Percepções reais e ilusórias de pacientes em coma induzido

As principais memórias relatadas após o coma induzido são sede, frio e dor. Há estudos em que os pacientes afirmaram não distinguir se estavam acordados ou sonhando, se o que acontecia era real ou irreal. Identificaram-se relatos de memórias satisfatórias relacionadas ao cuidado recebido e ao uso de diários de cabeceira.

Conclusão:

As evidências mostraram um leque de estudos direcionados a identificar o delirium, porém com menor foco na identificação da percepção real ou ilusória do paciente após coma induzido. Desse modo, esta revisão integrativa proporcionou a identificação de evidências científicas sobre as memórias relativas à percepção do paciente sedado e em estadia na Unidade de Terapia Intensiva.

Descritores:
Sedação Profunda; Memória; Delírio; Cuidados Críticos; Enfermagem

Nível de evidência	Delineamento metodológico	Número de participantes	Percepções identificadas
VI	Qualitativo	10 pacientes	Memórias de delirium, medo e insegurança⁽¹³13 Svenningsen H, Egerod I, Dreyer P. Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur’s interpretation theory. J Clin Nurs [Internet]. 2016 [cited 2017 Dec 22];25(19-20):2807-15. Available from: https://doi.org/10.1111/jocn.13318 https://doi.org/10.1111/jocn.13318... ⁾
VI	Qualitativo	14 pacientes	Memória de intubação e dor incontrolada, mesmo com a administração de sedativos e analgésicos⁽¹⁴14 Fink RM, Makic MB, Poteet AW, Oman KS. The ventilated patient’s experience. Dimens Crit Care Nurs [Internet]. 2015 [cited 2017 Dec 22];34(5):301-8. Available from: https://doi.org/10.1097/DCC.0000000000000128 https://doi.org/10.1097/DCC.000000000000... ⁾
VI	Qualitativo	4 pacientes	Memórias de si mesmo, como externas a si⁽¹⁵15 Whitehorne K, Gaudine A, Meadus R, Solberg S. Lived experience of the intensive care unit for journal who experienced delirium. Am J Crit Care [Internet]. 2015 [cited 2017 Dec 22];24(6):474-9. Available from: https://doi.org/10.4037/ajcc2015435 https://doi.org/10.4037/ajcc2015435... ⁾
VI	Qualitativo	24 pacientes	O uso do diário de cabeceira possibilitou o resgate de memórias consistentes⁽¹⁶16 Clukey L, Weyant RA, Roberts M, Henderson A. Discovery of unexpected pain in intubated and sedated patients. Am J Crit Care. [Internet] 2014 [cited 2017 Dec 22];23(3):216-20 Available from: https://doi.org/10.4037/ajcc2014943 https://doi.org/10.4037/ajcc2014943... ⁾.
IV	Coorte/ prospectiva	152 pacientes	Menor memória factual dos pacientes delirantes em relação aos não delirantes⁽⁸8 Costa JB, Marcon SS, Macedo CRL, Jorge AC, Duarte PAD. Sedation and memories of patients subjected to mechanical journal in an intensive care unit. Rev Bras Ter Intensiva [Internet]. 2014 [cited 2017 Dec 22];26(2):122-129. Available from: https://doi.org/10.5935/0103-507X.20140018 https://doi.org/10.5935/0103-507X.201400... ⁾
VI	Qualitativo	18 pacientes	Memória de medo e percepção de morte⁽¹⁷17 Ewens B, Champman R, Tulloch A, Hendricks JM. ICU survivors’ utilisation of diaries post discharge: A qualitative descriptive study. Aust Crit Care [Internet]. 2014 [cited 2017 Dec 22];27(1):28-35. Available from: https://doi.org/10.1016/j.aucc.2013.07.001 https://doi.org/10.1016/j.aucc.2013.07.0... ⁾
IV	Coorte/ prospectiva	115 pacientes	O uso do diário auxiliou na recuperação da memória⁽¹⁸18 Meriläinen M, Kyngäs H, Ala-Kokko T. Patient’s interactions in an intensive care unit and their memories of intensive care: a mixed method study. Intensive Crit Care Nurs [Internet]. 2013 [cited 2017 Nov 20];29(2):78-87. Available from: https://doi.org/10.1016/j.iccn.2012.05.003 https://doi.org/10.1016/j.iccn.2012.05.0... ⁾.
