Multi-disciplinary and pharmacological interventions to reduce post-operative delirium in elderly patients: A systematic review and meta-analysis

Igwe, Ezinne O; Nealon, Jessica R.; Mohammed, Mohammed; Hickey, Blake Anthony; Chou, Kuei‐Ru; Chen, Kee Hsin; Traynor, Victoria

doi:10.1016/j.jclinane.2020.110004

Cited by 20 publications

(20 citation statements)

References 51 publications

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“…Multidisciplinary intervention, often involving non‐pharmacological components (i.e. screening for POD, geriatric consultation, nurse‐led POD prevention strategies) revealed to be effective in reducing the incidence and prevalence of POD (Chen et al, 2017 ; Igwe et al, 2020 ; Jin et al, 2020 ). The implementation of checklists and tools for detecting delirium and its risk factors already in the preoperative phase offers the advantage of collecting information (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Multidisciplinary programs have shown to be effective in the prevention and management of elderly patients with delirium in different settings (Chen et al, 2017 ; Hempenius et al, 2013 ; Igwe et al, 2020 ). As identifying patients at risk of developing POD and early recognition of delirium symptoms through screening and assessment is thereby part of delirium prevention and management, a comprehensive training of healthcare staff, such as on performing screening and assessment for POD is fundamental (Oberai et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…Multidisciplinary intervention, often involving non-pharmacological components (i.e. screening for POD, geriatric consultation, nurse-led POD prevention strategies) revealed to be effective in reducing the incidence and prevalence of POD(Chen et al, 2017;Igwe et al, 2020;Jin et al, 2020). The B L E 2 Intra-and postoperative characteristics of the patient sample and associations with postoperative delirium…”

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confidence: 99%

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Delirium in elderly postoperative patients: A prospective cohort study

Muzzana¹,

Mantovan

Huber

et al. 2022

Nursing Open

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Aim To describe the incidence, time in days and risk factors for postoperative delirium in elderly patients. Design Prospective cohort study. Methods Patients over 65 years were daily screened with the 4A's Test and the Delirium Observation Screening Scale for postoperative delirium. A psychiatrist assessed according to the DSM‐V. We performed descriptive and logistic regression analyses. Results From 202 patients, 7.5% ( N = 15) had a diagnosed postoperative delirium, whereby 73.3% ( N = 11) developed the delirium during the first 48 hr after surgery. The median duration was 1 day. Patients over 80 years suffering from heart failure with surgical drains, bladder catheter, central venous catheter had higher odds for developing a postoperative delirium. The incidence of postoperative delirium in our sample was lower compared with other surgical and ortho‐geriatric populations. Despite age, several modifiable postoperative factors were associated with the occurrence of postoperative delirium.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Delirium in elderly postoperative patients: A prospective cohort study

Muzzana¹,

Mantovan

Huber

et al. 2022

Nursing Open

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“…3 Age is a risk factor of POD, and $80% of geriatric patients who underwent surgery develop POD. 4 Geriatric patients with POD are three times more likely to experience dementia. 5 Therefore, it is necessary to investigate promising approaches to alleviate POD in geriatric patients.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Paravertebral Block Ameliorates Postoperative Delirium in Geriatric Patients

