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Risk factors for icu delirium after cardiac surgery
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POSTER PRESENTATIONS
Increase in the number of TUNEL positive cells in I/R group compared to sham and I/RþHFD groups. I/RþATA and I/RþATC groups showed significantly less apoptotic cells (p o0,01). Conclusion. These results showed that decrease in ACh induced contraction due to I/R was reversed in both ATC and ATA groups and that AT treatment decreased intestinal injury during reperfusion by the oxidative stress. Histological findings showed number of IL8 and TUNEL (þ) cells decreased after AT treatment of I/R. Compared to ATA; ATC treatment showed better protection against I/R. REFERENCE 1. Campos VF, et al: Atenolol to Treat Intestinal Ischemia and Reperfusion in Rats. Transplantation Proceedings, 2012 BP-3 Risk factors for ICU delirium after cardiac surgery Gabor Zilahi1, Orsolya Miskolci1, Martin Lenihan1, Aogan O Muircheartaigh1, Wahid Altaf1, Fauzi Othman1, Brian Marsh1, Roisin Ni Mhuircheartaigh1 1
Mater Misericordiae University Hospitlal
Background. Prior to the introduction of a formal screening tool (Confusion Assessment Method - Intensive Care Unit; CAM-ICU) a retrospective chart review from 2013 detected delirium in 12% of our post-cardiac surgical patients. We hypothesized that a) formal screening would reveal a higher incidence, and b) some modifiable pre and intraoperative risk factors may be target for intervention. Aims. 1. Measure the impact of the introduction of the CAM-ICU tool in our ICU/HDU on the detection of delirium in this patient group. 2. Study the clinical and psychosocial history of patients who developed delirium to distinguish fixed and modifiable risk factors in our patient population. 3. Use these data to develop a ‘delirium bundle’ for ICU/HDU staff to improve the detection of post-operative delirium. Methods. Informed consent for collection of perioperative data and post-operative CAM-ICU testing was obtained from 101 patients presenting for elective cardiac surgery over four months period (01.09.2014 - 31.12.2014). After consenting the patients, a pre-operative questionnaire gathered details of each patient’s smoking and alcohol use, their need for glasses or a hearing aid, any history of depression or anxiety, or psychoactive medication use. Other important intra and postoperative parameters were also collected. The CAM-ICU assessment was carried out daily unless delirium was diagnosed, in which case it was carried out twice a day until delirium resolved. There was no change in the perioperative medical management. Results. Use of the CAM-ICU tool increased our detection of delirium in this patient group from 12% to 21.7%. The median duration of delirium was 48 hours (range 12-552). Those diagnosed with delirium did not have a significantly different profile of proposed psychosocial risk factors. Factors that were significantly different in those patients diagnosed with delirium were generally not modifiable, i.e. higher Euro Score I & II, longer duration of cardiopulmonary bypass, intraoperative blood loss and moderate or high inotropic support following CPB. Conclusion. Our hypothesis that a history of alcohol or nicotine dependence or the need for sensory aids may increase the risk of delirium was not supported by our study. However, increased
vigilance in patients with identified fixed risk factors is an important component of the implementation of our new delirium bundle. REFERENCES 1. Brown, CH: Delirium in the cardiac surgical ICU. Current Opinion in Anesthesiology 27:117-122, 2014. 2. Barr, J. et al: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Med. 41:278-280, 2013 BP-4 Postoperative delirium following cardiac surgery: an analysis of incidence, risk factors and outcome Judita Andrejaitiene1,2, Edmundas Sirvinskas1,2 1 Institute of Cardiology at the Lithuanian University of Health Sciences, 2Department of Cardiac, Thoracic and Vascular Surgery of Hospital of Lithuanian University of Health Sciences Kauno klinikos Kaunas, Lithuania
