Delirium in cardiac surgery - risk factors and prevention

Abstract

Introduction. Delirium is defined as an acute change in mental status that leads to disturbance in perception, thinking, memory, attention, emotional status, as well as sleep rhythm disorders and is most often reversible. Postoperative delirium is an acute mental disorder that develops after cardiovascular surgery with an incidence of 20 - 50% of operated patients. This complication is associated with a longer hospitalization, longer stay in the intensive care unit, as well as increased morbidity and mortality. Risk Factors. The risk factors are divided into preoperative, intraoperative and postoperative. The most common preoperative risk factors are older age, stenosis of the carotid arteries, previous cerebral diseases, depression, diabetes, hypertension, low ejection fraction of the left ventricle, as well as heart rhythm disorders. Intraoperative risk factors include the type of surgery, type of anesthesia, duration of extracorporeal circulation, and duration of aortic clamp. The most important postoperative risk factors include the use of psychoactive drugs, prolonged pain, the use of opioid drugs, duration of mechanical ventilation, and the length of stay in the intensive care unit. Prevention. Prevention is a very important aspect that is most often focused on intraoperative and postoperative precipitating factors. Preventive treatment includes pharmacological and non-pharmacological methods. The main recommendation refers to avoiding routine use of antipsychotics. Conclusion. Continuous infusion of dexmedetomidine compared to propofol reduces the incidence of postoperative delirium. Nonpharmacological approach consists of a series of procedures that are carried out postoperatively, such as the protocol that includes monitoring of Awakening, Breathing, Coordination, Delirium, Early mobility, and Family engagement.