Delirium after cardiac surgery. Incidence, phenotypes, predisposing and precipitating risk factors, and effects

Sanson, Gianfranco; Khlopenyuk, Yuliya; Milocco, Sara; Sartori, Massimiliano; Dreas, Lorella; Fabiani, Adam

doi:10.1016/j.hrtlng.2018.04.005

Cited by 57 publications

(57 citation statements)

References 63 publications

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“…It has been suggested that delirium may be associated with high ow and cerebral perfusion during CPB in excess of cerebral metabolic requirements, resulting in excessive brain micro-emboli load, endothelial cell damage, and damage to the blood-brain barrier, leading to cerebral edema, and thereby brain dysfunction [29,30]. In summary, existing studies suggest an increased risk of postoperative delirium in a small number of patients with chronic or deep hypotension, but this risk is not statistically signi cant [31]. Further studies are needed to con rm the effect of blood pressure management on the incidence of delirium.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine reduces the incidence of postoperative delirium after cardiac surgery: A meta-analysis of randomized controlled trials

Zhao

Xie

et al. 2021

Preprint

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Background The role of dexmedetomidine in preventing delirium after cardiac surgery remains controversial because of several recent trials with negative results. We aimed to perform an updated meta-analysis of randomized controlled trials (RCTs) to clarify this controversy. Methods RCTs investigating the perioperative administration of dexmedetomidine in cardiac surgery were retrieved from PubMed, Web of Science, and the Cochrane library until August,27,2020. Two researchers independently screened the literature, collected the data and evaluated the bias risk of the included studies. The meta-analysis was performed with the RevMan 5.3. Results A total of 15 studies including 2813 patients were included in the study. A pooled result showed that dexmedetomidine could reduce the risk of delirium in adult population underwent cardiac surgery (OR 0.56, 95%CI 0.35–0.89, P = 0.0003, I = 64%). The subgroup analysis demonstrated that the protective effect of dexmedetomidine was only present in the patients injected with dexmedetomidine after surgery but not from the start of surgery, in the adult patients without specific age limitation but not in the elderly, and in the studies in comparison with other sedatives but not with placebo. There were no statistical differences when analyzing the secondary outcomes including hypotension (OR 1.13; 95% CI 0.54–2.37, P < 0.00001, I²=85%), bradycardia (OR 1.72; 95% CI 0.84–3.53, P = 0.04, I²=58%) and atrial fibrillation (OR 0.87; 95% CI 0.70–1.08, P = 0.43, I²=0). Conclusions Dexmedetomidine can reduce the incidence of delirium compared to other sedatives and opioids after cardiac surgery in adult patients. The proper population and timing for perioperative use of dexmedetomidine after cardiac surgery remain to be further investigated.

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Section: Discussionmentioning

confidence: 99%

Dexmedetomidine reduces the incidence of postoperative delirium after cardiac surgery: A meta-analysis of randomized controlled trials

Zhao

Xie

et al. 2021

Preprint

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“…Postoperative delirium (POD) is a severe cerebral dysfunction, and is characterized by episodes of confusion, inattention, thinking disorder and mental state change of mental state change 1 . It is one of the neurological complications after cardiac surgery with the incidence of as high as 11.0%-54.9% 2,3 . And the incidence of delirium after aortic dissection surgery is 32.5%-52.0% 4 .…”

Section: Introductionmentioning

confidence: 99%

Association Between Glucose Variability And Postoperative Delirium In Acute Aortic Dissection Patients: An Observational Study

Lin

Peng

et al. 2020

Preprint

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Background: Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients.Methods: We prospectively analyzed 257 patients including 103 patients with delirium. The patients were divided into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of the Intensive Care Unit stay, and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess.Results: A total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in age, body mass index, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration, and the length of Intensive Care Unit stay (P<0.05). The median of the mean of blood glucose and the standard deviation of blood glucose were higher in the delirium group than in the non-delirium group, and the difference was statistically significant (P<0.05). In model 1, the adjusted hazard ratio of the standard deviation of blood glucose was 1.436 (P<0.05). In Model 2, the standard deviation of blood glucose (AHR=1.418, 95% CI=1.195-1.681, P<0.05) remained significant after adjusting for confounders (P<0.05). The area under the curve of the standard deviation of blood glucose was 0.763 (95% CI=0.704-0.821, P<0.01). The sensitivity was 81.6%, and the specificity was 57.8%. Conclusions: Glucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.

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“…Nevertheless, a few studies involving postcardiotomy patients had explored the association between intraoperative MAP and agitation/ delirium with controversial results. 14,15 The difference might due to the subjects selected or investigated. Patients with ECMO support experienced more severe cerebral hypo-perfusion or hypoxia prior to ECMO implantation and more severe reperfusion injury, so pre-emptive brain protection strategies during the operation could reduce the side effect of intraoperatively low MAP.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for agitation and hyperactive delirium in adult postcardiotomy patients with extracorporeal membrane oxygenation support: an observational study

et al. 2020

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Background: Agitation and delirium in critically ill patients after cardiac surgery carry poor in-hospital prognosis. Identifying risk factors may promote its prevention and management. Accordingly, this study aimed to evaluate the incidence of agitation and hyperactive delirium in postcardiotomy patients during the extracorporeal membrane oxygenation support and to identify the risk factors for its development. Methods: This single center, retrospective study was conducted at Beijing Anzhen Hospital, Capital Medical University. Data were extracted from the prospective institutional registry database of extracorporeal membrane oxygenation patients. Univariate and multivariate logistic regression analyses were performed to predict risk factors. Results: A total of 170 consecutive adult patients underwent extracorporeal membrane oxygenation in our hospital from January 2016 to December 2017. Ninety-four patients were included in the final analysis. The incidence of agitation and hyperactive delirium was 35% in our population of extracorporeal membrane oxygenation–supported postcardiotomy patients. Agitation and delirium usually occurred within the first 3 days of extracorporeal membrane oxygenation. Multivariable analysis showed that history of previous stroke (without preoperative cognitive dysfunction; odds ratio, 4.425, 95% confidence interval: 1.171-16.716; p = 0.028) and mean arterial pressure reduction (before extracorporeal membrane oxygenation initiation) ⩾ 49 mmHg (odds ratio, 7.570, 95% confidence interval: 2.366-24.219, p = 0.001) were independent risk factors for agitation and hyperactive delirium during extracorporeal membrane oxygenation support. The areas under the receiver operating characteristic curve for the prediction of agitation and hyperactive delirium was 0.704 (95% confidence interval 0.589-0.820, p = 0.001). There was more severe arrhythmia in the agitation patients. Conclusion: Our results suggest that the prevalence of agitation and hyperactive delirium in postcardiotomy patients with extracorporeal membrane oxygenation support is high. In addition, previous stroke and severe mean arterial pressure reduction before extracorporeal membrane oxygenation initiation is predictive of agitation and hyperactive delirium.

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Delirium after cardiac surgery. Incidence, phenotypes, predisposing and precipitating risk factors, and effects

Cited by 57 publications

References 63 publications

Dexmedetomidine reduces the incidence of postoperative delirium after cardiac surgery: A meta-analysis of randomized controlled trials

Dexmedetomidine reduces the incidence of postoperative delirium after cardiac surgery: A meta-analysis of randomized controlled trials

Association Between Glucose Variability And Postoperative Delirium In Acute Aortic Dissection Patients: An Observational Study

Risk factors for agitation and hyperactive delirium in adult postcardiotomy patients with extracorporeal membrane oxygenation support: an observational study

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