Introduction. Postoperative delirium (POD) is a common and serious complication after cardiac surgery and numerous studies have confirmed this in occurence from 10% to 60% (1), patients have an increased risk of developing POD that is associated with poor outcomes (2). The aim of this study was to identify POD incidence, potential risk factors and to evaluate clinical outcome. Methods. A single-centre cohort of 292 patients undergoing elective cardiac surgery were prospectively enrolled. The patients were assessed and monitored preoperatively, during surgery and in the early postoperative period. The CAM-ICU delirium assessment tool was conducted. Results. The incidence of POD was 27.74% and it most common on 2.14(⫾0.73) post-operative day. The analysis showed that POD prolonged the length of the ICU stay 5.8 (⫾2.89) vs 3.86(⫾1.91) days, po0.001, patients after POD more frequent was required re-intubation (OR: 13.169; 95% CI 1.456119.087, p¼0.022) and had had the prolonged length of the postoperative hospital stay 410 days (OR: 2.060; 95% CI 1.226-3.460, p¼0.006). Univariate logistic regression of possible risk factors for POD analysis revealed pre-, peri- and postoperative risk factors as predictors of POD. Multivariate analysis remained as an independent predictors for POD: age 4 70 yr (OR: 2.227; 95% CI 1.325-3.742, p¼0.003), ejection fraction o 42% (OR: 2.398; 95% CI 1.397-4.117, p¼0.002), length of stay in the hospital before surgery 4 6 days (OR: 1.840; 95% CI 1.064-3.180, p¼0.029), combined valve repair and CABG surgery (OR: 2.083; 95% CI 1.153-3.761, p¼0.015), duration of CPB 4 86 min (OR: 2.068; 95% CI 1.182-3.618, p¼0.009) and postoperative atrial fibrillation (OR: 2.244; 95% CI 1.158-4.347, p¼0.007). Discussion. Our current analysis suggests that POD is a frequent complication and worsen patient outcome following cardiac surgery. POD may affect the many reasons and a multifactorial risk model should be applied to identify patients at an increased risk of developing POD. Our study and other examples in the literature (2) suggest that many factors cannot be changed or avoided but some can be modified and it depends from us: if to shorten the length of stay in the hospital before surgery o 6 days, it may reduce the number of patients who develop POD. By the way, a large prospective randomised study in this regard is needed.
POSTER PRESENTATIONS
Increase in the number of TUNEL positive cells in I/R group compared to sham and I/RþHFD groups. I/RþATA and I/RþATC groups showed significantly less apoptotic cells (p o0,01). Conclusion. These results showed that decrease in ACh induced contraction due to I/R was reversed in both ATC and ATA groups and that AT treatment decreased intestinal injury during reperfusion by the oxidative stress. Histological findings showed number of IL8 and TUNEL (þ) cells decreased after AT treatment of I/R. Compared to ATA; ATC treatment showed better protection against I/R. REFERENCE 1. Campos VF, et al: Atenolol to Treat Intestinal Ischemia and Reperfusion in Rats. Transplantation Proceedings, 2012 BP-3 Risk factors for ICU delirium after cardiac surgery Gabor Zilahi1, Orsolya Miskolci1, Martin Lenihan1, Aogan O Muircheartaigh1, Wahid Altaf1, Fauzi Othman1, Brian Marsh1, Roisin Ni Mhuircheartaigh1 1
Mater Misericordiae University Hospitlal
Background. Prior to the introduction of a formal screening tool (Confusion Assessment Method - Intensive Care Unit; CAM-ICU) a retrospective chart review from 2013 detected delirium in 12% of our post-cardiac surgical patients. We hypothesized that a) formal screening would reveal a higher incidence, and b) some modifiable pre and intraoperative risk factors may be target for intervention. Aims. 1. Measure the impact of the introduction of the CAM-ICU tool in our ICU/HDU on the detection of delirium in this patient group. 2. Study the clinical and psychosocial history of patients who developed delirium to distinguish fixed and modifiable risk factors in our patient population. 