Motor Subtypes of Postoperative Delirium in Older Adults

Robinson, Thomas N.; Raeburn, Christopher D.; Tran, Zung Vu; Brenner, Lisa A.; Moss, Marc

doi:10.1001/archsurg.2011.14

Cited by 197 publications

(162 citation statements)

References 29 publications

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“…A study had shown that hypoactive delirium was the most common motor subtype in geriatric patients. 32 Pandharipande and colleagues found hyperactive delirium in no more than 1% of surgical ICU patients, whereas the majority of patients had hypoactive (64%) delirium in the postoperative period. 33 On the other hand, delirium assessment is somewhat subjective and may be susceptible to observational bias.…”

Section: Effect Of Dex On Cardiac Surgerymentioning

confidence: 98%

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The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients

Cheng

Young

et al. 2017

Survey of Anesthesiology

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Objective: The goal of this retrospective study was to investigate the effects of perioperative use of dexmedetomidine (Dex) on outcomes for older patients undergoing cardiac surgery.Design: Retrospective investigation. Setting: Patients from a single tertiary medical center. Participants: A total of 505 patients (Z65 years old) who underwent coronary artery bypass graft (CABG) or valve surgery. CABG and/or valve surgery plus other procedures were divided into 2 groups: 283 received intravenous Dex infusion (Dex group) and 222 did not (Non-Dex group).Interventions: Perioperative Dex intravenous infusion (0.24 to 0.6 μg/kg/h) initiated after cardiopulmonary bypass and continued for o24 hours postoperatively in the ICU.Measurements and Main Results: Data were risk adjusted, propensity score weighted, and multivariate logistic regression was used. The primary outcome was mortality. Secondary outcomes included postoperative stroke, coma, myocardial infarction, heart block, cardiac arrest, delirium, renal failure, and sepsis. Perioperative Dex infusion significantly decreased in-hospital mortality (0.90% v 2.83%; adjusted odds ratio (OR), 0.099; 95% confidence interval (CI), 0.030-0.324; p ¼ 0.004) and operative mortality (1.35% v 3.18%; adjusted OR, 0.251; 95% CI, 0.077-0.813; p ¼ 0.021). Perioperative Dex treatment also reduced the risk of stroke (0.90% v 1.77%; adjusted OR, 0.15; 95% CI, 0.038-0.590; p ¼ 0.007), and delirium (7.21% v 10.95%; adjusted OR, 0.35; 95% CI, 0.212-0.578; p o 0.0001).Conclusions: Results from this study (ClinicalTrials.gov identifier: NCT01683448) suggested perioperative use of dexmedetomidine was associated with decreases in inhospital and operative mortality in elderly patients following cardiac surgery. It also reduced incidences of postoperative stroke and delirium in elderly patients.

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Section: Effect Of Dex On Cardiac Surgerymentioning

confidence: 98%

“…26,27 The incidence of postoperative delirium was reported to range from 30% to 55% in elderly patients undergoing cardiac surgery. 26,[28][29][30][31][32] The authors of this study also …”

mentioning

confidence: 99%

The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients

Cheng

Young

et al. 2017

Survey of Anesthesiology

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“…A patient is defined as having 'hyperactive delirium' if the CAM-ICU screening is positive for the presence of delirium and the RASS score is above 0; 'hypoactive delirium' is identified when the CAM-ICU screening is positive for delirium and the RASS score is between À1 and À3. It is an interesting reporting that the prevalence of hypoactive delirium in critically ill patients ranges from 43.5% to 67%, [48][49][50] while the pure hyperactive and mixed ranges from 0% to 1.6%, and from 6% to 54.9%, respectively. [48][49][50] Additional definitions 'Subsyndromal delirium (SSD)' is defined as a condition in which patients have one or more symptoms that never progress to a full diagnosis of delirium as described by the DSM-IV-TR criteria.…”

Section: Additional Definitionsmentioning

confidence: 99%

“…It is an interesting reporting that the prevalence of hypoactive delirium in critically ill patients ranges from 43.5% to 67%, [48][49][50] while the pure hyperactive and mixed ranges from 0% to 1.6%, and from 6% to 54.9%, respectively. [48][49][50] Additional definitions 'Subsyndromal delirium (SSD)' is defined as a condition in which patients have one or more symptoms that never progress to a full diagnosis of delirium as described by the DSM-IV-TR criteria. For instance, a patient can have an acute change in mental status and disorganised thinking but does not show signs of inattention.…”

Section: Additional Definitionsmentioning

confidence: 99%

Understanding terminology of delirium and long-term cognitive impairment in critically ill patients

Morandi

Pandharipande

Jackson

et al. 2012

Best Practice & Research Clinical Anaesthesiology

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Keywords: delirium long-term cognitive impairment terminology critical careDelirium, an acute brain dysfunction, frequently affects intensive care unit (ICU) patients during the course of a critical illness. Besides the acute morbidities, ICU survivors often experience longterm sequelae in the form of cognitive impairment (LTCI-CI). Though delirium and LTCI-CI are associated with adverse outcomes, little is known on the terminology used to define these acute and chronic co-morbidities. The use of a correct terminology is a key factor to spread the knowledge on clinical conditions. Therefore, we first review the epidemiology, definition of delirium and its related terminology. Second, we report on the epidemiology of LTCI-CI and compare its definition to other forms of cognitive impairments. In particular, we define mild cognitive impairment, dementia and finally postoperative cognitive dysfunction. Future research is needed to interpret the trajectories of LTCI-CI, to differentiate it from neurodegenerative diseases and to provide a formal disease classification.

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“…[29] Hypoactive delirium is the most common in older patients; it often goes unrecognized and usually is associated with a worse prognosis than the other motor subtypes. [23,30,31] Patients presenting with mixed delirium can fluctuate between hypoactive and hyperactive manifestations. Early recognition is crucial because delirium may be the first sign of an underlying severe illness, and timely management may limit adverse outcomes.…”

Section: Recognition Of Deliriummentioning

confidence: 99%

Delirium: The 21st century health care challenge for bedside clinicians

Richards

Azad

Adeola

et al. 2016

JNEP

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Delirium is a leading cause of preventable injury in hospitalized patients. Early recognition and intervention for delirium are critical to prevent morbidity and mortality, especially in the older population. Older patients are at increased risk for delirium owing to a combination of age-related changes and environmental factors. Health care providers, including nurses and physicians, often miss delirium symptoms and diagnosis in patients. Without early recognition and treatment, delirium can have significant life-changing consequences in our most vulnerable patients. This acute change in cognition can continue throughout the hospital course and may require additional rehabilitation or placement, delaying transition to home. As the baby boomers age, the older population is expected to increase, with significant implications for health care. With this in mind, the health care team, including frontline caregivers, need to be well informed about delirium. This article will expand readers' knowledge and familiarity with delirium with the purpose of improving their practice and care of the older patient. It will also address the impact of delirium and discuss tools that can help to improve recognition. The most recent advances and current treatment methods to integrate into daily patient care are also discussed. This article places heavy emphasis on identification and prevention of delirium as these are the most important aspect of understanding delirium. Thus, treatment and management are both discussed after prevention since the primary focus of delirium is understanding and preventing this devastating syndrome in our hospitalized patients.

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Motor Subtypes of Postoperative Delirium in Older Adults

Cited by 197 publications

References 29 publications

The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients

The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients

Understanding terminology of delirium and long-term cognitive impairment in critically ill patients

Delirium: The 21st century health care challenge for bedside clinicians

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