Impact of pneumonia on hyperactive delirium in end-stage lung cancer patients

Suzuki, Hidekazu; Hirashima, Tomonori; Kobayashi, Masashi; Okamoto, Norio; Matsuura, Yuka; Tamiya, Motohiro; Morishita, Naoko; Okafuji, Kohei; Shiroyama, Takayuki; Morimura, Osamu; Morita, Satomu; Kawase, Ichiro

doi:10.1007/s00520-012-1522-8

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…Studies in patients with lung cancer, however, demonstrated that pneumonia is associated with hyperactive delirium. 21 Acute hypoxia or hypercapnia due to lung disease may result in additional postoperative stress, increasing the risk of emergence agitation.…”

Section: Discussionmentioning

confidence: 99%

Postanaesthetic emergence agitation in adult patients after general anaesthesia for urological surgery

Kim

Jeon

et al. 2015

J Int Med Res

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Objective: To investigate the incidence and risk factors for emergence agitation in the postanaesthetic care unit (PACU), in adult patients undergoing urological surgery. Methods: Medical records were retrospectively reviewed. Preoperative, intraoperative and postoperative variables were evaluated. Emergence agitation was defined as a Riker sedationagitation score !5. Logistic regression analysis was used to determine independent risk factors for emergence agitation. Results: Emergence agitation was observed in 48/488 (9.8%) patients. Chronic lung disease (odds ratio [OR] 2.72, 95% confidence interval [CI] 1.03, 7.17), duration of surgery (OR 1.01, 95% CI 1.00, 1.01), history of social drinking (OR 2.48, 95% CI 1.25, 4.93), postoperative pain score (OR 1.32, 95% CI 1.14, 1.53), voiding urgency (OR 2.20, 95% CI 1.01, 4.77) and presence of gastric tube (OR 2.85, 95% CI 1.07, 7.54) were independent risk factors for emergence agitation. Conclusions: Adequate postoperative pain management and prevention of catheter-related bladder discomfort may be helpful in reducing the incidence of emergence agitation in urology patients.

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Section: Discussionmentioning

confidence: 99%

Postanaesthetic emergence agitation in adult patients after general anaesthesia for urological surgery

Kim

Jeon

et al. 2015

J Int Med Res

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“…Our previous study [6] demonstrated that the majority of patients at our institution have died during hospitalization. However, many terminally ill Japanese patients prefer to die at home [10], and in 2013, the at-home death rate of patients with malignant neoplasms was reported to be 9.5% [11].…”

Section: Introductionmentioning

confidence: 83%

“…Since we frequently observe ≥ 100 LC-related deaths each year at our institution, our team is required to manage various symptoms (e.g., delirium) in end-stage LC patients [6]. Thus, the proportion of LC patients in our care with subcutaneously implanted central venous access device ports (CV-ports) has been increasing.…”

Section: Introductionmentioning

confidence: 99%

Clinical Course of Lung Cancer Patients with Subcutaneously Implanted Central Venous Access Device Ports from the Time of Receiving Chemotherapy to the Endpoint of Cancer

Hirashima¹,

Tsumori²,

Sakai³

et al. 2016

JCT

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Background: As the prognosis of lung cancer (LC) patients improves, subcutaneously implanted central venous access device ports (CV-ports) have frequently been used for continuing chemotherapy (CC) or palliative care (PC). In this study, we examined the clinical course of LC patients with subcutaneously implanted CV-ports from the time of receiving chemotherapy to the endpoint of cancer. Materials and Methods: We retrospectively reviewed the clinical data and treatment history of LC patients with subcutaneously implanted CV-ports between June 2008 and November 2013 using clinical records and a pharmacy database. Results: Of the 132 LC patients with subcu-* Corresponding author. T. Hirashima et al. 520 taneously implanted CV-ports, 79 (59.8%) had CV-ports for CC (the CC group) and 53 (40.2%) had CV-ports for PC (the PC group). After CV-port implantation, LC patients in the CC group received a median of two regimens with a median of 6 cycles. The median survival time of patients in the CC and PC groups was 457 and 44 days, respectively. In the CC group, the median survival time of small cell and non-small cell LC patients was 342 (95% confidence interval, 235-627) and 563 (95% confidence interval, 368-728) days, respectively. Nine patients (6.8%) had their CV-ports removed due to complications. Forty (30.3%) of the 132 enrolled patients were referred for at-home PC. The at-home death rate observed among these 40 patients was 30.0% (N = 12). Conclusion: CV-ports may contribute to seamless oncological care.

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“…However, it led to the exclusion of some possibly relevant studies, such as those of delirium risk factors for terminally ill patients in the general hospital setting. 66,67…”

Section: Discussionmentioning

confidence: 99%

“…However, it led to the exclusion of some possibly relevant studies, such as those of delirium risk factors for terminally ill patients in the general hospital setting. 66,67 What this study adds Delirium guidelines, not specific to palliative care contexts, such as NICE 64 and SIGN, 65 and systematic reviews of multicomponent interventions, 6,7 recommend delirium risk reduction through targetting modifiable risk factors. The evidence from this review suggests positive associations between delirium and opioid use, higher opioid dose and toxicity in palliative care settings.…”

Section: Strengths and Limitations Of The Reviewmentioning

confidence: 99%

Risk factors for delirium in adult patients receiving specialist palliative care: A systematic review and meta-analysis

et al. 2021

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Background: Delirium is common and distressing for patients receiving palliative care. Interventions targetting modifiable risk factors in other settings have been shown to prevent delirium. Research on delirium risk factors in palliative care can inform context-specific risk-reduction interventions. Aim: To investigate risk factors for the development of delirium in adult patients receiving specialist palliative care. Design: Systematic review and meta-analysis (PROSPERO CRD42019157168). Data sources: CINAHL, Cochrane Database of Systematic Reviews, Embase, MEDLINE and PsycINFO (1980-2021) were searched for studies reporting the association of risk factors with delirium incidence/prevalence for patients receiving specialist palliative care. Study risk of bias and certainty of evidence for each risk factor were assessed. Results: Of 28 included studies, 16 conducted only univariate analysis, 12 conducted multivariate analysis. The evidence for delirium risk factors was limited with low to very low certainty. Potentially modifiable risk factors: Opioids and lower performance status were positively associated with delirium, with some evidence also for dehydration, hypoxaemia, sleep disturbance, liver dysfunction and infection. Mixed, or very limited, evidence was found for some factors targetted in multicomponent prevention interventions: sensory impairments, mobility, catheter use, polypharmacy (single study), pain, constipation, nutrition (mixed evidence). Non-modifiable risk factors: Older age, male sex, primary brain cancer or brain metastases and lung cancer were positively associated with delirium. Conclusions: Findings may usefully inform interventions to reduce delirium risk but more high quality prospective cohort studies are required to enable greater certainty about associations of different risk factors with delirium during specialist palliative care.

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Impact of pneumonia on hyperactive delirium in end-stage lung cancer patients

Abstract: Pneumonia was identified as a significant risk factor for the development of hyperactive delirium among end-stage lung cancer patients.

Cited by 7 publications

References 13 publications

Postanaesthetic emergence agitation in adult patients after general anaesthesia for urological surgery

Postanaesthetic emergence agitation in adult patients after general anaesthesia for urological surgery

Clinical Course of Lung Cancer Patients with Subcutaneously Implanted Central Venous Access Device Ports from the Time of Receiving Chemotherapy to the Endpoint of Cancer

Risk factors for delirium in adult patients receiving specialist palliative care: A systematic review and meta-analysis

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