Delirium after cardiac surgery: A critical review

Mast, Rose C. van der; Roest, F. H. J.

doi:10.1016/0022-3999(96)00005-0

Cited by 70 publications

(33 citation statements)

References 55 publications

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“…Furthermore, the prevalence of delirium in critical care units is high, 78,79 and this is associated with the underlying condition and the severity of illness necessitating admission to a critical care unit. 80,81 Overall, the multifactorial nature of the causes of delirium is important. Inouye 9 found that the effects of precipitating factors and baseline vulnerability are multiplicative rather than additive.…”

Section: Predictors Of Postoperative Deliriummentioning

confidence: 99%

Postoperative Delirium After Colorectal Surgery in Older Patients

Mangnall¹,

Gallagher²,

Stein‐Parbury³

2010

American Journal of Critical Care

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Background Postoperative delirium in older patients results in worse outcomes and increased costs. The prevalence and predictors of postoperative delirium in patients undergoing major colorectal surgery are not clear. Objectives To determine the prevalence and predictors of postoperative delirium in older patients after major colorectal surgery. Methods Patients older than 50 years, without preexisting cognitive impairment, were recruited before surgery. These patients were assessed after surgery for delirium daily for 3 days by using the Confusion Assessment Method. Regression analysis was used to determine independent predictors of postoperative delirium. Results Patients (n = 118) had a mean age of 71.81 years, and approximately half were women (54%). Most participants (64%) were married, and comorbid conditions were common. Delirium developed in 35% of the patients in the 3 days after surgery and in 21% in the first 24 hours. New cases of delirium were identified on each of the 3 days after surgery, and a few patients (7%) had delirium for the entire 3 days. Odds for delirium in the first 24 hours were increased for patients who had early admission (odds ratio [OR] = 4.48; P = .06) and decreased for patients who were married (OR = 0.25; P = .01). Odds for delirium in the first 3 days after surgery were increased for men (OR = 4.27; P = .02), older patients (OR = 1.05; P = .04), and patients who stayed overnight in the critical care unit (OR = 2.97; P = .06). Conclusions Postoperative delirium is common and persistent in older patients in the first 3 days after colorectal surgery.

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Section: Predictors Of Postoperative Deliriummentioning

confidence: 99%

Postoperative Delirium After Colorectal Surgery in Older Patients

Mangnall¹,

Gallagher²,

Stein‐Parbury³

2010

American Journal of Critical Care

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“…34 Another review of the literature on postcardiotomy delirium concluded that there were no significant correlations between delirium and any psychological or demographic factor. 35 In summary, published research strongly points to underlying medical problems, rather than environmental or psychosocial factors, as the primary cause of delirium in the ICU. The proposition that ICU syndrome is in fact a delirium has been articulated previously, 36,37 yet the concept of a distinct ICU syndrome seems to persist in much of the peer-reviewed literature.…”

Section: Psychological Factorsmentioning

confidence: 99%

Intensive Care Unit Syndrome

McGuire¹,

Basten²,

Ryan³

et al. 2000

Arch Intern Med

177

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“…Higher rates are seen in emergent hip fracture surgery in which a large proportion of patients present with preoperative (4-36%) or post-operative delirium (up to 53%) [19]. Post-operative delirium after cardiac surgery varies from 2 to 57% according to the procedure, type of patients and study methodology [22,138]. In the context of sepsis, delirium affects 9-71% of patients [37].…”

Section: Introductionmentioning

confidence: 99%

The neuroinflammatory hypothesis of delirium

et al. 2010

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Delirium is a neuropsychiatric syndrome characterized by a sudden and global impairment in consciousness, attention and cognition. It is particularly frequent in elderly subjects with medical or surgical conditions and is associated with short-and long-term adverse outcomes. The pathophysiology of delirium remains poorly understood as it involves complex multi-factorial dynamic interactions between a diversity of risk factors. Several conditions associated with delirium are characterized by activation of the inflammatory cascade with acute release of inflammatory mediators into the bloodstream. There is compelling evidence that acute peripheral inflammatory stimulation induces activation of brain parenchymal cells, expression of proinflammatory cytokines and inflammatory mediators in the central nervous system. These neuroinflammatory changes induce neuronal and synaptic dysfunction and subsequent neurobehavioural and cognitive symptoms. Furthermore, ageing and neurodegenerative disorders exaggerate microglial responses following stimulation by systemic immune stimuli such as peripheral inflammation and/or infection. In this review we explore the neuroinflammatory hypothesis of delirium based on recent evidence derived from animal and human studies.

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Delirium after cardiac surgery: A critical review

Cited by 70 publications

References 55 publications

Postoperative Delirium After Colorectal Surgery in Older Patients

Postoperative Delirium After Colorectal Surgery in Older Patients

Intensive Care Unit Syndrome

The neuroinflammatory hypothesis of delirium

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