Prevalence and Risk Factors for Postoperative Delirium in a Cardiovascular Intensive Care Unit

2008 ◽  
Vol 17 (6) ◽  
pp. 567-575 ◽  
Author(s):  
Yu-Ling Chang ◽  
Yun-Fang Tsai ◽  
Pyng-Jing Lin ◽  
Min-Chi Chen ◽  
Chia-Yih Liu
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Postoperative Delirium ◽  
Acute Infection ◽  
Univariate Analysis ◽  
Open Heart Surgery ◽  
Chang Gung Memorial Hospital ◽  
Cardiovascular Intensive Care

Background Delirium after cardiac surgery is a common complication in cardiovascular intensive care units. The prevalence of delirium and its likely risk factors have not previously been explored in a single sample of postoperative cardiac patients in an intensive care unit. Objective To compare a variety of characteristics in patients with and without delirium and to identify risk factors associated with delirium in patients hospitalized in an intensive care unit after cardiac surgery. Methods A retrospective chart review was used to collect data on 288 patients who had open heart surgery during the period 2004 to 2005 at Chang Gung Memorial Hospital in northern Taiwan. A researcher-designed checklist of 52 patient-related risk factors for delirium was used to collect preoperative, intra-operative, and postoperative data. All patients were assessed by psychiatrists, and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Data were analyzed via univariate analysis and multivariate logistic regression. Results The prevalence of postoperative delirium was 41.7%. Patients with and without delirium differed significantly on 29 variables. Four postoperative factors, hematocrit less than 30%, cardiogenic shock, hypoalbuminemia, and acute infection, were significant, independent predictors of postoperative delirium. Conclusions The results of this study can be used to develop a revised checklist of 29 preoperative, intraoperative, and postoperative risk factors for delirium, with special attention to the 4 predictive postoperative factors. Use of such a checklist may facilitate the ability to prevent or detect delirium early and provide suitable treatment.

scholarly journals Prevalence of postoperative delirium according to the intraoperative general anesthetic agents in patients undergoing cardiac surgery: A retrospective and propensity-score matched study

2020 ◽  
Author(s):  
Hyun-Jung Shin ◽  
Soo Lyoen Choi ◽  
Hyo-Seok Na
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Postoperative Delirium ◽  
Bypass Graft ◽  
Significant Risk ◽  
Anesthetic Agents

Abstract Background: Postoperative delirium (PD) is still an issue in post-cardiac surgery patients despite the constant efforts to reduce it. Although various risk factors for PD after cardiac surgery have been identified, there is limited clinical data regarding the effect of intraoperative anesthetic agents on the PD.Methods: The medical records of 534 patients, who had undergone heart valve surgery or coronary artery bypass graft surgery with cardiopulmonary bypass (CPB) between January 2012 and August 2017, were investigated. They were divided into two groups according to the main anesthetic agent: sevoflurane with dexmedetomidine (sevo-dex group, n = 340) and propofol (propofol group, n = 194). The incidence of PD was evaluated as the primary outcome. PD was defined as the positive Confusion Assessment Method for the Intensive Care Unit during the intensive care unit stay. Patient-, surgery-, and anesthesia-related factors and postoperative complications were investigated as secondary outcomes. To reduce the risk of confounder effects between the two groups, 194 patients were selected from the sevo-dex group after propensity-score matching.Results: After propensity-score matching, the incidence of PD was not significantly different between the sevo-dex (6.2%) and propofol (10.8%) groups (P = 0.136). In comparison of the incidence of each type of PD, only hyperactive PD occurred significantly less in the sevo-dex group than in the propofol group (P = 0.021). Older age, lower preoperative albumin levels, and emergency surgery were significant risk factors for PD.Conclusions: The overall incidence of PD after cardiac surgery with CPB is not associated with the main anesthetic agents, sevoflurane and dexmedetomidine-based vs. propofol-based anesthesia. Only hyperactive PD occurred less frequently after in patients receiving sevoflurane and dexmedetomidine-based anesthesia.

