Postoperative Delirium in Intensive Care Patients: Risk Factors and Outcome

Veiga, D.; Luís, C.; Parente, D.; Fernandes, Vera; Botelho, M.; Santos, P.; Abelha, Fernando

doi:10.1016/s0034-7094(12)70146-0

Cited by 72 publications

(46 citation statements)

References 31 publications

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“…Postoperative delirium (POD) has been studied at acute and sub-acute time courses ranging from postoperative Day 0e1 to as many as 5e30 days after surgery. 1,2 POD can be further subclassified by its clinical setting, such as delirium in the ICU (ICU delirium) 3 or in the PACU [PACU delirium (PACU-D)]. 2,4 Characteristic slow oscillations in EEG recordings are known to signal unconsciousness in deep sleep, general anaesthesia, and encephalopathies.…”

mentioning

confidence: 99%

Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

Hesse

Kreuzer

Hight

et al. 2019

British Journal of Anaesthesia

139

157

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Background: Postoperative delirium is associated with an increased risk of morbidity and mortality, especially in the elderly. Delirium in the postanaesthesia care unit (PACU) could predict adverse clinical outcomes. Methods: We investigated a potential link between intraoperative EEG patterns and PACU delirium as well as an association of PACU delirium with perioperative outcomes, readmission and length of hospital stay. The risk factors for PACU delirium were also explored. Data were collected from 626 patients receiving general anaesthesia for procedures that would not interfere with frontal EEG recording. Results: Of the 626 subjects enrolled, 125 tested positive for PACU delirium. Whilst age, renal failure, and pre-existing neurological disease were associated with PACU delirium in the univariable analysis, the multivariable analysis revealed the importance of information derived from the EEG, anaesthetic technique, anaesthesia duration, and history of stroke or neurodegenerative disease. The occurrence of EEG burst suppression during maintenance [odds ratio (OR)¼1.86 (1.13e3.05)] and the type of EEG emergence trajectory may be predictive of PACU delirium. Specifically, EEG emergence trajectories lacking significant spindle power were strongly associated with PACU delirium, especially in cases that involved ketamine or nitrous oxide [OR¼6.51 (3.00e14.12)]. Additionally, subjects with PACU delirium were at an increased risk for readmission [OR¼2.17 (1.13e4.17)] and twice as likely to stay >6 days in the hospital.Conclusions: Specific EEG patterns were associated with PACU delirium. These findings provide valuable information regarding how the brain reacts to surgery and anaesthesia that may lead to strategies to predict PACU delirium and identify key areas of investigation for its prevention.

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mentioning

confidence: 99%

Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

Hesse

Kreuzer

Hight

et al. 2019

British Journal of Anaesthesia

139

157

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“…In fact, age is the most consensual predictor for delirium and this has been widely reported [45]. Postoperative delirium has also been associated with longer LOS in the ICU and PACU [46]. …”

Section: Discussionmentioning

confidence: 99%

Outcome after hepatectomy-delirium as an independent predictor for mortality

et al. 2013

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BackgroundMost studies that follow up hepatectomy cases are limited in scope to an investigation of mortality and morbidity rates or the costs and length of hospital stay. In this study the authors aimed to characterize the quality of life and to evaluate mortality and its determinants after hepatectomy.MethodsThis prospective study was carried in a Post-Anaesthesia Care Unit (PACU) over 15 months, and 70 patients submitted to hepatectomy were enrolled. Demographic and peri-operative characteristics were evaluated for associations with mortality. At admission and 6 months after discharge, patients completed a Short Form-36 questionnaire (SF-36) and have their independence in Activities of Daily Living (ADL) was evaluated. Binary and multiple logistic regression analyses were used to evaluate of associations with mortality, and the Wilcoxon signed rank test was used to compare SF-36 scores before and after 6 months after hepatectomy.ResultsThe mortality rate was 19% at 6 months. Multivariate analysis identified postoperative delirium as an independent determinant for mortality. Six months after discharge, 46% patients stated that their health in general was better or much better than that 1 year previously. Six months after hepatectomy, patients had worse scores in the physical function domain of SF-36; however, scores for all the other domains did not differ. At this time point, patients were more dependent in instrumental ADL than before surgery (32% versus 7%, p = 0.027).ConclusionThis study identified postoperative delirium as an independent risk factor for mortality 6 months after hepatectomy. After 6 months, survivors were more dependent in instrumental ADL tasks and had worse scores in the physical function domain of SF-36.

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“…Delirium is consistently associated with an increased mortality rate across all nonsurgical patient populations, including general medical, geriatric, intensive care unit (ICU), stroke, dementia, nursing home, and emergency department. Patients who develop delirium in the ICU are at 2–4 fold increased risk of death both in and out of the hospital; 15–18 those who develop delirium on general medical or geriatric wards are at 1.5-fold increased risk for death in the year following hospitalization; 19–21 and patients with delirium in the emergency department have an approximately 70% increased risk of death during the first six months after the visit. 22 Cognitive impairment is common among surgical patients who develop delirium, with impairments lasting up to one year postoperatively; 12, 23, 24 and physical function is impaired for 30 days or more after discharge among surgical and non-surgical patients who develop delirium.…”

Section: Epidemiologymentioning

confidence: 99%

Delirium in elderly people

Inouye¹,

Westendorp²,

Saczynski³

2014

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Delirium, an acute disorder of attention and cognition, is a common, serious, costly, under-recognized and often fatal condition for seniors. Its diagnosis requires a formal cognitive assessment and history of acute onset of symptoms. Given its typically complex multifactorial etiology, multicomponent nonpharmacologic risk factor approaches have proven to be the most effective strategy for prevention. To date, there is no convincing evidence that pharmacologic prevention or treatment is effective. Drug reduction for sedation and analgesia combined with nonpharmacologic approaches are recommended. Delirium may provide a window to elucidate brain pathophysiology, serving both as a marker of brain vulnerability with decreased reserve and a potential mechanism for permanent cognitive damage. As a potent patient safety indicator, delirium provides a target for system-wide process improvements. Public health priorities will include improvements in coding and reimbursement, improved research funding, and widespread education for clinicians and the public about the importance of delirium.

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Postoperative Delirium in Intensive Care Patients: Risk Factors and Outcome

Cited by 72 publications

References 31 publications

Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

Outcome after hepatectomy-delirium as an independent predictor for mortality

Delirium in elderly people

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