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Randomized Controlled Trial
. 2017 Nov 14;14(1):221.
doi: 10.1186/s12974-017-0999-y.

Hypertonic saline for prevention of delirium in geriatric patients who underwent hip surgery

Xi Xin  1 , Fei Xin  2 , Xuguang Chen  1 , Qi Zhang  1 , Yanan Li  1 , Shuping Huo  1 , Chongfu Chang  1 , Qiujun Wang  3
Affiliations
Randomized Controlled Trial

Hypertonic saline for prevention of delirium in geriatric patients who underwent hip surgery

Xi Xin et al. J Neuroinflammation. .

Abstract

Background: Postoperative delirium (POD) is a common disorder in the elderly patients, and neuroinflammation is the possible underlying mechanism. This study is designed to determine whether or not hypertonic saline (HS) pre-injection can alleviate POD in aged patients.

Methods: This prospective study recruited 120 geriatric patients who underwent hip surgery. The patients were randomly divided into two groups: control group (NS group) and HS group. Patients in the NS group were pre-injected with 4 mL/kg isotonic saline, and those in the HS group were pre-injected with 4 mL/kg 7.5% HS. All 120 patients were then subjected to general anesthesia. Blood samples were extracted to detect the concentration of inflammatory factors, namely, IL-1β, IL-6, IL-10, and TNF-α, and the nerve injury factor S100β. Flow cytometry was used to detect the number of monocytes in peripheral venous blood and evaluate the relationship of inflammation to delirium. The nursing delirium screening scale (Nu-DESC) was used to determine cognitive function 1 to 3 days postoperatively.

Results: Analysis using random-effect multivariable logistic regression indicated that HS administration before anesthesia was associated with a low risk of POD (odds ratio [OR], 0.13; 95% CI, 0.04 to 0.41; P = 0.001) and few CD14 + CD16+ monocytes (β = - 0.61; 95% CI, - 0.74 to - 0.48; P = 0.000) the following day. When the association between HS and delirium was controlled for CD14 + CD16+ monocytes, the effect size became nonsignificant (odds ratio [OR], 0.86; 95% CI, 0.14 to 5.33; P = 0.874). TNF-α was significantly associated with POD (odds ratio [OR], 1.10; 95% CI, 1.05 to 1.16; P = 0.000). However, IL-1β, IL-6, IL-10, and S100β were not significantly related to POD.

Conclusion: HS can alleviate POD in geriatric patients and may inhibit the secretion of inflammatory factors by monocytes.

Keywords: Cytokines; Elderly; Hypertonic saline; Monocytes; Neuroinflammation; Postoperative delirium.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by ethics committee of the Third Hospital of Hebei Medical University (2016-012-1), and written informed consent was obtained from all subjects.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Relationship between the levels of CD14 + CD16+ monocytes according to prophylactic hypertonic saline (HS) before anesthesia. Each point shows the average CD14 + CD16+ monocytes (%) in each group along with standard deviation
Fig. 2
Fig. 2
Analysis of the receiver operating characteristic for the predictive value of delirium
See this image and copyright information in PMC

References

    1. Page V, Navarange S, Gama S, MaAuley D. Routine delirium monitoring in a UK critical care unit. Crit Care. 2009;13(1):R16. doi: 10.1186/cc7714. - DOI - PMC - PubMed
    1. Ehlenbach WJ, Hough CL, Crane PK, et al. Association between acute care and critical illness hospitalization and cognitive function in older adults. JAMA. 2010;303:763–770. doi: 10.1001/jama.2010.167. - DOI - PMC - PubMed
    1. Milbrandt EB, Deppen S, Harrison PL, et al. Costs associated with delirium in echanically ventilated patients. Crit Care Med. 2004;32:955–962. doi: 10.1097/01.CCM.0000119429.16055.92. - DOI - PubMed
    1. Lee KH, Ha YC, Lee YK, Kang H, Koo KH. Frequency, risk factors, and prognosis of prolonged delirium in elderly patients after hip fracture surgery. Clin Orthop Relat Res. 2011;469:2612–2620. doi: 10.1007/s11999-011-1806-1. - DOI - PMC - PubMed
    1. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996;275:852–857. doi: 10.1001/jama.1996.03530350034031. - DOI - PubMed

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