Delirium After Cardiac Surgery and Cumulative Fluid Balance: A Case-Control Cohort Study

Mailhot, Tanya; Cossette, Sylvie; Lambert, Jean; Beaubien‐Souligny, William; Cournoyer, Alexis; O’Meara, Eileen; Maheu‐Cadotte, Marc‐André; Fontaine, Guillaume; Bouchard, Josée; Lamarche, Yoan; Benkreira, Aymen; Rochon, Antoine; Denault, André

doi:10.1053/j.jvca.2018.07.012

Cited by 20 publications

(20 citation statements)

References 37 publications

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“…Consequently, an increased in/out balance during surgery may be caused gas exchange disturbances, electrolyte balance disturbances, and low output. The in/out balance during surgery is possibly associated with postoperative delirium [34]. Smelter, et al reported that the in/out balance during surgery is an independent risk factor for delirium in patients who underwent cardiac surgery, (OR = 2.77 [95% CI = 1.51-5.11], p = 0.001) [35], in line with our findings.…”

Section: In/out Balance During the Surgerysupporting

confidence: 91%

Risk Factors for Postoperative Delirium after Cardiac Surgery

Matsuura¹,

Mitsuki²,

Akiko³

2018

Int Arch Nurs Health Care

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The currently reported incidence of delirium in the ICU is 20-50% [6-10]. Furthermore, there are reports that the incidence of delirium in patients after cardiac surgery ranges from 21% to 46% [11-13]. Delirium is linked to higher mortality and increased lengths of stay in the hospital or ICU [14-16], a higher frequency of medical accidents caused by dangerous behavior, and greater medical costs [17]. For these reasons, it is important for medical professions to prevent and detect delirium early in the clinical course and implement appropriate interventions.

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Section: In/out Balance During the Surgerysupporting

confidence: 91%

Risk Factors for Postoperative Delirium after Cardiac Surgery

Matsuura¹,

Mitsuki²,

Akiko³

2018

Int Arch Nurs Health Care

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“…A retrospective casecontrol cohort study demonstrated an association between the cumulative fluid balance and delirium, based on the hypothesis that a hypervolaemic state in combination with inflammation could lead to venous congestion reaching the brain. 36 Similarly to these results in cardiac surgical patients, Radtke et al 3 demonstrated a significant reduction of delirium after noncardiac surgery with depth of anesthesia monitoring and the associated prevention of excessive depth of anesthesia. However, the reduction of postoperative delirium was only by 20%, and whereas the authors observed lower mean BIS average in the control group (ie, potentially deeper anesthesia than necessary), mean BIS values were similar in both groups in the study by Radtke et al 3 Whether improved depth of anesthesia has an effect on postoperative mortality is currently assessed in the Balanced Anesthesia Study, which is a prospective randomized clinical trial assessing 2 levels of anesthetic depth on patient outcome after major surgery.…”

Section: Discussionmentioning

confidence: 87%

Intraoperative Optimization of Both Depth of Anesthesia and Cerebral Oxygenation in Elderly Patients Undergoing Coronary Artery Bypass Graft Surgery—A Randomized Controlled Pilot Trial

Kunst

Gauge

Salaunkey

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…Our findings also do no support this association. First, a highly positive fluid balance, often associated with CPB, was found to be associated with an increased incidence of postoperative delirium [ 29 ]. Second, as delirium incidence did not differ between OPCAB and CABG, it is unlikely that the perioperative increase of NT-proCNP in CPB promoted delirium.…”

Section: Discussionmentioning

confidence: 99%

Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study

et al. 2020

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Background and Objectives: Delirium is a common and major complication subsequent to cardiac surgery. Despite scientific efforts, there are no parameters which reliably predict postoperative delirium. In delirium pathology, natriuretic peptides (NPs) interfere with the blood–brain barrier and thus promote delirium. Therefore, we aimed to assess whether NPs may predict postoperative delirium and long-term outcomes. Materials and Methods: To evaluate the predictive value of NPs for delirium we retrospectively analyzed data from a prospective, randomized study for serum levels of atrial natriuretic peptide (ANP) and the precursor of C-type natriuretic peptide (NT-proCNP) in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (off-pump coronary bypass grafting; OPCAB). Delirium was assessed by a validated chart-based method. Long-term outcomes were assessed 10 years after surgery by a telephone interview. Results: The overall incidence of delirium in the total cohort was 48% regardless of the surgical approach (CABG vs. OPCAB). Serum ANP levels > 64.6 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 100% (75.3–100) and specificity of 42.9% (17.7–71.1). Serum NT-proCNP levels >1.7 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 92.3% (64.0–99.8) and specificity of 42.9% (17.7–71.1). Both NPs could not predict postoperative survival or long-term cognitive decline. Conclusions: We found a positive correlation between delirium and preoperative plasma levels of ANP and NT-proCNP. A well-powered and prospective study might identify NPs as biomarkers indicating the risk of delirium and postoperative cognitive decline in patients at risk for postoperative delirium.

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Delirium After Cardiac Surgery and Cumulative Fluid Balance: A Case-Control Cohort Study

Cited by 20 publications

References 37 publications

Risk Factors for Postoperative Delirium after Cardiac Surgery

Risk Factors for Postoperative Delirium after Cardiac Surgery

Intraoperative Optimization of Both Depth of Anesthesia and Cerebral Oxygenation in Elderly Patients Undergoing Coronary Artery Bypass Graft Surgery—A Randomized Controlled Pilot Trial

Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study

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