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Intervenciones y efectividad del Paquete ABCDEF en el tratamiento de delirium: revisión de alcance
Interventions and effectiveness of the ABCDEF Bundle for treating delirium: A scoping review
Intervenções e efetividade do pacote ABCDEF no tratamento do delirium: revisão de escopo
DOI:
https://doi.org/10.15446/av.enferm.v39n3.85828Keywords:
Delirium, Unidad de Cuidados Intensivos, Prevención de Enfermedades, Evaluación de Eficacia-Efectividad de Intervenciones (es)Delirium, Unidades de Terapia Intensiva, Prevenção de Doenças, Avaliação de Eficácia-Efetividade de Intervenções (pt)
Delirium, Intensive Care Units, Disease Prevention, Evaluation of the Efficacy-Effectiveness of Interventions (en)
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Objetivo: describir las intervenciones de cada componente del paquete ABCDEF y su efectividad para prevenir y tratar el delirium en pacientes hospitalizados en cuidados intensivos.
Síntesis de contenido: se realizó una revisión de alcance empleando los términos MeSH delirium e intensive care units, agregando ABCDEF con el operador AND, en las bases de datos Medline, ScienceDirect, Biblioteca Virtual de Salud y Scopus. Se seleccionó un total de 23 artículos según los criterios de inclusión establecidos. Entre estos, se logró identificar intervenciones para el control del dolor (A), el despertar y la respiración espontánea (B), sedación de la analgesia y sedación (C), monitorización del delirium (D), movilidad temprana (E) y el empoderamiento de la familia (F). Todo el paquete ABCDEF y sus componentes mostraron efectividad en la reducción de la incidencia y duración del delirium, así como de los días de ventilación mecánica y de la mortalidad.
Conclusiones: las intervenciones del paquete ABCDEF identificadas fueron la monitorización del dolor y su control con fármacos y relajación; la implementación del protocolo de despertar y respiración espontánea, según criterios de seguridad; la administración de analgesia antes de la sedación —siendo esta última nula o mínima—, monitorizando el estado de conciencia y profundidad de la sedación con escalas validadas y monitorizando el delirium al menos una vez al día; movilización temprana, progresiva y al máximo potencial que se pueda lograr; y la vinculación de la familia en las rondas, en el cuidado básico y en la prevención del delirium.
Objective: To describe the interventions of each component of the ABCDEF bundle and their effectiveness in the prevention and treatment of delirium in patients hospitalized in intensive care units.
Content synthesis: Scoping review using the MeSH terms delirium and intensive care units, adding
ABCDEF through the AND operator, in the databases Medline, ScienceDirect, Virtual Health Library, and Scopus. A total of 23 articles were identified based on the inclusion criteria. From these works, it was possible to identify interventions for pain control (A), awakening and spontaneous breathing (B), sedation from analgesia and sedation (C), monitoring of delirium (D), early mobility (E), and family empowerment (F). The ABCDEF bundle and its components showed effectiveness in reducing
the incidence and duration of delirium, as well as the days of mechanical ventilation and mortality.
Conclusions: The ABCDEF bundle interventions identified were pain monitoring and its control with
drugs and relaxation; the implementation of the protocol of awakening and spontaneous breathing according to safety criteria; the administration of analgesia before sedation —being this null or minimal—, monitoring the state of consciousness and depth of sedation with validated scales, as well as monitoring delirium at least once a day; early, progressive and maximum-potential mobilization; and engaging family members in the rounds, basic care, and prevention activities for treating delirium.
Objetivo: descrever as intervenções de cada componente do pacote ABCDEF e sua eficácia na prevenção e no tratamento do delirium em pacientes internados em terapia intensiva.
Síntese do conteúdo: foi realizada uma revisão de escopo, utilizando os termos MeSH delirium e intensive care units, e acrescentando ABCDEF com o operador AND, nas bases de dados Medline, ScienceDirect, Biblioteca Virtual de Saúde e
Scopus, chegando a 23 artigos de acordo com os critérios de inclusão. Destes, foi possível identificar intervenções para controle da dor (A); despertar e respiração espontânea (B); sedação de analgesia e sedação (C); monitorar delirium (D); mobilidade precoce (E) e empoderamento familiar (F). O ABCDEF e seus componentes mostraram-se eficazes na redução da incidência e da duração do delirium, bem como dos dias de ventilação mecânica e mortalidade.
Conclusões: as intervenções do pacote ABCDEF encontradas foram: monitoramento da dor e seu controle com medicamentos e relaxamento;
implantação do protocolo de despertar e respiração espontânea segundo critérios de segurança; administração de analgesia antes da sedação,
— sendo esta última nula ou mínima —, monitorando o estado de consciência e profundidade da sedação com escalas validadas, monitorando delirium pelo menos uma vez ao dia; mobilização precoce, progressiva e ao máximo potencial que possa ser
alcançado; e vinculação da família nas rondas, na atenção básica e na prevenção do delirium.
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