Factors associated with post-surgical delirium in patients undergoing open heart surgery

Yadollah Jannati, Masoumeh Bagheri-Nesami, Maryam Sohrabi, Jamshid Yazdani-Cherati, Shahrzad Mazdarani, Yadollah Jannati, Masoumeh Bagheri-Nesami, Maryam Sohrabi, Jamshid Yazdani-Cherati, Shahrzad Mazdarani

Abstract

Objective: The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery.

Method: This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression) on SPSS software version 15.

Results: We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%.

Conclusion: Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium.

Keywords: Cognitive impairment; Delirium; Heart surgery; NeeCham Confusion scale.

References

    1. Rezaee F. [Translation of Pshychiatry Abstrac, Behavioral Sciences]. Kaplan H, Sadock V(Authors). Tehran: Arjmand Publication; 2008.P.405-42. (persian)
    1. Akechi T, Ishiguro C, Okuyama T, Endo C, Sagawa R, Uchida M, et al. . Delirium training program for nurses. Psychosomatics 2010. Mar-Apr;51(2):106-111. 10.1016/S0033-3182(10)70670-8
    1. Smeltzer SC, Bare BG. Brunner and Suddarth Textbook of Medical-Surgical Nursing: Lippincott Willams, 2010.
    1. Cerejeira J, Mukaetova-Ladinska EB. A clinical update on delirium: from early recognition to effective management. Nurs Res Pract 2011;2011:875196.
    1. Page VJ, Navarange S, Gama S, McAuley DF. Routine delirium monitoring in a UK critical care unit. Crit Care 2009;13(1):R16. 10.1186/cc7714
    1. Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, et al. . Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010. Jul;38(7):1513-1520. 10.1097/CCM.0b013e3181e47be1
    1. Bush SH, Bruera E. The assessment and management of delirium in cancer patients. Oncologist 2009. Oct;14(10):1039-1049. 10.1634/theoncologist.2009-0122
    1. Bilotta F, Doronzio A, Stazi E, Titi L, Zeppa IO, Cianchi A, et al. . Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial–the PINOCCHIO trial. Trials 2011;12:170-177. 10.1186/1745-6215-12-170
    1. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, Jr, et al. . Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004. Apr;291(14):1753-1762. 10.1001/jama.291.14.1753
    1. Liu YH, Wang DX, Li LH, Wu XM, Shan GJ, Su Y, et al. . The effects of cardiopulmonary bypass on the number of cerebral microemboli and the incidence of cognitive dysfunction after coronary artery bypass graft surgery. Anesth Analg 2009. Oct;109(4):1013-1022. 10.1213/ane.0b013e3181aed2bb
    1. Luukkanen MJ, Uusvaara J, Laurila JV, Strandberg TE, Raivio MM, Tilvis RS, et al. . Anticholinergic drugs and their effects on delirium and mortality in the elderly. Dement Geriatr Cogn Dis Extra 2011. Jan;1(1):43-50. 10.1159/000322883
    1. Ghanavati A, Foroghi M, Esmaeeli S, Hasantash A, Bolorian A, Shahzamani M. (Detecting of intraoprative riskfactors in cardiac surgery). Journal of Iran Surgery. 2008;17(3):1-10. persian.
    1. Sockalingam S, Parekh N, Bogoch II, Sun J, Mahtani R, Beach C, et al. . Delirium in the postoperative cardiac patient: a review. J Card Surg 2005. Nov-Dec;20(6):560-567. 10.1111/j.1540-8191.2005.00134.x
    1. Inouye SK, Foreman MD, Mion LC, Katz KH, Cooney LM, Jr. Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med 2001. Nov;161(20):2467-2473. 10.1001/archinte.161.20.2467
    1. Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth 2009. Dec;103(1)(Suppl 1):i41-i46. 10.1093/bja/aep291
    1. Ali S, Patel M, Jabeen S, Bailey RK, Patel T, Shahid M, et al. . Insight into delirium. Innov Clin Neurosci 2011. Oct;8(10):25-34.
