Risk factors for postoperative delirium on oxygen delivery-guided perfusion

Mukaida, Hiroshi; Matsushita, Satoshi; Minami, Yoichi; Sato, Go; Usuba, Masato; Kondo, Rinako; Asai, Tomohiro; Amano, Atsushi

doi:10.1186/s13019-022-01938-z

Cited by 3 publications

(1 citation statement)

References 27 publications

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“…Delirium was defined using the Intensive Care Delirium Screening Checklist (ICDSC) as an ICDSC score � 4 (sensitivity, 99%; specificity, 64%) [12]. Scoring was performed according to physician or nurse records, as in previous studies [13][14][15]. ICDSC scoring was performed once a day, starting on the first postoperative day.…”

Section: Data Collection and Analysismentioning

confidence: 99%

Effect of pharmacist-led intervention protocol on preventing postoperative delirium after elective cardiovascular surgery

Asai,

Yanagawa,

Takahashi

2023

PLoS ONE

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Postoperative delirium (PD) is an acute brain dysfunction, with a particularly high incidence after cardiovascular surgery. Pharmacist-led interventions show limited evidence in attenuating PD in cardiovascular surgery. In this retrospective cohort study, we aimed to clarify the risk factors of PD for cardiovascular surgery focused on pharmacotherapy and elucidate the effect of pharmacist-led intervention on the PD attenuation rate based on protocol-based pharmaceutical management (PBPM). This study included 142 adult patients who underwent elective valve replacement or valvuloplasty. The risk factors for PD were investigated using multivariate logistic regression analysis. Taking risk factors into consideration, a protocol was developed to discontinue benzodiazepines prescriptions by ward pharmacists, and replace with ramelteon and suvorexant if all the following factors apply: 1) number of medications ≥ 6 drugs, 2) number of doses to take ≥ 4 times, and 3) regular use of benzodiazepines or insomnia. Subsequently, the PD rate was compared during a period of two years and 6 months between the pre-PBPM (n = 39) and post-PBPM (n = 62). The PD rate for elective valve replacement or valvuloplasty was 25% (35/142). The adjusted odds ratio for polypharmacy was 3.3 (95% confidence interval: 1.2–8.9, p = 0.016), suggesting that preoperative risk assessment may be essential for patients with polypharmacy. The PD rate significantly decreased to 13% (8/62) in the post-PBPM group compared with 33% (13/39) in the pre-PBPM group (p = 0.014). There was a significant decrease in benzodiazepines use in post-PBPM compared with pre-PBPM (p = 0.026); however, the rate of ramelteon and orexin receptor antagonists use increased by PBPM introduction (p < 0.001). Although the present PBPM still requires further modification, it is simple and potentially useful for pharmacists to assess the risk of patients undergoing any elective cardiovascular surgery.

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Section: Data Collection and Analysismentioning

confidence: 99%

Effect of pharmacist-led intervention protocol on preventing postoperative delirium after elective cardiovascular surgery

Asai,

Yanagawa,

Takahashi

2023

PLoS ONE

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Impact of robotic surgery on postoperative gastrointestinal dysfunction following minimally invasive colorectal surgery: incidence, risk factors, and short-term outcomes

Zhang,

Pan,

Yang

et al. 2024

Int J Colorectal Dis

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Effect of oxygen delivery during cardiopulmonary bypass on postoperative neurological outcomes in patients undergoing cardiac surgery: A scoping review of the literature

Elsebaie,

Shakeel,

Zhang

et al. 2024

Perfusion

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Background Reduced oxygen delivery (DO2) during cardiopulmonary bypass (CPB) was proposed as a risk factor for the development of postoperative neurological complications (PONCs), including cerebrovascular accidents (CVA), delirium, and postoperative cognitive dysfunction (POCD). We aimed to review the current evidence on the association between intraoperative DO2 and the incidence of PONCs. Methods MEDLINE, Embase, the Cochrane Library, and Web of Science were electronically searched to identify comparative studies from inception until July 2023 that reported the association between intraoperative DO2 levels and the incidence of PONCs (as defined by the scales and diagnostic tools utilized by the studies’ authors) in adults patients undergoing cardiac surgery using CPB. Results Of the 2513 papers identified, 10 studies, including 21,875 participants, were included. Of these, three studies reported on delirium, two on POCD, and five on CVA. Eight studies reported reduced intraoperative DO2 in patients who developed delirium and CVA. There was a lack of consensus on the cut-off of DO2 levels or the correlation between the period below these threshold values and the development of PONC. Conclusions Limited data suggest that maintaining intraoperative DO2 above the critical threshold levels and ensuring adequate intraoperative cerebral perfusion may play a role in minimizing the incidence of neurological events in adult patients undergoing cardiac surgery on cardiopulmonary bypass.

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Risk factors for postoperative delirium on oxygen delivery-guided perfusion

Cited by 3 publications

References 27 publications

Effect of pharmacist-led intervention protocol on preventing postoperative delirium after elective cardiovascular surgery

Effect of pharmacist-led intervention protocol on preventing postoperative delirium after elective cardiovascular surgery

Impact of robotic surgery on postoperative gastrointestinal dysfunction following minimally invasive colorectal surgery: incidence, risk factors, and short-term outcomes

Effect of oxygen delivery during cardiopulmonary bypass on postoperative neurological outcomes in patients undergoing cardiac surgery: A scoping review of the literature

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