Abordaje Integral para prevenir alteraciones mentales en pacientes de la Unidad de Cuidados Intensivos (UCI)

Joselyn Lizeth Coyago Puente; Katherine Imbaquingo; Juleiky García Beracierto

doi:10.37431/conectividad.v5i4.183

Authors

Joselyn Lizeth Coyago Puente Universidad Iberoamericana del Ecuador https://orcid.org/0000-0002-4432-4782
Katherine Imbaquingo Universidad Iberoamericana del Ecuador https://orcid.org/0009-0000-1918-7264
Juleiky García Beracierto Universidad Iberoamericana del Ecuador https://orcid.org/0000-0003-2748-0895

DOI:

https://doi.org/10.37431/conectividad.v5i4.183

Keywords:

Mental disorders, approaches, nursing, intensive care unit

Abstract

Introduction: The Intensive Care Unit (ICU) is a complex environment that generates a great psychological impact on patients, which can trigger mental disorders such as delirium, depression, anxiety, and acute or post-traumatic stress. Objective: To analyze the comprehensive approach to the prevention of mental disorders in ICU patients. Methodology: A descriptive, non-experimental, qualitative systematic review was conducted, using databases such as PubMed, SciELO, Scopus, and ScienceDirect. Results: 12 articles were identified that detail current tools used by various health professionals to prevent mental disorders in ICUs. Interventions such as pain control, spontaneous breathing, family participation, music, and healthy sleep were shown to be effective in reducing delirium in critically ill patients. Cognitive, auditory, and sensory stimulation, along with early mobilization, were also effective in reducing delirium and anxiety. Desensitization and reprocessing therapy showed a significant reduction in anxiety, while ICU diaries were not useful in preventing post-traumatic stress. Conclusions: Although many interventions are effective, further research is crucial to develop new strategies to reduce these pathologies and improve the quality of life of patients.

References

Alberdi Canillas, J., García Gómez, P., Suarez Caballero, B. J., Alberdi Canillas, J., García Gómez, P., & Suarez Caballero, B. J. (2020). Impacto psicosocial en personal sanitario víctima de agresiones por parte de la ciudadanía: una revisión sistemática. Medicina y Seguridad Del Trabajo, 66(259), 100–111. https://doi.org/10.4321/S0465-546X2020000200004.

Bates, A., Golding, H., Rushbrook, S., Shapiro, E., Pattison, N., Baldwin, D., Grocott, M., & Cusack, R. (2023). A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19. Journal of the Intensive Care Society, 24(3), 309. https://doi.org/10.1177/17511437221136828

Borzikowsky, C., Howroyd, F., Brobeil, A., Lindner, M., von Haken, R., McWilliams, D., Nydahl, P., & Weiler, N. (2022). Mobilization in the evening to prevent delirium: A pilot randomized trial. Nursing in Critical Care, 27(4), 519–527. https://doi.org/10.1111/NICC.12638.

Brennstuhl, M. J., Pascale, T., Rydberg, J., Tarquinio, C., Peter, L., Rotonda, C., & Tarquinio, C. (2022). Treating COVID-19 patients with EMDR: A pilot study. European Journal of Trauma & Dissociation, 6(3), 100276. https://doi.org/10.1016/J.EJTD.2022.100276.

Cedeño Vivar, V. M., Casas Rodríguez, J., Moreno Sasig, N. G., & Campuzano Franco, M. A. (2021). Consecuencias que generan a los pacientes ingresados en la unidad de terapia intensiva. RECIMUNDO, 5(1), 179–185. https://doi.org/10.26820/recimundo/5.(esp.1).nov.2021.179-185.

Chahal, J. K., Sharma, P., Sulena, & Rawat, H. C. L. (2021). Effect of music therapy on ICU induced anxiety and physiological parameters among ICU patients: An experimental study in a tertiary care hospital of India. Clinical Epidemiology and Global Health, 11, 100716. https://doi.org/10.1016/J.CEGH.2021.100716

Del Campo Rivas, M. N., Alarcon Tapia, K., Escobar Coccio, M., Bañados Leiro, Y., Silva Ríos, A. P., del Campo Rivas, M. N., Alarcon Tapia, K., Escobar Coccio, M., Bañados Leiro, Y., & Silva Ríos, A. P. (2020). Evaluación económica del costo de estadía hospitalaria en una unidad de paciente crítico. Ciencia y Enfermería, 26, 1–8. https://doi.org/10.29393/CE26- 11EEMK50011