    1. Burns KD, Jenkins W, Yeh D, Procyshyn RM, Schwarz SK, Honer WG, et al. . Delirium after cardiac surgery: A retrospective case-control study of incidence and risk factors in a Canadian sample. J BC Medical. 2009;51(5):206-210
    1. Inouye SK, Bogardus ST, Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, et al. . A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999. Mar;340(9):669-676. 10.1056/NEJM199903043400901
    1. Kazmierski J, Kowman M, Banach M, Fendler W, Okonski P, Banys A, et al. IPDACS Study . Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS Study. J Psychosom Res 2010. Aug;69(2):179-185. 10.1016/j.jpsychores.2010.02.009
    1. Tashakori A, Shanesaz A, Mogehi N. (Comparing the delirium rate in patients with cardiac surgery and general surgery in Golestan Hospital). Journal of Ahvaz Medicine. 2002;41:37-43. persian.
    1. Gemertvan LA, Schuurmans MJ. The Neecham Confusion Scale and the Delirium Observation Screening Scale: Capacity to discriminate and ease of use in clinical practice. BMC Nurs 2007;6(3):1-6.
    1. Vreeswijk R, Timmers JF, Jonghe FM, Kalisvaart KJ. Assessment scales for delirium. Aging Health. 2009;5(3):409-425 .10.2217/ahe.09.10
    1. Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Elseviers M, Bossaert L. A comparison of the CAM-ICU and the NEECHAM Confusion Scale in intensive care delirium assessment: an observational study in non-intubated patients. Crit Care 2008;12(1):R16. 10.1186/cc6790
    1. Norkienė I, Samalavičius R, Misiūrienė I, Paulauskienė K, Budrys V, Ivaškevičius J. Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting. Medicina (Kaunas) 2010;46(7):460-464.
    1. Rolfson DB, McElhaney JE, Rockwood K, Finnegan BA, Entwistle LM, Wong JF, et al. . Incidence and risk factors for delirium and other adverse outcomes in older adults after coronary artery bypass graft surgery. Can J Cardiol 1999. Jul;15(7):771-776.
    1. Olin K, Eriksdotter-Jönhagen M, Jansson A, Herrington MK, Kristiansson M, Permert J. Postoperative delirium in elderly patients after major abdominal surgery. Br J Surg 2005. Dec;92(12):1559-1564. 10.1002/bjs.5053
    1. Hall JB, Schweickert W, Kress JP. Role of analgesics, sedatives, neuromuscular blockers, and delirium. Crit Care Med 2009. Oct;37(10)(Suppl):S416-S421. 10.1097/CCM.0b013e3181b6f95b
    1. Khalifezadeh A, Safazadeh S, Mehrabi T, Mansour BA. Reviewing the effect of nursing interventions on delirious patients admitted to intensive care unit of neurosurgery ward in Al-Zahra Hospital, Isfahan University of Medical Sciences. Iran J Nurs Midwifery Res 2011;16(1):106-112.
    1. Maldonado JR, Wysong A. Starre PJvd, Block T, Miller C, Reitz BA. Dexmedetomidine and the Reduction of Postoperative Delirium after Cardiac Surgery. J Psychosomatics. 2009;50:206-217 .10.1176/appi.psy.50.3.206
    1. Rompaey BV, Elseviers MM. chuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L. Risk factors for delirium in intensive care patients: a prospective cohort study. J Crit Care Med. 2009;13:1-12
    1. Nazeri A, Khajemogehi N, Pakseresht S, Ramzani A. The effect of multicomponent intervention in prevention of delirium in patient undergoing cardiac surgery. Journal of Ahvaz Medicine. 2007;6:1-10. persian.
    1. Tylor K, Lailise K. Principle of Tylor. Tehran: Boshra Publication, 2001. (persian)
    1. Zolfaghari M, Bahramnejad F. Nursing Care in Intensive Care Unit. Tehran: Boshra Publication; 2008.(persian)
    1. Koster S, Hensens AG, Schuurmans MJ, van der Palen J. Risk factors of delirium after cardiac surgery: a systematic review. Eur J Cardiovasc Nurs 2011. Dec;10(4):197-204. 10.1016/j.ejcnurse.2010.09.001

Source: PubMed

3
S'abonner