scholarly journals Incidence and Risk Factors of Early Delirium after Cardiac Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Ieva Norkienė ◽  
Donata Ringaitienė ◽  
Vilma Kuzminskaitė ◽  
Jūratė Šipylaitė
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Postoperative Delirium ◽  
Group Versus ◽  
University Hospital ◽  
Low Cardiac Output Syndrome ◽  
Duration Of Surgery

Introduction. The aim of our study was to identify the incidence and risk factors of delirium after cardiac surgery implementing Intensive Care Delirium Screening Checklist (ICDSC).Material and Methods. 87 patients, undergoing cardiac surgery at Vilnius University hospital, were prospectively monitored for postoperative delirium development, during intensive care unit stay.Results. The incidence of postoperative delirium was 13.30%. No statistically relevant preoperative predictors of delirium were found. The duration of surgery was significantly longer in delirium group ( versus hours, ). Patients in delirium group more often had blood product transfusions (1.50 (± 1.57) versus 0.49 (± 0.91) ) and had a higher incidence of low cardiac output syndrome (33.30% versus 3.00%, ); they were significantly longer mechanically ventilated ( versus 8.78 ± 4.77 ()) hours (OR = 1.15 ()) and had twice longer ICU stay ( versus 2.60 ± 1.10 ()) days (OR = 1.91 ()).Conclusions. The incidence of delirium after cardiac surgery was 13.3%. Independent predictors of delirium were duration of postoperative mechanical ventilation and intensive care unit stay.

Interacting risk factors determine the outcome of patients with a prolonged intensive care unit stay after cardiac surgery

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
J Schöttler ◽  
C Grothusen ◽  
T Attmann ◽  
C Friedrich ◽  
S Freitag-Wolf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Unit Stay

Readmission to the Intensive Care Unit after Fast-Track Cardiac Surgery: An Analysis of Risk Factors and Outcome according to the Type of Operation

2010 ◽  
Vol 13 (4) ◽  
pp. E212-E217 ◽  
Author(s):  
Fevzi Toraman ◽  
Sahin Senay ◽  
Umit Gullu ◽  
Hasan Karabulut ◽  
Cem Alhan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Fast Track

scholarly journals Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

2021 ◽  
Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

scholarly journals Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

2020 ◽  
Vol 47 (5) ◽  
pp. 627-633 ◽  
Author(s):  
Hongbai Wang ◽  
Liang Zhang ◽  
Qipeng Luo ◽  
Yinan Li ◽  
Fuxia Yan
Keyword(s):  
Intensive Care Unit ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Sleep Quality ◽  
Sleep Disorder ◽  
Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Post Cardiac Surgery

ABSTRACT:Background:Post-cardiac surgery patients exhibit a higher incidence of postoperative delirium (PD) compared to non-cardiac surgery patients. Patients with various cardiac diseases suffer from preoperative sleep disorder (SPD) induced by anxiety, depression, breathing disorder, or other factors.Objective:To examine the effect of sleep disorder on delirium in post-cardiac surgery patients.Methods:We prospectively selected 186 patients undergoing selective cardiac valve surgery. Preoperative sleep quality and cognitive function of all eligible participants were assessed through the Pittsburgh Sleep Quality Index (PSQI) and the Montreal Cognitive Assessment, respectively. The Confusion Assessment Method for Intensive Care Unit was used to assess PD from the first to seventh day postoperatively. Patients were divided into two groups according to the PD diagnosis: (1) No PD group and (2) the PD group.Results:Of 186 eligible patients, 29 (15.6%) were diagnosed with PD. A univariate analysis showed that gender (p = 0.040), age (p = 0.009), SPD (p = 0.008), intraoperative infusion volume (p = 0.034), postoperative intubation time (p = 0.001), and intensive care unit stay time (p = 0.009) were associated with PD. A multivariate logistic regression analysis demonstrated that age (odds ratio (OR): 1.106; p = 0.001) and SPD (OR: 3.223; p = 0.047) were independently associated with PD. A receiver operating characteristic curve demonstrated that preoperative PSQI was predictive of PD (area under curve: 0.706; 95% confidence interval: 0.595–0.816). A binomial logistic regression analysis showed that there was a significant association between preoperative 6 and 21 PSQI scores and PD incidence (p = 0.009).Conclusions:Preoperative SPD was significantly associated with PD and a main predictor of PD.