Duque, C., & Arias, M. (2022). La familia en la unidad de cuidados intensivos frente a una crisis situacional. Enfermería Intensiva, 33(1), 4–19. https://doi.org/10.1016/J.ENFI.2021.02.003

Fernández Trujillo, A., López Ortiz, C., Cuñat Rodriguez, O., del Hoyo Buxo, B., Parrilla, F. J., Serrano-Blanco, A., & Berrade Zubiri, J. J. (2022). Antecedente de trastorno mental en la UCI e interconsulta a psiquiatría. Medicina Intensiva, 46(10), 559–567. https://doi.org/10.1016/J.MEDIN.2021.03.013

Gómez, L., & Henao, A. (2024). Dynamic delirium – Nursing intervention to reduce delirium in patients critically Ill, a randomized control trial. Intensive and Critical Care Nursing, 83, 103691. https://doi.org/10.1016/J.ICCN.2024.103691

Hsiao, W. L., Hsieh, P. Y., Hsu, L. F., Lai, Y. H., Wang, M. L., & Yeh, Y. C. (2024). Effectiveness of a delirium risk assessment and multidisciplinary care approach in reducing delirium incidence among surgical intensive care unit patients: A retrospective pre-post intervention study. Journal of Clinical Anesthesia, 98, 111566. https://doi.org/10.1016/J.JCLINANE.2024.111566

Instituto Nacional para la Excelencia en la Salud y la Atención (NICE). (2023).Delirium: prevention, diagnosis and management in hospital and long-term care.

NICE Guideline, January. https://www.ncbi.nlm.nih.gov/books/NBK553009/ Jawed, Y. T., Golovyan, D., Lopez, D., Khan, S. H., Wang, S., Freund, C., Imran, S.,Hameed, U. Bin, Smith, J. P., Kok, L., & Khan, B. A. (2021). Feasibility of a virtual reality intervention in the intensive care unit. Heart & Lung: The Journal of Critical Care, 50(6), 748. https://doi.org/10.1016/J.HRTLNG.2021.05.007

Khan, S. H., Xu, C., Purpura, R., Durrani Mbbs, S., Lindroth, H., Wang, S., Gao, S., Heiderscheit, A., Chlan, L., Boustani, M., & Khan, B. A. (2020). Decreasing Delirium Through Music: A Randomized Pilot Trial. American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses, 29(2), e31–e38. https://doi.org/10.4037/AJCC2020175

Li, Y., Peng, J., Yang, P., Weng, J., Liu, J., Xu, S., Guan, L., Huang, D., Wang, Q., Qian, J., Zhao, Z., Wei, Y., Ge, J., & Huang, X. (2024). Virtual reality-based cognitive-behavioural therapy for the treatment of anxiety in patients with acute myocardial infarction: a randomised clinical trial. Psychiatry, 37, 101434. https://doi.org/10.1136/gpsych-2023-101434

Mann, S. K., Marwaha, R., & Torrico, T. J. (2024). Posttraumatic Stress Disorder. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK559129/

Moldes, M., González, M., Díaz, R., & Paz, N. (2019). Necesidades psicosociales y alteraciones psicológicas más comunes del paciente grave en Terapia Intensiva Cardiológica Most common psychological needs and psychosocial alterations of grave patients in The Cardiological Intensive Care Unit. XVIII Congreso de La Sociedad Cubana de Enfermería. https://congresosenfermeriacubana.sld.cu/index.php/enfermeria22/2022/paper/v iewFile/243/86

Nydahl, P., Fischill, M., Deffner, T., Neudeck, V., & Heindl, P. (2019). [Diaries for intensive care unit patients reduce the risk for psychological sequelae: Systematic literature review and meta-analysis]. Medizinische Klinik, Intensivmedizin Und Notfallmedizin, 114(1), 68–76. https://doi.org/10.1007/S00063-018-0456-4

Organización Mundial de la Salud. (2022, June 8). Trastornos mentales. https://www.who.int/es/news-room/fact-sheets/detail/mental-disorders

Palmero Picazo, J., & Lassard Rosenthal, J. (2021). Delirium: una revisión actual.

