Objective: To describe the multiprofessional care for the management of critical patients in delirium in the ICU from the evidences found in the literature.Methods: This integrative review was carried out in the period from February 1 to June 30, 2016 through searches on PubMed, Scopus, Web of Science, and CINAHL, with the following descriptors: delirium, critical care e intensive care units, which brought up 17 original papers. Results:A bundle and a guideline, two systematic reviews, evidence 1a and four clinical trials, evidence 1b and 2b, cohort and observational studies were found. The multiprofessional care was presented to better understand the diagnosis of delirium, sedation pause, early mobilization, pain, agitation and delirium guidelines, psychomotor agitation, cognitive orientation, sleep promotion, environment and family participation. Conclusion:The care for delirium is wide and not specific, which determines its multifactorial aspect. Keywords: Delirium. Intensive care units. Critical care. Patient care team. Review. RESUMO Objetivo: Descrever os cuidados multiprofissionais para manejo de pacientes críticos em delirium na UTI a partir das evidências encontradas na literatura.Métodos: Trata-se de uma revisão integrativa realizada no período de 1º de fevereiro a 30 de junho de 2016, através de busca nas bases de dados PubMed, Scopus, Web of Science e CINAHL, com os descritores delirium, critical care e intensive care units que finalizou com 17 estudos originais. Resultados:Foram encontrados um bundle e uma diretriz, duas revisões sistemáticas, evidência 1a e quatro ensaios clínicos, evidência 1b e 2b, os demais estudos de coorte e observacionais. Os cuidados multiprofissionais foram apresentados para melhor entendimento em diagnóstico de delirium, pausa de sedação, mobilização precoce, diretrizes para dor, agitação e delirium, agitação psicomotora, orientação cognitiva, promoção do sono, ambiente e participação da família. Conclusão:Os cuidados para delirium são abrangentes e pouco específicos, determinando seu aspecto multifatorial. Palavras-chave: Delírio. Unidades de terapia intensiva. Cuidados críticos. Equipe de assistência ao paciente. Revisão. RESUMEN Objetivo: Se objetivó describir los cuidados multiprofesionales para manejo de pacientes críticos en delirium en la UCI, a partir de las evidencias encontradas en la literatura.Métodos: Se trata de una revisión integradora, realizada en el período del 1 de febrero al 30 de junio de 2016 a través de búsqueda en PubMed, Scopus, Web of Science, y CINAHL con descriptores delirium, critical care e intensive care units que finalizó con 17 estudios originales.Resultados: Se encontraron un bundle, una directriz, dos revisiones sistemáticos, evidencia 1a, cuatro ensayos clínicos, evidencia 1b y 2b, los demás estudios de cohorte y observacionales. Se presentaron los cuidados multiprofesionales para una mejor comprensión de diagnóstico de delirium, pausa de sedación, movilización temprana, directrices para el dolor, agitación, y delirium, agitación...

Objectives Gastric emptying testing (GET) assesses gastric motility, however is non-specific and insensitive for neuromuscular disorders. Gastric Alimetry (GA) is a new medical device combining non-invasive gastric electrophysiological mapping and validated symptom profiling. This study assessed patient-specific phenotyping using GA compared to GET. Methods Patients with chronic gastroduodenal symptoms underwent simultaneous GET and GA, comprising a 30-minute baseline, 99mTC-labelled egg meal, and 4-hour postprandial recording. Results were referenced to normative ranges. Symptoms were profiled in the validated GA App and phenotyped using rule-based criteria based on their relationships to the meal and gastric activity: i) sensorimotor; ii) continuous; and iii) other. Results 75 patients were assessed; 77% female. Motility abnormality detection rates were: GET 22.7% (14 delayed, 3 rapid); GA spectral analysis 33.3% (14 low rhythm stability / low amplitude; 5 high amplitude; 6 abnormal frequency); combined yield 42.7%. In patients with normal spectral analysis, GA symptom phenotypes included: sensorimotor 17% (where symptoms strongly paired with gastric amplitude; median r=0.61); continuous 30%; other 53%. GA phenotypes showed superior correlations with GCSI, PAGI-SYM, and anxiety scales, whereas Rome IV Criteria did not correlate with psychometric scores (p>0.05). Delayed emptying was not predictive of specific GA phenotypes. Conclusions GA improves patient phenotyping in chronic gastroduodenal disorders in the presence and absence of motility abnormalities with improved correlation with symptoms and psychometrics compared to gastric emptying status and Rome IV criteria. These findings have implications for the diagnostic profiling and personalized management of gastroduodenal disorders.

Purpose: To evaluate accuracy of defining characteristics (DCs) for impaired gas exchange (IGE), impaired spontaneous ventilation (ISV), and ineffective breathing pattern (IBP) in respiratory deterioration. Methods: This study is a retrospective analysis of medical records. The accuracy and predictive ability of DC or of clusters are calculated. Findings: In this study, 391 records were evaluated. For IGE, DCs or clusters with higher efficiency were "hypercapnia" (78%), "somnolence" (74.4%), and "hypercapnia + tachycardia" (88%); for ISV, the cluster with higher efficiency was "increased heart rate ± decrease in cooperation" (70.1%); and for IBP, no DC or cluster exceeded 70% efficiency. These were confirmed by logistic regression. Conclusion: Few DCs had adequate efficiency for respiratory nursing diagnoses, while in some cases clusters accounted for higher efficiency. Implications for Nursing Practice: Clusters of DC may be relevant for respiratory diagnoses.

Introduction Positive fluid status has been associated with a worse prognosis in intensive care unit (ICU) patients. Given the potential for errors in the calculation of fluid balance totals and the problem of accounting for indiscernible fluid losses, measurement of body weight change is an alternative non-invasive method commonly used for estimating body fluid status. The objective of the study is to compare the measurements of fluid balance and body weight changes over time and to assess their association with ICU mortality. Methods This prospective observational study was conducted in the 34-bed multidisciplinary ICU of a tertiary teaching hospital in southern Brazil. Adult patients were eligible if their expected length of stay was more than 48 hours, and if they were not receiving an oral diet. Clinical demographic data, daily and cumulative fluid balance with and without indiscernible water loss, and daily and total body weight changes were recorded. Agreement between daily fluid balance and body weight change, and between cumulative fluid balance and total body weight change were calculated. Results Cumulative fluid balance and total body weight change differed significantly among survivors and non survivors respectively, +2.53L versus +5.6L (p= 0.012) and -3.05kg vs -1.1kg (p= 0.008). The average daily difference between measured fluid balance and body weight was +0.864 L/kg with a wide interval: -3.156 to +4.885 L/kg, which remained so even after adjustment for indiscernible losses (mean bias: +0.288; limits of agreement between -3.876 and +4.452 L/kg). Areas under ROC curve for cumulative fluid balance, cumulative fluid balance with indiscernible losses and total body weight change were, respectively, 0.65, 0.56 and 0.65 (p= 0.14). Conclusion The results indicated the absence of correspondence between fluid balance and body weight change, with a more significant discrepancy between cumulative fluid balance and total body weight change. Both fluid balance and body weight changes were significantly different among survivors and non-survivors, but neither measurement discriminated ICU mortality.

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