Perioperative predictors of delirium and incidence factors in adult patients post cardiac surgery

Abstract

BackgroundDelirium is a quite common complication in adult patients post-cardiac surgery. The purpose of our study was to identify perioperative characteristics and also focus on incidence factors that could predict delirium in the cardiac surgery intensive care unit (CICU) postoperatively.MethodsWe conducted a prospective study of 179 consecutive patients, who underwent open-heart surgical operation and were admitted to the CICU of a general tertiary hospital in Athens, Greece. The patients were screened for delirium by using the diagnostic tools of Rich-mond Agitation Sedation Scale (RASS score) and the Confusion Assessment Method – ICU (CAM-ICU). The delirium assessment was carried out on the 1st and the 2nd postoperative day, and was conducted twice every nursing shift. A short questionnaire on sociodemographics and clinical patient characteristics was used for data collection purposes.ResultsA total of 179 patients who underwent open-heart surgical operation with cardiopulmonary bypass (CPB) were enrolled in our study. The 2-day incidence of postoperative delirium in ICU was 11.2% (n=20/179). The main independent predictors of delirium on the 2nd postoperative day were neutrophil-to-lymphocyte ratio (p=0.001) and urea levels (p=0.016). Additionally, increased perioperative creatinine (p=0.006) and sodium (p=0.039) levels were significantly associated with delirium occurrence. Furthermore, elevated EuroSCORE (p=0.001), extended length of stay (LOS) in ICU (p<0.001), and extended LOS with endotracheal tube (p=0.001) were also statistically significant indicators.ConclusionPatients with extended LOS with endotracheal tube and prolonged stay in ICU in accordance with peaked urea, neutrophil-to-lymphocyte ratio, creatinine, and sodium levels seem to have a significantly greater probability of developing delirium in the ICU. Further research is needed in the field of postoperative cardiac patients in order to determine the causality and etiology of certain risk factors for delirium.

C-reactive Protein to Albumin Ratio as A Novel Inflammatory Biomarker for Postoperative Delirium in Patients Undergoing Transcatheter Aortic Valve Replacement

“…Previous reports have proposed that systemic inflammation contributes to the pathogenesis of POD by compromising blood-brain barrier integrity and consequently promoting neuronal injury, causing neurocognitive behavioural abnormalities (4,5,9). Several immune and inflammatory alterations such as increased acute-phase reactants and abnormal levels of inflammatory cytokines detected in both the serum and cerebrospinal fluid of delirious individuals have been reported in the literature (4,(8)(9)(10)(11)24). Therefore, the identification of inflammatory markers associated with POD can improve our understanding of POD pathophysiology and ultimately leads to new interventions that may improve patient outcomes.…”

“…As such, identifying accurate biomarkers for POD may shed light on the pathophysiology and potentially improve delirium recognition and prediction after TAVR. Several inflammatory markers, such as proinflammatory cytokines, chemokines, and the neutrophil-to-lymphocyte ratio (NLR), have been proposed to be associated with POD in various clinical conditions including cardiac surgery (8)(9)(10). In addition, although there are conflicting results, delirium has been found to be associated with proteins involved in the stress response, including the markers of systemic inflammation such as positive acute-phase reactant C-reactive protein (CRP) and negative acutephase reactant albumin (2,4,5,11).…”

Ações de enfermagem para a prevenção e controle do delirium em pacientes pós-operatório de cirurgia cardí­aca: uma revisão integrativa

“…Em estudo recente com pacientes em pós-operatório de cirurgias cardíacas foi possível analisar que os pacientes submetidos a cirurgia de revascularização miocárdica e trocas valvares e que tiveram um tempo maior de CEC e de isquemia durante a CEC apresentaram uma incidência maior de delirium. O delirium pode carretar várias complicações como sedação e ventilação mecânica por maior tempo, tempo maior de internação e risco aumentando de quedas, por isso é necessário que sejam realizados o diagnóstico e reconhecimento do delirium precocemente (12) .…”

ICU delirium:what is different between the type of diseases?

“…Prospective studies with a much greater sample size would be needed in order to determine the causality of certain risk factors for delirium [34,35].…”