Aten Fam, 28(4). https://doi.org/10.22201/fm.14058871p.2021.4.80600

Pun, Brenda T. DNP, RN, FCCM1; Balas, Michele C. PhD, RN, CCRN-K, FCCM, FAAN2,3; Barnes-Daly, Mary Ann MS, RN, CCRN-K, DC4; Thompson, Jennifer L. MPH5; Aldrich, J. Matthew MD6; Barr, Juliana MD, FCCM7,8; Byrum, Diane MSN, RN, CCRN-K, CCNS, FCCM9; Carson, Shannon S. MD10; Devlin, John W. PharmD, FCCM11; Engel, Heidi J. PT, DPT12; Esbrook, Cheryl L. OTR/L, BCPR13; Hargett, Ken D. MHA, FAARC, FCCM14; Harmon, Lori RRT, MBA, CPHQ15; Hielsberg, Christina MA15; Jackson, James C. PsyD1; Kelly, Tamra L. BS, RRT, MHA4; Kumar, Vishakha MD, MBA15; Millner, Lawson RRT16; Morse, Alexandra PharmD4; Perme, Christiane S. PT, CCS, FCCM14; Posa, Patricia J. BSN, MSA, CCRN-K17; Puntillo, Kathleen A. PhD, RN, FCCM, FAAN18; Schweickert, William D. MD19; Stollings, Joanna L. PharmD, FCCM20; Tan, Alai PhD2; D’Agostino McGowan, Lucy PhD21; Ely, E. Wesley MD, MPH, FCCM1,22. Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults. Critical Care Medicine 47(1):p 3-14, January 2019. | DOI: 10.1097/CCM.0000000000003482

Rincón, M., Giordani, C., Duarte, N., Torres, C., Páez, A., & Durán, M. (2021). Multicomponent nursing program to prevent delirium in critically ill patients: a randomized clinical trial. Revista Gaucha de Enfermagem, 42. https://doi.org/10.1590/1983-1447.2021.20200278

Rodríguez, J. (2019). Cuidados de enfermería basados en evidencia y modelo de Betty Neuman, para controlar estresores del entorno que pueden ocasionar delirium en unidad de cuidados intensivos. Scielo. https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1695- 61412016000100004

Rose, L., Muttalib, F., & Adhikari, N. K. J. (2019). Psychological Consequences of Admission to the ICU: Helping Patients and Families. JAMA, 322(3), 213–215. https://doi.org/10.1001/JAMA.2019.9059

Ruidiaz, K., & Fernández, S. (2020). Temor y angustia: experiencia del paciente en la unidad de cuidados intensivos. Revista Ciencia y Cuidado, 17(3), 7–19. https://doi.org/10.22463/17949831.1695

Sayde, G., Stefanescu, A., Conrad, E., Nielsen, N., & Hammer, R. (2020). Implementing an intensive care unit (ICU) diary program at a large academic medical center: Results from a randomized control trial evaluating psychological morbidity associated with critical illness. General Hospital Psychiatry, 66, 96. https://doi.org/10.1016/J.GENHOSPPSYCH.2020.06.017

Sosa, G. K., Véliz, G. Y., Alcívar, M. F., & Jalca, J. E. (2022). Epidemiología de los problemas mentales: Factores de Riesgo y Causas en Habitantes de Latinoamérica. Revista Científica Higía de La Salud, 7(2). https://doi.org/10.37117/HIGIA.V7I2.752.

Tilouche, N., Hassen, M. F., Ali, H. B. S., Jaoued, O., Gharbi, R., & El Atrous, S. (2019). Delirium in the Intensive Care Unit: Incidence, Risk Factors, and Impact on Outcome. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 22(3), 144. https://doi.org/10.4103/IJCCM.IJCCM_244_17

Torres, C., Páez, A., Rincon, M., Rivera, R., Márquez, M., & Díaz, A. (2021). Nursing intervention to prevent delirium in critically ill adults. Revista Da Escola de Enfermagem Da USP, 55, e03685. https://doi.org/10.1590/S1980- 220X2019035003685

Vélez, J. L., Tercero, W., Bucheli, R., & Valles, V. (2018). Epidemiología del delirio en una cohorte de pacientes críticos en la Unidad de Terapia Intensiva del Hospital Pablo Arturo Suárez, 2017. Metro Ciencia, 26(2), 63–65. https://doi.org/10.1016/J.AJEM.2016.12.075

Wu, T. T., Kooken, R., Zegers, M., Ko, S., Bienvenu, O. J., Devlin, J. W., & Van Den Boogaard, M. (2022). Baseline Anxiety and Depression and Risk for ICU Delirium: A Prospective Cohort Study. Critical Care Explorations, 4(7), E0743. https://doi.org/10.1097/CCE.0000