scholarly journals Risk Factors for Candidemia After Open Heart Surgery: Results From a Multicenter Case–Control Study

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Daniele Roberto Giacobbe ◽  
Antonio Salsano ◽  
Filippo Del Puente ◽  
Ambra Miette ◽  
Antonio Vena ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Surgery ◽  
Case Control Study ◽  
Open Heart Surgery ◽  
Case Control ◽  
Open Heart ◽  
Previous Therapy ◽  
Control Study

Abstract Background Candida species are among the most frequent causative agents of health care–associated bloodstream infections, with mortality &gt;40% in critically ill patients. Specific populations of critically ill patients may present peculiar risk factors related to their reason for intensive care unit admission. The primary objective of the present study was to assess the predictors of candidemia after open heart surgery. Methods This retrospective, matched case–control study was conducted in 8 Italian hospitals from 2009 to 2016. The primary study objective was to assess factors associated with the development of candidemia after open heart surgery. Results Overall, 222 patients (74 cases and 148 controls) were included in the study. Candidemia developed at a median time (interquartile range) of 23 (14–36) days after surgery. In multivariable analysis, independent predictors of candidemia were New York Heart Association class III or IV (odds ratio [OR], 23.81; 95% CI, 5.73–98.95; P &lt; .001), previous therapy with carbapenems (OR, 8.87; 95% CI, 2.57–30.67; P = .001), and previous therapy with fluoroquinolones (OR, 5.73; 95% CI, 1.61–20.41; P = .007). Crude 30-day mortality of candidemia was 53% (39/74). Septic shock was independently associated with mortality in the multivariable model (OR, 5.64; 95% CI, 1.91–16.63; P = .002). No association between prolonged cardiopulmonary bypass time and candidemia was observed in this study. Conclusions Previous broad-spectrum antibiotic therapy and high NYHA class were independent predictors of candidemia in cardiac surgery patients with prolonged postoperative intensive care unit stay.

scholarly journals Incidence and Risk Factors for Ventilator-Associated Pneumonia in Kathmandu University Hospital

2012 ◽  
Vol 9 (1) ◽  
pp. 28-31 ◽  
Author(s):  
S Ranjit ◽  
B Bhattarai
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Univariate Analysis ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Chi Square ◽  
H2 Blockers ◽  
Observational Cohort ◽  
Level Of Significance

Background Ventilator associated pneumonia is a major cause of morbidity in the intensive care unit. Difficulties in identification of the risk factors, in diagnosing and in prevention, have intensified the problem. Objectives To measure the incidence of ventilator associated pneumonia in intensive care unit and to identify the risk factors associated. Methods A prospective observational cohort study of 69 patients who were mechanically ventilated for more than 48 hours were evaluated to find out the development of nosocomial pneumonia and presence or absence of risk factors. Data were subjected to univariate analysis using chi-square and t-test. Level of significance was set at 0.05. Results Twenty two (31.88%) out of 69 patients developed ventilator associated pneumonia, majority of them between four days to 14 days. Reintubation, invasive lines, H2 blockers and low PaO2/FiO2 were identified as major risk factors in our study. Enteral feeding via nasogastric tube and use of steroids was not associated with development of ventilator associated pneumonia. The patients with ventilator associated pneumonia had significantly longer duration of mechanical ventilation (18.88±7.7 days vs 7.36±4.19 days) and stay (29±17.8 days vs 9.22±5.14 days). The morality was similar for both the groups with or without ventilator associated pneumonia. ConclusionThe incidence of ventilator pneumonia is high. Patients requiring prolonged ventilation, re-intubation, more invasive lines and H2 blockers, are at high risk and need special attention towards prevention.http://dx.doi.org/10.3126/kumj.v9i1.6258 Kathmandu Univ Med J 2011;9(1):28-31 

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