Diagnosis, prevention, and management of delirium in the intensive cardiac care unit

Cortés-Beringola, Alejandro; Vicent, Lourdes; Martín‐Asenjo, Roberto; Puerto, Elena; Domínguez‐Pérez, Laura; Maruri, Ramón; Moreno, Guillermo; Vidán, María Teresa; Arribas, Fernando; Bueno, Héctor

doi:10.1016/j.ahj.2020.11.011

Cited by 41 publications

(41 citation statements)

References 61 publications

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“…In the whole study population, 669 (9.2%) patients were diagnosed with POD. The incidence corresponded to reported literature but lay within the lower portion of reported ranges ( 1 , 3 – 5 ). It is probably due to the difference of study population and exclusion of patients with cognitive dysfunction and a cerebral accident, which were recognized to be associated with increased risk of delirium ( 1 , 3 , 10 ).…”

Section: Discussionsupporting

confidence: 87%

“…The data for confounders were derived from previous literature findings ( 1 , 3 , 4 , 10 , 21 , 22 ) and hospital EMR dataset characteristics, and the following variables were included in the analyses: demographics: age, gender; comorbidities: hypertension, diabetes, myocardial infarction, hyperlipidemia, cerebral vascular disease, atrial fibrillation, chronic obstructive pulmonary disease (COPD), congestive heart failure, renal disease, liver disease; operation information: operation time, intraoperative blood pressure fluctuation, intraoperative blood loss, intraoperative blood transfusion, operation type; length of mechanical ventilation (MV) time, ICU stay and hospital stay before the index date. Renal disease was defined as a preoperative glomerular filtration rate <30 ml/min/1.73 m 2 (body surface area) ( 23 ).…”

Section: Methodsmentioning

confidence: 99%

“…Delirium, marked by acute decline and fluctuation of attention, cognitive function, and disturbance of consciousness, refers to a common complication in patients receiving cardiac surgery. Delirium could result in poor prognosis, including prolonged intensive care unit (ICU) stay, longer duration of hospital stay, increased mortality risks, and long-term impairment of physiological function ( 1 , 2 ). As revealed from existing studies, the incidence of delirium after cardiac surgery reached nearly 8~52% ( 1 , 3 – 5 ).…”

Section: Introductionmentioning

confidence: 99%

“…Delirium could result in poor prognosis, including prolonged intensive care unit (ICU) stay, longer duration of hospital stay, increased mortality risks, and long-term impairment of physiological function ( 1 , 2 ). As revealed from existing studies, the incidence of delirium after cardiac surgery reached nearly 8~52% ( 1 , 3 – 5 ). Unfortunately, the pathophysiologic cause of delirium remains unclear, and there has been no unique intervention or medication to treat delirium thus far.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Hypernatremia and Delirium After Cardiac Surgery: A Nested Case-Control Study

Hong

Shen

Shi

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe association between hypernatremia and delirium after cardiac surgery has rarely been investigated. This study aimed to determine whether hypernatremia increases the risk of delirium after exposure.Materials and MethodsFrom April 2016 to June 2021, 7,831 consecutive patients receiving cardiac surgery were screened for potential enrollment. The primary outcome was postoperative delirium (POD). For the respective case of delirium, 10 controls were matched according to the index date within the nested case-control design. Hypernatremia exposure was defined as serum sodium > 145 mmol/L within 7 days before the index date. A generalized estimation equation was performed to assess excess risks for POD associated with hypernatremia, adjusted for demographics and clinical variables.ResultsAbout 7,277 patients were included in the final analyses. About 669 (9.2%) patients with POD were assigned to the case group, and 6,690 controls were identified from the whole population. About 66.5% of the cases and 36.3% of the controls had hypernatremia exposure. After being adjusted to certain well-recognized confounding factors, hypernatremia showed a significant correlation with increased risk of delirium after cardiac surgery (adjusted OR, 1.73; 95% CI, 1.41~2.12). An e-value analysis suggested the robustness to unmeasured confounding.ConclusionsHypernatremia was associated with an increased risk of delirium after cardiac surgery. This finding could have implications for risk stratification, early detection, and management of delirium in patients receiving cardiac surgery.