Heng

Wang

et al. 2021

Thorac Cardiovasc Surg

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Objectives Thoracic surgery often causes postoperative delirium (POD) in geriatric patients. This study aimed to explore the effect of ultrasound-guided continuous thoracic paravertebral block (UG-TPVB) on POD in geriatric patients undergoing pulmonary resection. Methods Total 128 patients who underwent pulmonary resection were randomly allocated to either the conventional patient-controlled analgesia (PCA) group or the UG-TPVB group (n = 64 per group). The consumption of opioid agents (propofol and remifentanil), postoperative hospital stay, postoperative pulmonary atelectasis, postoperative nausea/vomiting, and postoperative itchiness were recorded. The diagnosis of delirium was dependent on the Nursing Delirium Screening Scale. The postoperative pain was assessed by visual analogue scale (VAS) score. The serum levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor-α were used to evaluate the postoperative neuroinflammation. Results The consumption of propofol and remifentanil, postoperative hospital stay, postoperative pulmonary atelectasis, postoperative nausea/vomiting, and postoperative itchiness in the UG-TPVB group were lower than that in the PCA group. Compared with the PCA group, the prevalence of POD was decreased in the UG-TPVB group. In addition, use of UG-TPVB not only reduced postoperative pain (VAS score) but also decreased postoperative neuroinflammation compared with PCA in geriatric patients undergoing pulmonary resection. Conclusions This study determined the benefits of UG-TPVB over PCA, providing an effectiveness approach to alleviate POD in geriatric patients undergoing pulmonary resection.

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“…Prevention of postoperative delirium is recommended in the clinical guidelines and consensus statements [ 3 – 5 ]. However, neurosurgical patients are often excluded from interventional studies on postoperative delirium mainly due to potential impairment of consciousness and cognition due to their underlying condition [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of low-dose dexmedetomidine for prevention of postoperative delirium after intracranial operations: a pilot randomized controlled trial

Cheng

Duan

et al. 2021

BMC Neurol

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Background Clinical trials have shown that dexmedetomidine might decrease the occurrence of postoperative delirium after major surgery, but neurosurgical patients were excluded from these studies. We aimed to determine the feasibility of conducting a full-scale randomized controlled trial of the effect of prophylactic low-dose dexmedetomidine on postoperative delirium in patients after elective intracranial operation for brain tumors. Methods In this single-center, parallel-arm pilot randomized controlled trial, adult patients who underwent an elective intracranial operation for brain tumors were recruited. Dexmedetomidine (0.1 μg/kg/hour) or placebo was continuously infused from intensive care unit (ICU) admission on the day of surgery until 08:00 AM on postoperative day one. Adverse events during the study-drug administration were recorded. The primary feasibility endpoint was the occurrence of study-drug interruption. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU during the first five postoperative days. The assessable rate of delirium evaluation was documented. Results Sixty participants were randomly assigned to receive either dexmedetomidine (n = 30) or placebo (n = 30). The study-drug was stopped in two patients (6.7%) in the placebo group due to desaturation after new-onset unconsciousness and an unplanned reoperation for hematoma evacuation and in one patient (3.3%) in the dexmedetomidine group due to unplanned discharge from the ICU. The absolute difference (95% confidence interval) of study-drug interruption between the two groups was 3.3% (− 18.6 to 12.0%), with a noninferiority P value of 0.009. During the study-drug infusion, no bradycardia occurred, and hypotension occurred in one patient (3.3%) in the dexmedetomidine group. Dexmedetomidine tended to decrease the incidence of tachycardia (10.0% vs. 23.3%) and hypertension (3.3% vs. 23.3%). Respiratory depression, desaturation, and unconsciousness occurred in the same patient with study-drug interruption in the placebo group (3.3%). Delirium was evaluated 600 times, of which 590 (98.3%) attempts were assessable except in one patient in the placebo group who remained in a coma after an unplanned reoperation. Conclusions The low rate of study-drug interruption and high assessable rate of delirium evaluation supported a fully powered trial to determine the effectiveness of low-dose dexmedetomidine on postoperative delirium in patients after intracranial operation for brain tumors. Trial registration The trial was registered at ClinicalTrials.gov (NCT04494828) on 31/07/2020.

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Multi-disciplinary and pharmacological interventions to reduce post-operative delirium in elderly patients: A systematic review and meta-analysis

Cited by 20 publications

References 51 publications

Delirium in elderly postoperative patients: A prospective cohort study

Delirium in elderly postoperative patients: A prospective cohort study

Thoracic Paravertebral Block Ameliorates Postoperative Delirium in Geriatric Patients

Feasibility of low-dose dexmedetomidine for prevention of postoperative delirium after intracranial operations: a pilot randomized controlled trial

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