Postoperative Delirium in Patients on Cardiopulmonary Bypass for Cardiovascular Surgeries: Incidence and Influencing Factors

ZHOU Chenxi, WANG Hui, WU Qiansheng, ZHOU Yanrong, WANG Lan, WANG Xiaoxiao, ZENG Ying, DAI Ling, ZHANG Na, QU

Abstract

To investigate the incidence and influencing factors of postoperative delirium (POD) and subsyndromal delirium (SSD) in patients connected to cardiopulmonary bypass during cardiovascular surgeries.  Methods  We collected the general data and the data for the perioperative hematological, physiological, and biochemical indicators and the surgical and therapeutic conditions of patients connected to cardiopulmonary bypass during the course of cardiovascular surgeries conducted at a tertiary-care hospital in Hubei province between May 2022 and September 2022. The outcome indicators, including the incidence of POD and SSD, were assessed with the Nursing Delirium Screening Scale (Nu-DESC). Multinomial logistic regression was performed to analyze the influencing factors of patients with different statuses of POD and SSD.   Results  Among the 202 patients, the incidence of SSD, SSD progressing to POD, and no POD or SSD (ND) progressing to POD were 13.4%, 6.4%, and 34.2%, respectively. Regression analysis showed that, with ND patients as the controls, the influencing factors for SSD were preoperative blood glucose (odds ratio [OR]=0.38, 95% confidence interval [CI]: 0.19-0.76), intraoperative platelet transfusion (OR=0.37, 95% CI: 0.15-0.92), intraoperative etomidate (OR=0.93, 95% CI: 0.87-0.98), and postoperative total bilirubin level (OR=1.04, 95% CI: 1.01-1.07). For the progression of SSD to POD, the influencing factors were age (OR=1.09, 95% CI: 1.01-1.17), ASA classification of IV and above (OR=10.72, 95% CI: 1.85-62.08), intraoperative dexmedetomidine (OR=1.01, 95% CI: 1.003-1.02), and the duration of mechanical ventilation (OR=1.04, 95% CI: 1.01-1.07). For the progression of ND to POD, the influencing factors were age (OR=1.06, 95% CI: 1.02-1.10), middle or high school education (OR=0.35, 95% CI: 0.15-0.83), and the duration of mechanical ventilation (OR=1.04, 95% CI: 1.01-1.07).   Conclusion  Age, education, ASA classification, preoperative blood glucose, intraoperative platelet transfusion, intraoperative etomidate, intraoperative dexmedetomidine, postoperative total bilirubin, and the duration of mechanical ventilation are influencing factors for different statuses of POD and SSD among patients connected to cardiopulmonary bypass when they are undergoing cardiovascular surgeries. The influencing factors vary across groups of patients with different statuses of POD and SSD. Therefore, we should accurately assess the risk factors of patients with different statuses of POD and SSD and carry out corresponding interventions, thereby preventing or reducing the occurrence of POD and SSD, and ultimately promoting enhanced recovery after surgery.

 

Keywords: Cardiopulmonary bypass,  Cardiovascular surgery,  Postoperative delirium,  Subsyndromal delirium,  Enhanced recovery after surgery

 

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References


HUANG H， LI H， ZHANG X， et al. Association of postoperative delirium with cognitive outcomes: a meta-analysis. J Clin Anesth，2021， 75: 110496. doi: 10.1016/j.jclinane.2021.110496.

LI H C， WEI Y C， HSU R B， et al. Surviving and thriving 1 year after cardiac surgery: frailty and delirium matter. Ann Thorac Surg，2021， 111(5): 1578–1584. doi: 10.1016/j.athoracsur.2020.07.015.

LEVKOFF S E， LIPTZIN B， CLEARY P D， et al. Subsyndromal delirium. Am J Geriatr Psychiatry，1996，4(4): 320–329. doi: 10.1097/ 00019442-199622440-00006.

DEVLIN J W， SKROBIK Y， GÉLINAS C， et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med，2018，46(9): e825–e873. doi: 10.1097/CCM.0000000000003299.

MAILHOT T， COSSETTE S， MAHEU-CADOTTE M A， et al. Subsyndromal delirium in cardiac surgery patients: risk factors and outcomes of the different trajectories. J Cardiovasc Nurs，2022，37(1): 41–49. doi: 10.1097/JCN.0000000000000793.

