentido <strong>de</strong> que<br />
produzem tipos específicos da alteração. Dever-se-ia criar mo<strong>de</strong>los experimentais que<br />
pu<strong>de</strong>ssem simular a via final comum da fisiopatogênese do <strong>de</strong>lirium.<br />
Tabela 2 - Priorida<strong>de</strong>s Futuras<br />
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