Incidence and clinical significance of postoperative delirium after brain tumor surgery

Budėnas, Antanas; Tamašauskas, Šarūnas; Šliaužys, Albertas; Navickaitė, Ieva; Sidaraitė, Miglė; Pranckevičienė, Aistė; Deltuva, Vytenis Pranas; Tamašauskas, Arimantas; Bunevičius, Adomas

doi:10.1007/s00701-018-3718-2

Cited by 21 publications

(50 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[12][13][14] Potential associations between POD and adverse outcomes have also been reported in neurosurgical patients. [8][9][10][11] These results indicate that early prevention of POD should be employed in this population. Perioperative preventive medications have been an active area of clinical POD researches.…”

mentioning

confidence: 76%

“…In four observational studies, including 2769 patients after intracranial operation, POD occurred in 349 patients with an overall pooled crude incidence of 13%. [8][9][10][11] A recent meta-analysis of non-cardiac patients showed that the incidence of POD reduced by approximately half when dexmedetomidine was used perioperatively. 14 We assume that the incidence of POD would be reduced by one-third in the dexmedetomidine group compared with the placebo group in the present study.…”

Section: Current Sample Size Justificationmentioning

confidence: 99%

“…6 7 Recently, more attention has been devoted to POD in patients after neurosurgery. [8][9][10][11] In our cohort with 800 adult patients admitted to the ICU after elective intracranial Strengths and limitations of the study ► The study design will be multicentre, randomised, double-blinded and placebo-controlled, with a relatively large sample size. ► To the best of our knowledge, this is the first study to evaluate the effect of prophylactic use of dexmedetomidine on postoperative delirium (POD) in neurosurgical patients.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours (DEPOD study): a study protocol and statistical plan for a multicentre randomised controlled trial

Cheng

Zhang

et al. 2020

BMJ Open

View full text Add to dashboard Cite

IntroductionPostoperative delirium (POD) is prevalent in patients after major surgery and is associated with adverse outcomes. Several studies have reported that dexmedetomidine, a highly selective α2-adrenergic receptor agonist, can decrease the incidence of POD. However, neurosurgical patients are usually excluded from previous studies. The present study was designed to investigate the impact of prophylactic use of low-dose dexmedetomidine on the incidence of POD in patients after intracranial operation.Methods and analysisThis is a multicentre, randomised, double-blinded and placebo-controlled trial. Seven hundred intensive care unit admitted patients after elective intracranial operation for brain tumours under general anaesthesia are randomly assigned to the dexmedetomidine group or the placebo group with a 1:1 ratio. For patients in the dexmedetomidine group, a continuous infusion of dexmedetomidine will be started at a rate of 0.1 μg/kg/hour immediately after enrolment on the day of operation and continued until 08:00 on postoperative day 1. For patients in the placebo group, normal saline will be administered at the same rate as in the dexmedetomidine group. The patients will be followed up for 28 days after enrolment. The primary endpoint is the incidence of POD, which is assessed two times per day using the Confusion Assessment Method for the intensive care unit (ICU), during the first 5 postoperative days. The secondary endpoints include the incidence of dexmedetomidine-related adverse events and non-delirium complications, the length of stay in the ICU and hospital and all-cause 28-day mortality after the operation.Ethics and disseminationThe study protocol was approved by the Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University (No KY2019-091-02) and registered at ClinicalTrials.gov. The results of the trial will be presented at national and international conferences relevant to subject fields and submitted to international peer-reviewed journals.Trial registration numberTrial registration number: NCT04399343; Pre-results.

show abstract

mentioning

confidence: 76%

Section: Current Sample Size Justificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours (DEPOD study): a study protocol and statistical plan for a multicentre randomised controlled trial

Cheng

Zhang

et al. 2020

BMJ Open

View full text Add to dashboard Cite

show abstract

“…The main concern about the use of the CAM-ICU in neurocritically ill patients is whether this instrument is assessable. To date, three cohort studies have used the CAM-ICU for postoperative delirium diagnosis in patients after brain tumor resection [11][12][13], two of which did not report the rate of "not assessable" evaluations [11,12]. In our previous study enrolling 815 patients after intracranial operations, CAM-ICU evaluation was attempted twice daily on postoperative day one and three, of which 27 (3.3%) and 20 (2.5%) were marked as "not assessable" [13].…”

