Risk factors for agitation and hyperactive delirium in adult postcardiotomy patients with extracorporeal membrane oxygenation support: an observational study

Wang, Hong; Hou, Dengbang; Tian, Xin; Wang, Liangshan; Li, Chenglong; Jia, Ming; Hou, Xiaotong

doi:10.1177/0267659120937549

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…A retrospective study of 1083 patients found that intraoperative and postoperative hypotension (MAP < 65 mmHg) exposure is associated with delirium [8]. Similarly, another study confirmed that a severe drop in MAP (� 49 mmHg) is one of the risk factors for hyperactive delirium in adult patients with postcardiotomy and with extracorporeal membrane oxygenation support [15]. There is also a new study showing that lower diastolic pressure may be…”

Section: Plos Onementioning

confidence: 97%

Higher intraoperative mean arterial blood pressure does not reduce postoperative delirium in elderly patients following gastrointestinal surgery: A prospective randomized controlled trial

Zhang

Zhou

et al. 2022

PLoS ONE

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Background This study aimed to describe the relationship between the different levels of intraoperative mean arterial blood pressure (MAP) and postoperative delirium in elderly patients undergoing gastrointestinal laparoscopic surgery. Materials and methods This prospective controlled clinical trial enrolled 116 patients aged 65 to 85 years who underwent gastrointestinal laparoscopic surgery. These patients were randomized 1:1 to a MAP goal of 65 to 85 mmHg (L group) or an 86 to 100 mmHg (H group). The primary endpoint was the incidence of postoperative delirium, assessed twice daily with the Confusion Assessment Method (CAM) and Richmond Agitation–Sedation Scale (RASS) during the first five postoperative days. Delirium severity was evaluated with the Delirium-O-Meter (D-O-M). Results 108 patients (L group n = 55, H group n = 53) were eventually included in intention-to-treat analyses. Postoperative delirium occurred in 18 (32.7%) of 55 cases of L group and in 15 (28.3%) of 53 cases of H group. The incidence of delirium subtypes between the two groups: hypoactive delirium 14.5% (8/55) vs 11.3% (6/53); hyperactive delirium 7.3% (4/55) vs 3.8% (2/53); mixed delirium 10.9% (6/55) vs 13.2% (7/53). However, the L group showed higher D-O-M scores of the first episode of delirium: 14.5 (Q1 = 12, Q3 = 18.5) vs 12 (Q1 = 10, Q3 = 14), which means the delirium is more severe. Conclusions Compared with 65 to 85 mmHg, maintaining intraoperative MAP at 86–100 mmHg did not reduce the incidence of postoperative delirium in elderly patients undergoing gastrointestinal laparoscopic surgery. However, the severity of delirium could be reduced and blood loss is a risk factor for postoperative delirium.

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Section: Plos Onementioning

confidence: 97%

Higher intraoperative mean arterial blood pressure does not reduce postoperative delirium in elderly patients following gastrointestinal surgery: A prospective randomized controlled trial

Zhang

Zhou

et al. 2022

PLoS ONE

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“…A multidimensional intervention bundle aimed at ECMO operation and management has been developed based on previous literature (9)(10)(11)(12) and the experience of our centers. The objective of the study was to evaluate the effect of the intervention up to 18 months after its implementation.…”

Section: Introductionmentioning

confidence: 99%

A phased intervention bundle to decrease the mortality of patients with extracorporeal membrane oxygenation in intensive care unit

et al. 2022

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AimTo evaluate whether a phased multidimensional intervention bundle would decrease the mortality of patients with extracorporeal membrane oxygenation (ECMO) and the complication incidence.Materials and methodsWe conducted a prospective observational study in comparison with a retrospective control group in six intensive care units (ICUs) in China. Patients older than 18 years supported with ECMO between March 2018 to March 2022 were included in the study. A phased intervention bundle to improve the outcome of patients with ECMO was developed and implemented. Multivariable logistic regression modeling was used to compare the mortality of patients with ECMO and the complication incidence before, during, and up to 18 months after implementation of the intervention bundle.ResultsThe cohort included 297 patients in 6 ICUs, mostly VA ECMO (68.7%) with a median (25th–75th percentile) duration in ECMO of 9.0 (4.0–15.0) days. The mean (SD) APECHII score was 24.1 (7.5). Overall, the mortality of ECMO decreased from 57.1% at baseline to 21.8% at 13–18 months after implementation of the study intervention (P < 0.001). In multivariable analysis, even after excluding the confounding factors, such as age, APECHII score, pre-ECMO lactate, and incidence of CRRT during ECMO, the intervention bundle still can decrease the mortality independently, which also remained true in the statistical analysis of V-V and V-A ECMO separately. Among all the ECMO-related complications, the incidence of bloodstream infection and bleeding decreased significantly at 13–18 months after implementation compared with the baseline. The CUSUM analysis revealed a typical learning curve with a point of inflection during the implementation of the bundle.ConclusionA phased multidimensional intervention bundle resulted in a large and sustained reduction in the mortality of ECMO that was maintained throughout the 18-month study period.Clinical trial registration[ClinicalTrials.gov], identifier [NCT05024786].

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Prevalence of delirium among critically ill patients who received extracorporeal membrane oxygenation therapy: A systematic review and proportional meta-analysis

Lee

Lai

et al. 2023

Intensive and Critical Care Nursing

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Risk factors for agitation and hyperactive delirium in adult postcardiotomy patients with extracorporeal membrane oxygenation support: an observational study

Cited by 3 publications

References 26 publications

Higher intraoperative mean arterial blood pressure does not reduce postoperative delirium in elderly patients following gastrointestinal surgery: A prospective randomized controlled trial

Higher intraoperative mean arterial blood pressure does not reduce postoperative delirium in elderly patients following gastrointestinal surgery: A prospective randomized controlled trial

A phased intervention bundle to decrease the mortality of patients with extracorporeal membrane oxygenation in intensive care unit

Prevalence of delirium among critically ill patients who received extracorporeal membrane oxygenation therapy: A systematic review and proportional meta-analysis

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