Al-QADHEEB N S， SKROBIK Y， SCHUMAKER G， et al. Preventing ICU subsyndromal delirium conversion to delirium with low dose IV haloperidol: a double-blind, placebo-controlled pilot study. Crit Care Med，2016，44(3): 583–591. doi: 10.1097/CCM.0000000000001411v.

SERAFIM R B， DAL-PIZZOL F， SOUZA-DANTAS V， et al. Impact of subsyndromal delirium occurrence and its trajectory during ICU stay. J Clin Med，2022，11(22): 6797. doi: 10.3390/jcm11226797.

KLIMIEC-MOSKAL E， SLOWIK A， DZIEDZIC T. Delirium and subsyndromal delirium are associated with the long-term risk of death after ischaemic stroke. Aging Clin Exp Res，2022，34(6): 1459–1462. doi: 10.1007/s40520-021-02071-y.

LI H C， CHEN Y S， CHIU M J， et al. Delirium, subsyndromal delirium, and cognitive changes in individuals undergoing elective coronary artery bypass graft surgery. J Cardiovasc Nurs，2015，30(4): 340–345. doi: 10. 1097/JCN.0000000000000170.

GAUDREAU J D， GAGNON P， HAREL F， et al. Fast, systematic, and continuous delirium assessment in hospitalized patients: the Nursing Delirium Screening Scale. J Pain Symptom Manage，2005，29(4): 368–375. doi: 10.1016/j.jpainsymman.2004.07.009.

LIU S， XV L， WU X， et al. Potential value of preoperative fasting blood glucose levels in the identification of postoperative delirium in non-diabetic older patients undergoing total hip replacement: the perioperative neurocognitive disorder and biomarker lifestyle study. Front Psychiatry，2022，13: 941048. doi: 10.3389/fpsyt.2022.941048.

RUDIGER A， BEGDEDA H， BABIC D， et al. Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU. Crit Care Lond Engl，2016，20: 264. doi: 10.1186/s13054-016-1445-8.

BRAMLEY P， MCARTHUR K， BLAYNEY A， et al. Risk factors for postoperative delirium: an umbrella review of systematic reviews. Int J Surg Lond Engl，2021，93: 106063. doi: 10.1016/j.ijsu.2021.106063.

CHEN H， MO L， HU H， et al. Risk factors of postoperative delirium after cardiac surgery: a meta-analysis. J Cardiothorac Surg，2021，16(1): 113. doi: 10.1186/s13019-021-01496-w.

WITZENRATH M， KUEBLER W M. The Lung–Brain Axis in Ventilator-induced Brain Injury: Enter IL-6. Am J Respir Cell Mol Biol， 2021，65(4): 339–340. doi: 10.1165/rcmb.2021-0233ED.

MENZENBACH J， FREDE S， PETRAS J， et al. Perioperative vascular biomarker profiling in elective surgery patients developing postoperative delirium: a prospective cohort study. Biomedicines，2021，9(5): 553. doi: 10.3390/biomedicines9050553.

WHITLOCK E L， TORRES B A， LIN N， et al. Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg，2014，118(4): 809–817. doi: 10.1213/ANE. 0000000000000028.

WU M， LIANG Y， DAI Z， et al. Perioperative dexmedetomidine reduces delirium after cardiac surgery: a meta-analysis of randomized controlled trials. J Clin Anesth，2018，50: 33–42. doi: 10.1016/j.jclinane. 2018.06.045.

TURAN A， DUNCAN A， LEUNG S， et al. Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): a randomised placebo-controlled trial. Lancet，2020， 396(10245): 177–185. doi: 10.1016/S0140-6736(20)30631-0.

OLIVEIRA F R， OLIVEIRA V H， OLIVEIRA Í M， et al. Hypertension, mitral valve disease, atrial fibrillation and low education level predict delirium and worst outcome after cardiac surgery in older adults. BMC Anesthesiol，2018，18(1): 15. doi: 10.1186/s12871-018-0481-0.

ORDÓÑEZ-VELASCO L M， HERNÁNDEZ-LEIVA E. Factors associated with delirium after cardiac surgery: a prospective cohort study. Ann Card Anaesth，2021，24(2): 183–189. doi: 10.4103/aca.ACA_43_20.


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