Meta-Analysis of Factors Which Influence Delirium Following Cardiac Surgery

Abstract

Background: The aim of this study is to determine the risk factors of delirium after cardiac surgery. Methods: A systematic literature search of MEDLINE, EMBASE, the Cochrane Library, and Science Citation Index limited to 2008 to 2011 and review of studies was conducted. Eligible studies were of randomized controlled trials or cohort studies, using delirium assessment tool, reporting at least one risk factor associated with delirium, and available to full text. Results: The search identified 106 potentially relevant publications; only 25 met selection criteria. Our systematic review revealed 33 risk factors: 17 predisposing and 16 precipitating factors for delirium after elective cardiac surgery. The most established predisposing risk factors were age, depression, and history of stroke, cognitive impairment, diabetes mellitus, and atrial fibrillation. The most established precipitating risk factors were duration of surgery, prolonged intubation, surgery type, red blood cell transfusion, elevation of inflammatory markers and plasma cortisol level, and postoperative complications. Moreover, sedation with dexmedetomidine may significantly predict the absence of postoperative delirium. Conclusions: Postoperative delirium is related to several risk factors following cardiac surgery. Sedation with dexmedetomidine and fast‐track weaning protocols may decrease the incidence of delirium in cardiac surgical patients. (J Card Surg 2012;27:481‐492)

Age- and gender-related peculiarities of patients with delirium in the cardiac intensive care unit

“…Finally, we collected little data about patients who did not develop delirium in the ICCU. As mentioned, we chose not to assess data regarding particular sedation agents used or doses and to focus instead on age-and gender-related differences, although in other studies [7,9,22,24,25] the significance of medication on development of delirium has been addressed. We are further investigating this subject and hope to publish our findings in the near future.…”

Effects of statins on delirium following cardiac surgery – evidence from literature

“…The pathogenesis of POD is complex and multifactorial, involving an interaction of multiple predisposing and precipitating factors [1][2][3][4][5][6][7][8][9][10] (Table 2). Among predisposing factors, older age, history of stroke and peripheral vascular disease are the most important ones, being mainly related to increased cerebral atherosclerosis, with a consequent inhibition of the cerebral blood flow, exacerbation of inhibition of flow, and increased cerebral embolisation risk [2,4,9,[16][17][18].…”

“…The incidence of postoperative delirium (POD) largely varies among studies, ranging from 1% to 50% [1][2][3][4][5][6][7][8][9][10]. Plausible explanations of this variation refer to the adopted definition, the mode of its detection and the clinical profile of patient populations [1][2][3][4][5][6][7][8][9][10]. Several definitions of POD have been proposed along with different diagnostic tools [10].…”

“…Plausible explanations of this variation refer to the adopted definition, the mode of its detection and the clinical profile of patient populations [1][2][3][4][5][6][7][8][9][10]. Several definitions of POD have been proposed along with different diagnostic tools [10]. POD is generally defined as an acute deterioration of brain function characterised by fluctuating mental status with inattention and disturbances in consciousness and presents clinically different subtypes, with or without accompanying agitation [11,12].…”

Zastosowanie deksmedetomidyny na oddziale intensywnej terapii dorosłych

“…[50] wykazali, że częstość występowania zespołu majaczeniowego po operacji serca wynosiła 3% u chorych otrzymujących sedację pooperacyjną deksmedetomidyną i po 50% w grupach poddanych sedacji propofolem lub midazolamem, przy czym zmniejszenie częstości wystę-powania delirium wiązało się ze zmniejszeniem kosztów leczenia. Opublikowana w ubiegłym roku metaanaliza obejmująca 33 badania dotyczące czynników ryzyka wystąpie-nia delirium po operacji serca wskazała stosowanie sedacji deksmedetomidyną jako jeden z dwóch czynników, obok stosowania protokołów Fast-track, istotnie zmniejszających ryzyko wystąpienia zespołu majaczeniowego [51].…”