IV	Coorte/ prospectiva	641 pacientes	O delirium foi detectado em 65% dos pacientes, durante a primeira entrevista na UTI⁽¹⁹19 Engström Å, Nyström N, Sundelin G, Rattray J. People’s experiences of being mechanically ventilated in an ICU: a qualitative study. Intensive Crit Care Nurs [Internet]. 2013 [cited 2017 Nov 20];29(2):88-95. Available from: https://doi.org/10.1016/j.iccn.2012.07.003 https://doi.org/10.1016/j.iccn.2012.07.0... ⁾.
VI	Descritivo	8 pacientes	Os diários possibilitaram lembranças da doença, do tratamento, das reações do paciente e da presença e apoio de profissionais⁽²⁰20 Svenningsen H. Associations between sedation, delirium and posttraumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit. Dan Med J [Internet]. 2013 [cited 2017 Nov 20];60(4):B4630. Available from: https://www.researchgate.net/publication/236653057_Associations_between_sedation_delirium_and_post-traumatic_stress_disorder_and_their_impact_on_quality_of_life_and_memories_following_discharge_from_an_intensive_care_unit https://www.researchgate.net/publication... ⁾.
VI	Descritivo	84 pacientes 77 familiares	Memórias de dor, sem correlação com a percepção do familiar⁽²¹21 Åkerman E, Ersson A, Feidlund B, Samuelson K. Preferred content and usefulness of a photodiary as journal by ICU patients: a mixed method analysis. Aust Crit Care [Internet]. 2013 [cited 2017 Nov 20];26(1):29-35. Available from: https://doi.org/10.1016/j.aucc.2012.04.002 https://doi.org/10.1016/j.aucc.2012.04.0... ⁾
VI	Descritivo	250 pacientes	Memórias agradáveis de assistência, alívio de estresse e memórias angustiantes de sofrimento físico e angústia perceptiva⁽²²22 Samuelson KAM. Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patient - findings from 250 interviews. Intensive Crit Care Nurs [Internet]. 2011 [cited 2017 Nov 20];27(2):76-84. Available from: https://doi.org/10.1016/j.iccn.2011.01.003 https://doi.org/10.1016/j.iccn.2011.01.0... ⁾
VI	Qualitativo	325 pacientes	Memórias de delirium em entrevista face a face, após duas semanas, e em entrevista telefônica, após dois e seis meses, eram mistura de fatos vividos e ficção⁽²³23 Storli SL, Lind R. The meaning of follow-up in intensive care: patients’ perspective. Scand J Caring Sci [Internet]. 2009 [cited 2017 Nov 20];23(1):45-56. Available from: https://doi.org/10.1111/j.1471-6712.2007.00589.x https://doi.org/10.1111/j.1471-6712.2007... ⁾.
IV	Coorte/ prospectiva	128 pacientes	Memória de internação na UTI, com uma combinação de eventos reais e ilusórios⁽²⁴24 Engström Å, Grip K, Hamrém M. Experiences of intensive care unit diaries: touching a tender wound. Nurs Crit Care [Internet]. 2009 [cited 2017 Dec 22];14(2):61-7. Available from: https://doi.org/10.1111/j.1478-5153.2008.00312.x https://doi.org/10.1111/j.1478-5153.2008... ⁾
VI	Qualitativo	9 pacientes	O diário forneceu conhecimento sobre os acontecimentos dos quais os pacientes possuíam lembranças fragmentadas⁽²⁵25 Roberts BL, Rickard CM, Rajbhandari D, Reynolds P. Factual memories of ICU: recall at two years post-discharge and comparison with delirium status during ICU admission - a multicenter cohort study. J Clin Nurs [Internet]. 2007 [cited 2017 Dec 22];16(9):1669-77. Available from: http://doi.org/10.1111/j.1365-2702.2006.01588.x http://doi.org/10.1111/j.1365-2702.2006.... ⁾.
VI	Qualitativo	8 pacientes	Memórias de dependência e entrega a outras pessoas, dependência da tecnologia como se o corpo não pudesse funcionar⁽²⁶26 Roulin MJ, Hurst S, Spirig R. Diaries written for ICU patients. Qual Health Res [Internet]. 2007 [cited 2017 Dec 22];17(7):893-901. Available from: http://doi.org/10.1177/1049732307303304 http://doi.org/10.1177/1049732307303304... ⁾.

