Journal
HEART & LUNG
Volume 47, Issue 4, Pages 408-417Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.hrtlng.2018.04.005
Keywords
Cardiac surgery; Delirium; Incidence; Intensive care; Phenotype; Subsyndromal delirium
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Background: In cardiac surgical patients little is known about different phenotypes of delirium and how the symptoms fluctuate over time. Objectives: Evaluate risk factors, incidence, fluctuations, phenotypic characteristics and impact on patients' outcomes of delirium. Methods: Prospective longitudinal study. In postoperative intensive care unit 199 patient were assessed three-times a day through an adapted versions of the Intensive Care Delirium Screening Checklist. Results: Delirium and subsyndromal delirium incidence were 30.7% and 31.2%, respectively. Delirium manifested mostly in the hypoactive form and showed a fluctuating trend for several days. Atrial fibrillation, benzodiazepine/opioids dosages, hearing impairment, extracorporeal circulation length, SAPS-II and mean arterial pressure were independent predictors for delirium. Delirium was a statistically significant predictor of chemical/physical restraint use and hospital length of stay. Conclusions: Given the fluctuating and phenotypic characteristics, delirium screening should be a systematic/intentional activity. Multidisciplinary prevention strategies should be implemented to identify and treat the modifiable risk factors. (C) 2018 Elsevier Inc. All rights reserved.
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