Section: Discussionmentioning

confidence: 99%

“…In four published cohort studies including a total of 2649 patients after brain tumor resection, postoperative delirium was diagnosed in 317 (12.0%, 95% con dence interval: 10.8-13.3%) with an incidence ranging from 4.2-18.4% [10][11][12][13]. These studies also found that postoperative delirium was likely associated with a prolonged stay in the intensive care unit (ICU) and hospital [10,12,13], a higher incidence of nondelirium postoperative complications [13], a greater risk of an unfavorable functional outcome [10,11], and higher hospital costs [12,13]. Based on the prevalence and the potential association with adverse consequences for postoperative delirium in patients after intracranial operations for brain tumors, intervention studies are warranted.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Low-dose Dexmedetomidine for Prevention of Postoperative Delirium after Intracranial Operations: A Pilot Randomized Controlled Trial

Cheng

Duan

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Clinical trials have shown that dexmedetomidine might decrease the occurrence of postoperative delirium after major surgery, but neurosurgical patients were excluded from these studies. We aimed to determine the feasibility of conducting a full-scale randomized controlled trial of the effect of prophylactic low-dose dexmedetomidine on postoperative delirium in patients after elective intracranial operation for brain tumors.Methods: This single-center, parallel-arm pilot randomized controlled trial was conducted in a twenty-bed intensive care unit (ICU) at an academic affiliated hospital. Adult patients who underwent an elective intracranial operation for brain tumors and admitted to the ICU were recruited. Dexmedetomidine (0.1 mg/kg/hour) or placebo was continuously infused from ICU admission on the day of surgery until 08:00 AM on postoperative day one. Adverse events during the study-drug administration were recorded. The primary feasibility endpoint was the occurrence of study-drug interruption. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU during the first five postoperative days. The assessable rate of delirium evaluation was documented.Results: Sixty participants were randomly assigned to receive either dexmedetomidine (n=30) or placebo (n=30). The study-drug was stopped in two patients (6.7%) in the placebo group due to desaturation after new-onset unconsciousness and an unplanned reoperation for hematoma evacuation and in one patient (3.3%) in the dexmedetomidine group due to unplanned discharge from the ICU (P=0.554). During the study-drug infusion, no bradycardia occurred, and hypotension occurred in one patient (3.3%) in the dexmedetomidine group. Dexmedetomidine tended to decrease the incidence of tachycardia (10.0% vs. 23.3%) and hypertension (3.3% vs. 23.3%), but the difference was not statistically significant (P=0.299 and 0.052). Respiratory depression, desaturation, and unconsciousness occurred in the same patient with study-drug interruption in the placebo group (3.3%). Delirium was evaluated 600 times, of which 590 (98.3%) attempts were assessable except in one patient in the placebo group who remained in a coma after an unplanned reoperation.Conclusions: The low rate of study-drug interruption and high assessable rate of delirium evaluation supported a fully powered trial to determine the effectiveness of low-dose dexmedetomidine on postoperative delirium in patients after intracranial operation for brain tumors.Trial registration: The trial was registered at ClinicalTrials.gov (NCT04494828) on July 31, 2020.

show abstract

Predisposing and Precipitating Factors Associated With Delirium

et al. 2023

View full text Add to dashboard Cite

ImportanceDespite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups.ObjectiveTo conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting.Evidence ReviewA literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium.FindingsA total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity.Conclusions and RelevanceIn this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium’s heterogeneous pathophysiology and treatment.

show abstract

Incidence and clinical significance of postoperative delirium after brain tumor surgery

Cited by 21 publications

References 38 publications

Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours (DEPOD study): a study protocol and statistical plan for a multicentre randomised controlled trial

Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours (DEPOD study): a study protocol and statistical plan for a multicentre randomised controlled trial

Feasibility of Low-dose Dexmedetomidine for Prevention of Postoperative Delirium after Intracranial Operations: A Pilot Randomized Controlled Trial

Predisposing and Precipitating Factors Associated With Delirium

Contact Info

Product

Resources

About