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[1] Autor Correspondente: Simone de Godoy. E-mail: sig@eerp.usp.br

Ano	Autor	Título do Artigo	Periódico	País
2016	Svenningsen H, Egerod I, Dreyer P⁽¹³13 Svenningsen H, Egerod I, Dreyer P. Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur’s interpretation theory. J Clin Nurs [Internet]. 2016 [cited 2017 Dec 22];25(19-20):2807-15. Available from: https://doi.org/10.1111/jocn.13318 https://doi.org/10.1111/jocn.13318... ⁾.	Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur's interpretation theory	Journal of clinical Nursing 25: 2807-2815	Dinamarca
2015	Fink RM, Makic MBF, Poteet AW, Oman KS⁽¹⁴14 Fink RM, Makic MB, Poteet AW, Oman KS. The ventilated patient’s experience. Dimens Crit Care Nurs [Internet]. 2015 [cited 2017 Dec 22];34(5):301-8. Available from: https://doi.org/10.1097/DCC.0000000000000128 https://doi.org/10.1097/DCC.000000000000... ⁾.	The ventilated patient`s experience	Dimensions of Critical Care Nursing 34: 301-308	EUA
2015	Whitehorne K, Gaudine A, Meadus R, Solberg S⁽¹⁵15 Whitehorne K, Gaudine A, Meadus R, Solberg S. Lived experience of the intensive care unit for journal who experienced delirium. Am J Crit Care [Internet]. 2015 [cited 2017 Dec 22];24(6):474-9. Available from: https://doi.org/10.4037/ajcc2015435 https://doi.org/10.4037/ajcc2015435... ⁾.	Lived experience of the intensive care unit for patients who experienced delirium	American Journal of Critical Care 24: 474-479	Canadá
2014	Clukey L, Weyant AR, Roberts M, Henderson A⁽¹⁶16 Clukey L, Weyant RA, Roberts M, Henderson A. Discovery of unexpected pain in intubated and sedated patients. Am J Crit Care. [Internet] 2014 [cited 2017 Dec 22];23(3):216-20 Available from: https://doi.org/10.4037/ajcc2014943 https://doi.org/10.4037/ajcc2014943... ⁾.	Discovery of unexpected pain in intubated and sedated patients	American Journal of Critical Care 23: 216-220	Canadá
2014	Costa JB, Marcon SS, Macedo CRL, Jorge AC, Duarte PAD⁽⁸8 Costa JB, Marcon SS, Macedo CRL, Jorge AC, Duarte PAD. Sedation and memories of patients subjected to mechanical journal in an intensive care unit. Rev Bras Ter Intensiva [Internet]. 2014 [cited 2017 Dec 22];26(2):122-129. Available from: https://doi.org/10.5935/0103-507X.20140018 https://doi.org/10.5935/0103-507X.201400... ⁾.	Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit.	Revista Brasileira de Terapia Intensiva 26: 122-129	Brasil
2014	Ewens B, Chapman R, Tulloch A, Hendricks JM⁽¹⁷17 Ewens B, Champman R, Tulloch A, Hendricks JM. ICU survivors’ utilisation of diaries post discharge: A qualitative descriptive study. Aust Crit Care [Internet]. 2014 [cited 2017 Dec 22];27(1):28-35. Available from: https://doi.org/10.1016/j.aucc.2013.07.001 https://doi.org/10.1016/j.aucc.2013.07.0... ⁾.	ICU survivors' utilisation of diaries post discharge: A qualitative descriptive study	Australian Critical Care 27: 28-35	Austrália
2013	Meriläinen M, Kyngäs H, Ala-Kokko T⁽¹⁸18 Meriläinen M, Kyngäs H, Ala-Kokko T. Patient’s interactions in an intensive care unit and their memories of intensive care: a mixed method study. Intensive Crit Care Nurs [Internet]. 2013 [cited 2017 Nov 20];29(2):78-87. Available from: https://doi.org/10.1016/j.iccn.2012.05.003 https://doi.org/10.1016/j.iccn.2012.05.0... ⁾.	Patients' interactions in an intensive care unit and their memories of intensive care: A mixed method study	Intensive and Critical Care Nursing 29: 78-87	Finlândia
2013	Engström A, Nyström N, Sundelin G, Rattray J⁽¹⁹19 Engström Å, Nyström N, Sundelin G, Rattray J. People’s experiences of being mechanically ventilated in an ICU: a qualitative study. Intensive Crit Care Nurs [Internet]. 2013 [cited 2017 Nov 20];29(2):88-95. Available from: https://doi.org/10.1016/j.iccn.2012.07.003 https://doi.org/10.1016/j.iccn.2012.07.0... ⁾.	People's experiences of being mechanically ventilated in an ICU: A qualitative study	Intensive and Critical Care Nursing 29: 88-95	Suécia
