Association between perioperative hypotension and postoperative delirium and atrial fibrillation after cardiac surgery: A post-hoc analysis of the DECADE trial

Wang, Jiayi; Mao, Guangmei; Malackany, Natasha; Marciniak, Donn; Donaldson, Chase; Wakefield, Brett J.; Hassan, Mohd Hasyizan; Ruetzler, Kurt; Sessler, Daniel I.; Turan, Alparslan

doi:10.1016/j.jclinane.2021.110584

Cited by 13 publications

(5 citation statements)

References 31 publications

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“…Three (1932 patients) out of six (3119 patients) included studies were designed to study the hypotension-delirium relationship [ 39 – 41 ]. One reported an association in favor of 'no hypotension,' while none favored hypotension.…”

Section: Resultsmentioning

confidence: 99%

Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis

Schuurmans,

van Rossem,

Rellum

et al. 2024

Intensive Care Med

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Purpose The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and morbidity, and to assess whether there is an exposure-severity relationship between hypotension exposure and patient outcomes. Methods CENTRAL, Embase, and PubMed were searched up to October 2022 for articles that reported an association between hypotension during ICU stay and at least one of the 11 predefined outcomes. Two independent reviewers extracted the data and assessed the risk of bias. Results were gathered in a summary table and studies designed to investigate the hypotension-outcome relationship were included in the meta-analyses. Results A total of 122 studies (176,329 patients) were included, with the number of studies varying per outcome between 0 and 82. The majority of articles reported associations in favor of ‘no hypotension’ for the outcomes mortality and acute kidney injury (AKI), and the strength of the association was related to the severity of hypotension in the majority of studies. Using meta-analysis, a significant association was found between hypotension and mortality (odds ratio: 1.45; 95% confidence interval (CI) 1.12–1.88; based on 13 studies and 34,829 patients), but not for AKI. Conclusion Exposure to hypotension during ICU stay was associated with increased mortality and AKI in the majority of included studies, and associations for both outcomes increased with increasing hypotension severity. The meta-analysis reinforced the descriptive findings regarding mortality but did not yield similar support for AKI. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07304-4.

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Section: Resultsmentioning

confidence: 99%

Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis

Schuurmans,

van Rossem,

Rellum

et al. 2024

Intensive Care Med

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“…The CAM scale has good sensitivity (94–100%) and specificity (90–95%), is short, easy to understand and use, and is therefore highly regarded by clinicians 22 . POD is defined as any symptom of confusion that appears within 5 days of surgery 7,23 . “Delirium was assessed twice per day, between 06:00–08:00 and 18:00–20:00, with Chinese version of the CAM for non‐intubated patients and CAM‐ICU for intubated patients” 24 .…”

Section: Methodsmentioning

confidence: 99%

“…22 POD is defined as any symptom of confusion that appears within 5 days of surgery. 7,23 "Delirium was assessed twice per day, between 06:00-08:00 and 18:00-20:00, with Chinese version of the CAM for non-intubated patients and CAM-ICU for intubated patients". 24 Patients who met the diagnostic criteria for CAM were classified as Group POD; otherwise, they were classified as Group Non-POD.…”

Section: Postoperativedeliriummentioning

confidence: 99%

Cigarette smoking is linked to an increased risk of delirium following arthroplasty in patients suffering from osteoarthritic pain

Chen

et al. 2023

CNS Neurosci Ther

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AimsPostoperative delirium (POD) is a common postoperative complication, and the potential relationship between cigarette smoking and POD is still unclear. The current study evaluated the relationship between preoperative smoking status in patients suffering from osteoarthritic pain and POD after total knee arthroplasty (TKA).MethodsA total of 254 patients who had undergone unilateral TKA were enrolled between November 2021 and December 2022, with no gender limitation. Preoperatively, patients' visual analog scale (VAS) scores at rest and during movement, hospital anxiety and depression (HAD) scores, pain catastrophizing scale (PCS) scores and smoking status were collected. The primary outcome was the incidence of POD, which was evaluated by the confusion assessment method (CAM).ResultsA total of 188 patients had complete datasets for final analysis. POD was diagnosed in 41 of 188 patients (21.8%) who had complete data for analysis. The incidence of smoking was significantly higher in Group POD than in Group Non‐POD (22 of 41 patients [54%] vs. 47 of 147 patients [32%], p < 0.05). The postoperative hospital stays were also longer than those of Group Non‐POD (p < 0.001). Multiple logistic regression analysis showed that preoperative smoking (OR: 4.018, 95% CI: 1.158–13.947, p = 0.028) was a risk factor for the occurrence of POD in patients with TKA. The length of hospital stay was correlated with the occurrence of POD.ConclusionsOur findings suggest that patients who smoked preoperatively were at increased risk of developing POD following TKA.

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“…Could the commonly seen hypotension in patients receiving longer durations of dexmedetomidine be, itself, causing delirium, which obscures a weakly protective effect in those most vulnerable to hypoperfusion (e.g., older adults) and is exacerbated by longer durations of infusion? This seems unlikely; a posthoc analysis of the DECADE trial failed to show an association between intraoperative hypotension and delirium [26]. Thus, the possibility remains that these counterintuitive conclusions suggest a deeper problem with the underlying literature.…”

Section: Meta-analysis: Trials and Tribulationsmentioning

confidence: 99%

Cardiac surgery, ICU sedation, and delirium: is dexmedetomidine the silver bullet?

Smith

Whitlock

2022

Current Opinion in Anaesthesiology

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Purpose of reviewDelirium is a marker of acute brain insufficiency and a harbinger of poor outcomes and increased healthcare costs. Despite success preventing delirium by nonpharmacologic measures, the incidence in the postcardiac surgical ICU population remains high. Dexmedetomidine, a selective alpha-2 agonist, is a plausible preventive agent with sedative, anxiolytic, analgesic, sympatholytic and anti-inflammatory properties, and is the subject of very active study in cardiac surgery populations.Recent findingsRecent trials, including DEXACET (2019), DECADE (2020), LOWDEXDEL (2021), and DIRECT (2022) individually, failed to show a benefit for dexmedetomidine and highlighted associated risks. Meta-analyses have offered conflicting results, highlighting the complexity of delirium, and likely interaction of multiple etiological pathways; those that concluded benefit often were driven by trials at high risk of bias. Meta-analyses excluding biased trials currently suggest no benefit for dexmedetomidine over control in unselected cardiac surgical populations.SummaryAlthough using dexmedetomidine to prevent delirium in unselected cardiac surgical patients is not supported by current evidence, there remains hope that it may offer benefits in highly selected populations, and further trials are ongoing.

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Association between perioperative hypotension and postoperative delirium and atrial fibrillation after cardiac surgery: A post-hoc analysis of the DECADE trial

Cited by 13 publications

References 31 publications

Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis

Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis

Cigarette smoking is linked to an increased risk of delirium following arthroplasty in patients suffering from osteoarthritic pain

Cardiac surgery, ICU sedation, and delirium: is dexmedetomidine the silver bullet?

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