Incidence and risk factors of postoperative delirium in patients admitted to the ICU after elective intracranial surgery

Wang, Chunmei; Huang, Huawei; Wang, Yumei; He, Xuan; Sun, Xu; Zhou, Yimin; Zhang, Guobin; Gu, Hongqiu; Zhou, Jianxin

doi:10.1097/eja.0000000000001074

Cited by 50 publications

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“…Open access operation under general anaesthesia, delirium was screened within 3 days after the surgery. 8 The incidence of POD is about 20%, which is comparable to the results in the control group of randomised controlled trials with non-neurosurgical patients (18%-21%). [12][13][14] Potential associations between POD and adverse outcomes have also been reported in neurosurgical patients.…”

supporting

confidence: 62%

“…[12][13][14] Potential associations between POD and adverse outcomes have also been reported in neurosurgical patients. [8][9][10][11] These results indicate that early prevention of POD should be employed in this population. Perioperative preventive medications have been an active area of clinical POD researches.…”

mentioning

confidence: 71%

“…In our previous cohort study with 800 neurosurgical patients admitted to the ICU after intracranial operations, 28% of the patients remained endotracheal intubation. 8 The CAM-ICU has been validated in mechanically ventilated patients 20 and non-intubated ICU patients. 21 The Chinese version of the CAM-ICU has been validated in the ICU setting in mainland China, 22 and the feasibility has been established in studies reported by our group and others.…”

Section: Discussionmentioning

confidence: 99%

“…In four observational studies, including 2769 patients after intracranial operation, POD occurred in 349 patients with an overall pooled crude incidence of 13%. [8][9][10][11] A recent meta-analysis of non-cardiac patients showed that the incidence of POD reduced by approximately half when dexmedetomidine was used perioperatively. 14 We assume that the incidence of POD would be reduced by one-third in the dexmedetomidine group compared with the placebo group in the present study.…”

Section: Current Sample Size Justificationmentioning

confidence: 99%

“…6 7 Recently, more attention has been devoted to POD in patients after neurosurgery. [8][9][10][11] In our cohort with 800 adult patients admitted to the ICU after elective intracranial Strengths and limitations of the study ► The study design will be multicentre, randomised, double-blinded and placebo-controlled, with a relatively large sample size. ► To the best of our knowledge, this is the first study to evaluate the effect of prophylactic use of dexmedetomidine on postoperative delirium (POD) in neurosurgical patients.…”

Section: Introductionmentioning

confidence: 99%

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Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours (DEPOD study): a study protocol and statistical plan for a multicentre randomised controlled trial

Cheng

Zhang

et al. 2020

BMJ Open

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IntroductionPostoperative delirium (POD) is prevalent in patients after major surgery and is associated with adverse outcomes. Several studies have reported that dexmedetomidine, a highly selective α2-adrenergic receptor agonist, can decrease the incidence of POD. However, neurosurgical patients are usually excluded from previous studies. The present study was designed to investigate the impact of prophylactic use of low-dose dexmedetomidine on the incidence of POD in patients after intracranial operation.Methods and analysisThis is a multicentre, randomised, double-blinded and placebo-controlled trial. Seven hundred intensive care unit admitted patients after elective intracranial operation for brain tumours under general anaesthesia are randomly assigned to the dexmedetomidine group or the placebo group with a 1:1 ratio. For patients in the dexmedetomidine group, a continuous infusion of dexmedetomidine will be started at a rate of 0.1 μg/kg/hour immediately after enrolment on the day of operation and continued until 08:00 on postoperative day 1. For patients in the placebo group, normal saline will be administered at the same rate as in the dexmedetomidine group. The patients will be followed up for 28 days after enrolment. The primary endpoint is the incidence of POD, which is assessed two times per day using the Confusion Assessment Method for the intensive care unit (ICU), during the first 5 postoperative days. The secondary endpoints include the incidence of dexmedetomidine-related adverse events and non-delirium complications, the length of stay in the ICU and hospital and all-cause 28-day mortality after the operation.Ethics and disseminationThe study protocol was approved by the Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University (No KY2019-091-02) and registered at ClinicalTrials.gov. The results of the trial will be presented at national and international conferences relevant to subject fields and submitted to international peer-reviewed journals.Trial registration numberTrial registration number: NCT04399343; Pre-results.

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supporting

confidence: 62%

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confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Current Sample Size Justificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours (DEPOD study): a study protocol and statistical plan for a multicentre randomised controlled trial

Cheng

Zhang

et al. 2020

BMJ Open

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Predisposing and Precipitating Factors Associated With Delirium

et al. 2023

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ImportanceDespite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups.ObjectiveTo conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting.Evidence ReviewA literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium.FindingsA total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity.Conclusions and RelevanceIn this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium’s heterogeneous pathophysiology and treatment.

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The economic cost of delirium: A systematic review and quality assessment

Kinchin

Mitchell

Agar

et al. 2021

Alzheimer's & Dementia

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Introduction: This review aims to systematically identify and appraise the methodological quality of claims on the cost of delirium; and discuss challenges and opportunities for improvements in the precision of the estimates.Methods: Searches of scientific papers and gray literature were performed up until June 2020. The Larg and Moss checklist was used to assess the methodological quality of the included studies.Results: After deduplication, the search identified 317 potentially relevant articles, of which 17 articles were eligible for inclusion. After adjusting for inflation and common currency, the cost of delirium ranged between $806 and $24,509 (in 2019 US$).Discussion: This review found significant variation among the cost estimates and methodological quality. There has been limited focus on dementia as a sequela of delirium in terms of economic implications, but recent evidence suggests cost implications of delirium may be 52% higher when dementia is considered.

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Incidence and risk factors of postoperative delirium in patients admitted to the ICU after elective intracranial surgery

Cited by 50 publications

References 50 publications

Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours (DEPOD study): a study protocol and statistical plan for a multicentre randomised controlled trial

Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours (DEPOD study): a study protocol and statistical plan for a multicentre randomised controlled trial

Predisposing and Precipitating Factors Associated With Delirium

The economic cost of delirium: A systematic review and quality assessment

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