Delirium after cardiac surgery. Incidence, phenotypes, predisposing and precipitating risk factors, and effects

Abstract

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.

Keywords: Cardiac surgery; Delirium; Incidence; Intensive care; Phenotype; Subsyndromal delirium.