3. Use these data to develop a ‘delirium bundle’ for ICU/HDU staff to improve the detection of post-operative delirium. Methods. Informed consent for collection of perioperative data and post-operative CAM-ICU testing was obtained from 101 patients presenting for elective cardiac surgery over four months period (01.09.2014 - 31.12.2014). After consenting the patients, a pre-operative questionnaire gathered details of each patient’s smoking and alcohol use, their need for glasses or a hearing aid, any history of depression or anxiety, or psychoactive medication use. Other important intra and postoperative parameters were also collected. The CAM-ICU assessment was carried out daily unless delirium was diagnosed, in which case it was carried out twice a day until delirium resolved. There was no change in the perioperative medical management. Results. Use of the CAM-ICU tool increased our detection of delirium in this patient group from 12% to 21.7%. The median duration of delirium was 48 hours (range 12-552). Those diagnosed with delirium did not have a significantly different profile of proposed psychosocial risk factors. Factors that were significantly different in those patients diagnosed with delirium were generally not modifiable, i.e. higher Euro Score I & II, longer duration of cardiopulmonary bypass, intraoperative blood loss and moderate or high inotropic support following CPB. Conclusion. Our hypothesis that a history of alcohol or nicotine dependence or the need for sensory aids may increase the risk of delirium was not supported by our study. However, increased
vigilance in patients with identified fixed risk factors is an important component of the implementation of our new delirium bundle. REFERENCES 1. Brown, CH: Delirium in the cardiac surgical ICU. Current Opinion in Anesthesiology 27:117-122, 2014. 2. Barr, J. et al: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Med. 41:278-280, 2013 BP-4 Postoperative delirium following cardiac surgery: an analysis of incidence, risk factors and outcome Judita Andrejaitiene1,2, Edmundas Sirvinskas1,2 1 Institute of Cardiology at the Lithuanian University of Health Sciences, 2Department of Cardiac, Thoracic and Vascular Surgery of Hospital of Lithuanian University of Health Sciences Kauno klinikos Kaunas, Lithuania
Introduction. Postoperative delirium (POD) is a common and serious complication after cardiac surgery and numerous studies have confirmed this in occurence from 10% to 60% (1), patients have an increased risk of developing POD that is associated with poor outcomes (2). The aim of this study was to identify POD incidence, potential risk factors and to evaluate clinical outcome. Methods. A single-centre cohort of 292 patients undergoing elective cardiac surgery were prospectively enrolled. The patients were assessed and monitored preoperatively, during surgery and in the early postoperative period. The CAM-ICU delirium assessment tool was conducted. Results. The incidence of POD was 27.74% and it most common on 2.14(⫾0.73) post-operative day. The analysis showed that POD prolonged the length of the ICU stay 5.8 (⫾2.89) vs 3.86(⫾1.91) days, po0.001, patients after POD more frequent was required re-intubation (OR: 13.169; 95% CI 1.456119.087, p¼0.022) and had had the prolonged length of the postoperative hospital stay 410 days (OR: 2.060; 95% CI 1.226-3.460, p¼0.006). Univariate logistic regression of possible risk factors for POD analysis revealed pre-, peri- and postoperative risk factors as predictors of POD. Multivariate analysis remained as an independent predictors for POD: age 4 70 yr (OR: 2.227; 95% CI 1.325-3.742, p¼0.003), ejection fraction o 42% (OR: 2.398; 95% CI 1.397-4.117, p¼0.002), length of stay in the hospital before surgery 4 6 days (OR: 1.840; 95% CI 1.064-3.180, p¼0.029), combined valve repair and CABG surgery (OR: 2.083; 95% CI 1.153-3.761, p¼0.015), duration of CPB 4 86 min (OR: 2.068; 95% CI 1.182-3.618, p¼0.009) and postoperative atrial fibrillation (OR: 2.244; 95% CI 1.158-4.347, p¼0.007). Discussion. Our current analysis suggests that POD is a frequent complication and worsen patient outcome following cardiac surgery. POD may affect the many reasons and a multifactorial risk model should be applied to identify patients at an increased risk of developing POD. Our study and other examples in the literature (2) suggest that many factors cannot be changed or avoided but some can be modified and it depends from us: if to shorten the length of stay in the hospital before surgery o 6 days, it may reduce the number of patients who develop POD. By the way, a large prospective randomised study in this regard is needed.