Postoperative Delirium in Cardiac Surgery Patients (original) (raw)
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Postoperative delirium after cardiac surgery; incidence, management and prevention
SUMMARY Delirium is an acute neurological state branded as confusion, distraction, and varied consciousness. Other symptoms include disorientation, memory impairment, perceptual disturbances, altered psycho-motor activity, and sleep disturbances. Gilman was the first person to report delirium as a complication of cardiac surgery in 1965. Despite peri-operative advancements, including both surgical and anesthetic, delirium is a frequent post cardiac surgery complication. Delirium is a common menace in the cardiac surgical ICU and outcome consequences of greater number of morbidity and mortality. Recent research has identified possible hazards for the occurrence of delirium and strategies to treat it. However, more studies are required to standardize the risk factors, its occurrence and treatment strategies in post cardiac surgical patients.
DELIRIUM POST CARDIAC SURGERY: REVIEW ON EPIDEMIOLOGY AND ASSOCIATED RISK FACTORS
Background: Delirium is a multifaceted condition in which the exact pathophysiology is still unknown. There are enormous risk factors associated with the development of delirium. Post cardiac surgery delirium is prevalent. Aim: This literature review is aimed to identify the incidence and associated risk factors of delirium among the population of post cardiac surgery adult patients. Methods: Literature search was carried out on CINAHL, MEDLINE, Google Scholar, Ovid, and Science Direct. The searching timeframe has been limited between the years 2012 and 2017. Findings: Thirteen studies were included in the final review. Incidence of delirium post cardiac surgery varied from 4.1% up to 68%. Post cardiac surgery delirium associated risk factors are categorized as preoperative, intraoperative, and post operative risk factors. Among the most frequently associated factors are advancement of age, stroke, hypertension, atrial fibrillation, history of diabetes mellitus, prolonged Cardio Pulmonary Bypass (CPB) time, time spent on mechanical ventilation, length of ICU stay, and transfusion of blood and it is products. Conclusion: There is a gap in the estimated incidence of delirium post cardiac surgery patients in addition to varied identified risk factors, because of the use of different diagnostic tools and protocols for delirium assessment. There is a need for a unified, standardized tool for delirium assessment among this population.
Delirium in ICU patients following cardiac surgery: An observational study
Journal of Clinical Nursing, 2018
Aims and objectivesTo observe the clinical and structural factors that can be associated with the post‐operative onset of delirium in patients who have undergone heart surgery.BackgroundSeveral risk factors could contribute to the development of delirium, such as the use of some sedative drugs and a patient's history with certain types of acute chronic disease. However, in the literature, there is little knowledge about the association between delirium in patients who have undergone cardiac surgical intervention and their clinical and environmental predictors.DesignWe used an observational design.MethodsWe enrolled 89 hospitalised patients in the ICU. Patients were first evaluated using the Richmond Agitation Sedation Scale and subsequently using the Confusion Assessment Method for the ICU. A linear model of regression was used to identify the predictors of delirium in patients.ResultsThe patients had an average age of 89 years (SD = 6.9), were predominantly male (84.3%) and wer...
Preoperative predictors of delirium after cardiac surgery: a preliminary study
General Hospital Psychiatry, 2006
Preoperative risk factors of postoperative delirium were evaluated in 260 patients admitted for open heart surgery. The incidence of delirium was 11.5%. Independent predictors included cognitive impairment, atrial fibrillation, a history of peripheral vascular disease major depression and advanced age. Aforementioned factors might be helpful in predicting delirium following cardiac surgery. D
Evaluation of the prevalence and risk factors of delirium in cardiac surgery ICU
Journal of cardiovascular and thoracic research, 2013
Delirium is defined as an acute cognitive disorder presenting with fluctuation in cognition, apathy and non-organized thinking. It may increase morbidity, mortality, ICU stay and cost. In patients who underwent heart surgery delirium may increase post-operative complications such as respiratory insufficiency, sternum instability and need to re-operation of the sternum. The aim of this study was to evaluate the prevalence and risk factors of delirium in patients admitted to cardiac surgery. 18 years or older patients who had undergone cardiac surgeries and stayed for more than 24 hours in ICU following surgery were recruited. All subjects were assessed for signs & symptoms of delirium using CAM-ICU and its risk factors. All data were analyzed by SPSS 16 at the end of the study. The prevalence of delirium in these patients was 23.5% (47 patients). The mean age of patients with delirium was more than other patients (P=0.001). The Incidence of delirium in the patients with cardiopulmona...
Delirium after cardiac surgery: A pilot study from a single tertiary referral center
Annals of cardiac anaesthesia
Advances in cardiac surgery has shifted paradigm of management to perioperative psychological illnesses. Delirium is a state of altered consciousness with easy distraction of thoughts. The pathophysiology of this complication is not clear, but identification of risk factors is important for positive postoperative outcomes. The goal of the present study was to prospectively identify the incidence, motoric subtypes, and risk factors associated with development of delirium in cardiac surgical patients admitted to postoperative cardiac intensive care, using a validated delirium monitoring instrument. This is a prospective, observational study. This study included 120 patients of age 18-80 years, admitted to undergo cardiac surgery after applying inclusion and exclusion criteria. Specific preoperative, intraoperative, and postoperative data for possible risk factors were obtained. Once in a day, assessment of delirium was done. Continuous variables were measured as mean ± standard deviat...