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Section: Discussionsupporting

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association Between Hypernatremia and Delirium After Cardiac Surgery: A Nested Case-Control Study

Hong

Shen

Shi

et al. 2022

Front. Cardiovasc. Med.

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“…The occurrence of hyperactive brain syndrome in patients in the ICU can cause many serious adverse outcomes. Its mortality and complication rates are significantly higher than those in patients with hyperactive brain syndrome, and the length of hospital stay, the length of stay in ICU, and the duration of mechanical ventilation were also significantly longer than those of hyperactive brain syndrome (3,4). Hyperactive brain syndrome can also increase the risk of iatrogenic pneumonia by 9 times, it can greatly increase the incidence of complications such as aspiration, pulmonary infarction, and pressure ulcer, and it can increase the risk of accidental extubation and offline difficulty or re-endotracheal intubation after extubation in patients with mechanical ventilation (5).…”

Section: Introductionmentioning

confidence: 91%

A systematic review and meta-analysis of the clinical efficacy of the intravenous injection of dexmedetomidine in ICU patients with hyperactive brain syndrome

Wu¹,

Li²,

Ma³

et al. 2022

Ann Palliat Med

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Background: The incidence of hyperactive brain syndrome in patients in the intensive care unit (ICU) is very high. Compared with other sedative drugs, existing research shows that dexmedetomidine can significantly reduce the incidence of hyperactive brain syndrome. This study systematically analyzed the clinical efficacy of a dexmedetomidine intravenous injection in ICU patients with hyperactive brain syndrome.Methods: The databases PubMed, Web of Science, Embase, and the Cochrane Library were searched from January 2000 to December 2020 to identify papers that studied the clinical efficacy of dexmedetomidine intravenous injection in ICU patients with hyperactive brain syndrome. The basic information and evaluation indexes in the literature were screened and extracted. Revman5.3 software was used for quality assessment and meta-analysis of the included studies, and forest maps were drawn.Results: A total of 255 patients were included in 5 studies. The results of the meta-analysis showed that intravenous infusion of dexmedetomidine could reduce the incidence of restless delirium in patients [odds ratio (OR) =0.14; 95% confidence interval (CI): 0.07 to 0.29; (Z test) Z=5.39, P<0.00001], total delirium after medication duration [mean difference (MD) =−15.50; 95% CI: −25.70 to −5.29; Z=2.98; P=0.003], and ICU hospitalization time (MD =−1.93; 95% CI: −3.57 to −0.29; Z=2.31; P=0.02). However, there was no significant difference in the incidence of adverse reactions (bradycardia and hypotension) in patients who were given an intravenous infusion of dexmedetomidine (OR =2.85; 95% CI: 0.21 to 38.74; Z=0.79; P=0.43).Discussion: The incidence of restlessness delirium, the duration of total delirium after medication, and the length of ICU stay in patients treated with a dexmedetomidine intravenous injection were significantly lower than those in patients treated with haloperidol, indicating that a dexmedetomidine intravenous injection had clinical efficacy in ICU patients with hyperactive brain syndrome.

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Management of Psychiatric Disorders in the Hospital

Amara

Pearce²

2022

Clinical Approaches to Hospital Medicine

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Diagnosis, prevention, and management of delirium in the intensive cardiac care unit

Cited by 41 publications

References 61 publications

Association Between Hypernatremia and Delirium After Cardiac Surgery: A Nested Case-Control Study

Association Between Hypernatremia and Delirium After Cardiac Surgery: A Nested Case-Control Study

A systematic review and meta-analysis of the clinical efficacy of the intravenous injection of dexmedetomidine in ICU patients with hyperactive brain syndrome

Management of Psychiatric Disorders in the Hospital

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