Postcardiotomy delirium

Although postcardiotomy delirium has been studied widely, there are few data about the current prevalence, compared to that reported in the late 1960s. There have been few efforts to replicate early observations. The authors review the literature using meta-analysis to combine the results of 44 studies. They examined the relationships between postcardiotomy delirium and 28 hypothesized risk variables. The prevalence of postcardiotomy delirium has remained fairly constant over time at 32%. There was no difference in the total prevalence of postcardiotomy delirium reported in studies that used interviews versus chart reviews...

Critical care patients become confused in the intensive care setting. Several dangers exist in acute confusional states. Confused patients jeopardize their own safety, are more likely to die than nonconfused patients and are more likely to become cognitively impaired and require institutionalization. This article reviews the literature about patients experiencing acute confusional states in the critical care setting including intensive care unit (ICU) psychosis, postcardiotomy delirium and confusion in the elderly...

The cause of postoperative delirium is unknown. In 7 patients with postcardiotomy delirium (6 men, 1 woman; mean age 67 years), we observed a plasma concentration of tryptophan and a plasma tryptophan ratio significantly lower than in 8 non-delirious postoperative control patients. We suggest that the mental symptoms of postcardiotomy delirium are the consequence of a reduced cerebral tryptophan availability due to a catabolic state.

One hundred heart surgery patients were followed throughout their postoperative periods to assess the incidence and etiology of postcardiotomy delirium. Factors evaluated were: age, sex, history of previous psychiatric illness, history of cerebrovascular disease, cardiac diagnosis and operation, time of anesthesia, time of bypass, time spent in the intensive-care unit, and amount of sleep during the postoperative period. Six patients developed delirium, five of whom had a lucid postoperative interval; four patients had perceptual disturbances only, without loss of contact with reality; three had neurological symptoms with mild confusion; 87 kept a clear mental state...

Any one of a number of psychologic patterns may appear cardiotomy: (1) Some patients may be elated and confident after awakening from anesthesis and have no severe changes of affect or neurologic deficit. Denial seems to be for them an adequate defense against anxiety. (2) Others are disoriented and manifest neurologic disturbance immediately after awakening, without a lucid interval. The sensorium begins to clear five days after surgery. (3) Some patients go into delirium after being lucid for as long as a week and have hallucinations, illusions, and motor excitation for a few days-or over several weeks...

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The literature concerning postcardiotomy delirium contains confusing definitions and contradictory results. In a critical review of the subject, we conclude that cardiac status, the severity of physical illness, the complexity of the surgical procedure, and preoperative organic brain disease are the determining factors in postcardiotomy delirium. Preoperative anxiety, denial, and depression also have some correlation. Age, sex, time on bypass, and preoperative psychological profile seem to have no influence on outcome...

This study reports the psychologic findings in 30 patients undergoing this operation. Approximately one third developed postcardiotomy delirium, an occurrence consistent with that after other forms of open-heart surgery. Acceptance of the operation as opposed to preoperative anxiety, depression or denial, adequate comprehension of the proposed procedure, and a stable postoperative environment seem associated with less postcardiotomy delirium. Preventive preoperative therapeutic suggestions based on these findings are given...

No abstract text is available yet for this article.