Outcomes associated with postoperative delirium after cardiac surgery
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2015
Delirium after surgery is a common condition that leads to poor outcomes. Few studies have examined the effect of postoperative delirium on outcomes after cardiac surgery. To assess the relationship between delirium after cardiac surgery and the following outcomes: length of stay after surgery, prevalence of falls, discharge to a nursing facility, discharge to home with home health services, and use of inpatient physical therapy. Electronic medical records of 656 cardiac surgery patients were reviewed retrospectively. Postoperative delirium occurred in 161 patients (24.5%). Patients with postoperative delirium had significantly longer stays (P < .001) and greater prevalence of falls (P < .001) than did patients without delirium. Patients with delirium also had a significantly greater likelihood for discharge to a nursing facility (P < .001) and need for home health services if discharged to home (P < .001) and a significantly higher need for inpatient physical therapy (P...
Delirium after cardiac surgery: incidence and risk factors
Interactive cardiovascular and thoracic surgery, 2013
Delirium after cardiac surgery is a problem with consequences for patients and healthcare. Preventive strategies from known risk factors may reduce the incidence and severity of delirium. The present aim was to explore risk factors behind delirium in older patients undergoing cardiac surgery with cardiopulmonary bypass. Patients (≥70 years) scheduled for routine cardiac surgery were included (n = 142). The patients were assessed and monitored pre-/postoperatively, and delirium was diagnosed from repeated assessments with the Mini-Mental State Examination and the Organic Brain Syndrome Scale, using the DSM-IV-TR criteria. Variables were analysed by uni-/multivariable logistic regression, including both preoperative variables (predisposing) and those extracted during surgery and in the early postoperative period (precipitating). Delirium was diagnosed in 78 patients (54.9%). Delirium was independently associated with both predisposing and precipitating factors (P-value, odds ratio, up...
Perioperative predictors of delirium and incidence factors in adult patients post cardiac surgery
Pragmatic and Observational Research
Background: Delirium is a quite common complication in adult patients post-cardiac surgery. The purpose of our study was to identify perioperative characteristics and also focus on incidence factors that could predict delirium in the cardiac surgery intensive care unit (CICU) postoperatively. Methods: We conducted a prospective study of 179 consecutive patients, who underwent open-heart surgical operation and were admitted to the CICU of a general tertiary hospital in Athens, Greece. The patients were screened for delirium by using the diagnostic tools of Richmond Agitation Sedation Scale (RASS score) and the Confusion Assessment Method-ICU (CAM-ICU). The delirium assessment was carried out on the 1st and the 2nd postoperative day, and was conducted twice every nursing shift. A short questionnaire on sociodemographics and clinical patient characteristics was used for data collection purposes. Results: A total of 179 patients who underwent open-heart surgical operation with cardiopulmonary bypass (CPB) were enrolled in our study. The 2-day incidence of postoperative delirium in ICU was 11.2% (n=20/179). The main independent predictors of delirium on the 2nd postoperative day were neutrophil-to-lymphocyte ratio (p=0.001) and urea levels (p=0.016). Additionally, increased perioperative creatinine (p=0.006) and sodium (p=0.039) levels were significantly associated with delirium occurrence. Furthermore, elevated EuroSCORE (p=0.001), extended length of stay (LOS) in ICU (p<0.001), and extended LOS with endotracheal tube (p=0.001) were also statistically significant indicators. Conclusion: Patients with extended LOS with endotracheal tube and prolonged stay in ICU in accordance with peaked urea, neutrophil-to-lymphocyte ratio, creatinine, and sodium levels seem to have a significantly greater probability of developing delirium in the ICU. Further research is needed in the field of postoperative cardiac patients in order to determine the causality and etiology of certain risk factors for delirium.
BioMed Research International, 2013
Background. Previous reports provided inconsistent data on the occurrence of postoperative delirium and emphasized its considerable impact on outcome. This study sought to evaluate the incidence and predictors of delirium, together with its relation to cerebral ischemia in a large cohort of cardiac surgery patients in a tertiary high-volume center. Methods and Results. Consecutive patients (n = 8792) were prospectively enrolled from 2003 to 2008. Exclusion criteria were history of psychiatric disorders, use of psychoactive drugs, alcohol abuse, and data incompleteness. Finally, 5781 patients were analyzed in terms of 100 perioperative patient-specific and treatment variables. The incidence of postoperative delirium (DSM IV criteria) was 4.1% and it coexisted with cerebral ischemia in 1.1% of patients. In bivariate analysis, 49 variables were significantly linked to postoperative delirium. Multivariate analysis confirmed that delirium was independently associated with postoperative stroke (logistic odds ratio (logOR) = 2.862, P = 0.004), any blood transfusions (logOR = 4.178, < 0.0001), age > 65 years (logOR = 2.417, P = 0.002), carotid artery stenosis (logOR = 2.15, P = 0.01), urgent/emergent surgery (logOR = 1.982, P = 0.02), fasting glucose level, intraoperative oxygen partial pressure fluctuations, and hematocrit. Area under ROC curve for the model was 0.8933. Conclusions. Early identification of nonpsychiatric perioperative determinants of delirium facilitates its diagnosis and might help develop preventive strategies to improve long-term outcome after cardiac surgery procedures.