2013	Svenningsen H⁽²⁰20 Svenningsen H. Associations between sedation, delirium and posttraumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit. Dan Med J [Internet]. 2013 [cited 2017 Nov 20];60(4):B4630. Available from: https://www.researchgate.net/publication/236653057_Associations_between_sedation_delirium_and_post-traumatic_stress_disorder_and_their_impact_on_quality_of_life_and_memories_following_discharge_from_an_intensive_care_unit https://www.researchgate.net/publication... ⁾.	Associations between sedation, delirium and post-traumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit	Danish Medical Journal 60: 1-22	Dinamarca
2013	Akerman E, Ersson A, Fridlund B, Samuelson K⁽²¹21 Åkerman E, Ersson A, Feidlund B, Samuelson K. Preferred content and usefulness of a photodiary as journal by ICU patients: a mixed method analysis. Aust Crit Care [Internet]. 2013 [cited 2017 Nov 20];26(1):29-35. Available from: https://doi.org/10.1016/j.aucc.2012.04.002 https://doi.org/10.1016/j.aucc.2012.04.0... ⁾.	Preferred content and usefulness of a photodiary as described by ICU patients - a mixed method analysis	Australian Critical Care 26: 29-35	Austrália
2011	Samuelson KAM⁽²²22 Samuelson KAM. Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patient - findings from 250 interviews. Intensive Crit Care Nurs [Internet]. 2011 [cited 2017 Nov 20];27(2):76-84. Available from: https://doi.org/10.1016/j.iccn.2011.01.003 https://doi.org/10.1016/j.iccn.2011.01.0... ⁾.	Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patient - findings from 250 interviews	Intensive and Critical Care Nursing 27: 76-84	Suécia
2009	Storli SL, Lind R⁽²³23 Storli SL, Lind R. The meaning of follow-up in intensive care: patients’ perspective. Scand J Caring Sci [Internet]. 2009 [cited 2017 Nov 20];23(1):45-56. Available from: https://doi.org/10.1111/j.1471-6712.2007.00589.x https://doi.org/10.1111/j.1471-6712.2007... ⁾.	The meaning of follow-up in intensive care: patients' perspective	Scandinavian Journal of Caring Science 23: 45-56	Noruega
2008	Engström A, Grip K, Hamrén M⁽²⁴24 Engström Å, Grip K, Hamrém M. Experiences of intensive care unit diaries: touching a tender wound. Nurs Crit Care [Internet]. 2009 [cited 2017 Dec 22];14(2):61-7. Available from: https://doi.org/10.1111/j.1478-5153.2008.00312.x https://doi.org/10.1111/j.1478-5153.2008... ⁾.	Experiences of intensive care unit diaries: touching a tender wound	Nursing in Critical Care 14: 61-67	Suécia
2007	Roberts BL, Rickard CM, Rajbhandari D, Reynolds P⁽²⁵25 Roberts BL, Rickard CM, Rajbhandari D, Reynolds P. Factual memories of ICU: recall at two years post-discharge and comparison with delirium status during ICU admission - a multicenter cohort study. J Clin Nurs [Internet]. 2007 [cited 2017 Dec 22];16(9):1669-77. Available from: http://doi.org/10.1111/j.1365-2702.2006.01588.x http://doi.org/10.1111/j.1365-2702.2006.... ⁾.	Factual memories of ICU: recall at two years post-discharge and comparison with delirium status during ICU admission - a multicenter cohort study	Journal of Clinical Nursing 16: 1669-1677	Austrália e Nova Zelândia
2007	Roulin MJ, Hurst S, Spirig R⁽²⁶26 Roulin MJ, Hurst S, Spirig R. Diaries written for ICU patients. Qual Health Res [Internet]. 2007 [cited 2017 Dec 22];17(7):893-901. Available from: http://doi.org/10.1177/1049732307303304 http://doi.org/10.1177/1049732307303304... ⁾.	Diaries written for ICU patients	Qualitative Health Research 17: 893-901	Suíça