Delirium affects length of hospital stay after lung transplantation

Abstract

Background Delirium is relatively common following lung transplantation, although its prevalence and prognostic significance have not been systematically studied. The purpose of the present study was to examine pre-transplant predictors of delirium and the short-term impact of delirium on clinical outcomes among lung transplant recipients. Methods Participants underwent pre-transplant cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status and the Trail Making Test. Following transplant, delirium was assessed using the Confusion Assessment Method until discharge. Results Sixty-three patients were transplanted between March and November, 2013, of which 23 (37%) developed delirium. Among transplanted patients, 48 patients completed pre-transplant cognitive testing. Better pre-transplant cognitive function was associated with lower risk of delirium (OR = 0.69 [95%CI 0.48, 0.99], P = .043); demographic and clinical features including native disease (P =.236), the Charlson comorbidity index (P = .581), and the lung allocation score (P = .871) were unrelated to risk of delirium, although there was a trend for women to experience delirium less frequently (P =.071). The presence (P = .006) and duration (P = .027) of delirium were both associated with longer hospital stays. Conclusion Delirium occurs in more than one third of patients following lung transplantation. Delirium was associated with poorer pretransplant cognitive functioning and longer hospital stays, after accounting for other medical and demographic factors.

Neurocognitive Changes after Lung Transplantation

“…In the present sample, patients who experienced delirium showed lower neurocognitive performance compared with their nondelirious counterparts during follow-up assessments. We also previously noted that patients with delirium displayed poorer cognition at baseline and had longer hospitalization stays compared with patients without delirium (16).…”

“…In the days immediately after transplantation, patients were assessed daily for the presence and severity of postoperative delirium using two validated clinical instruments (16): the Confusion Assessment Method (CAM) and Delirium Rating Scale (DRS-98).…”

Reduced Cerebral Perfusion Pressure during Lung Transplant Surgery Is Associated with Risk, Duration, and Severity of Postoperative Delirium

“…For example, mechanistic studies in animal models have demonstrated that experimental venous obstruction of the superior vena cava results in significant decreases in cerebral perfusion (43), which may be alleviated through either pharmacologic intervention or partial obstruction relief (44). These findings suggest that future studies may benefit from examining potential treatment strategies to mitigate superior vena cava obstruction during lung transplant, as the presence of postoperative delirium has been shown to improve clinical outcomes following hospitalization (6,8,45). It is also possible that elevated CVP resulted in increased edema or passive congestion, as elevated CVP has been associated with prolonged mechanical ventilation time and higher mortality among lung transplant recipients (46).…”

“…Delirium is common following lung transplant and has been shown to be associated with poorer clinical outcomes (8) and future cognitive impairment (9). Several recent studies have suggested that poorer intraoperative hemodynamic function may be associated with adverse neurocognitive outcomes among patients undergoing surgical procedures requiring single-lung ventilation (10,11).…”

Delirium after lung transplantation: Association with recipient characteristics, hospital resource utilization, and mortality

“…The available data on delirium after lung transplantation is limited to a few small single center studies 9–11 . A retrospective study of 30 lung transplant recipients found that 73% of patients developed delirium in the first 2 weeks after transplantation 9 .…”