Una complicación quirúrgica escasamente sospechada: la disfunción cognitiva postoperatoria

Lira, David; Mar-Meza, Marcela; Montesinos, Rosa; Herrera-Pérez, Eder; Cuenca-Alfaro, José; Castro‐Suárez, Sheila; Custodio, Nilton

doi:10.20453/rnp.v81i2.3339

Cited by 4 publications

(7 citation statements)

References 28 publications

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“…We divided these factors into two groups, which are shown in the following tables with the items ordered according to their level of evidence and quality (John Hopkins Nursing Evidence-Based Practice [66]) according to the studies from which they were extracted. [19,29,40,44,80,88] Low level of education [4,9,28,58,67] Hypertension [75,80,87,88] Hypotension [14,16,23,76,81] High creatinine level [29,84,100] Immobilisation [30,32,75,91] Anaemia [44,70,81,83,91] Arterial fibrillation [17,26,44,83,90] Abnormally high albumin level [3,44,60,74,100] Cerebral aging [16,81,95] Functional deficit [29,78,…”

Section: Factors Associated With the Onset And Development Of Postoperative Deliriummentioning

confidence: 99%

“…[19,29,40,44,80,88] Low level of education [4,9,28,58,67] Hypertension [75,80,87,88] Hypotension [14,16,23,76,81] High creatinine level [29,84,100] Immobilisation [30,32,75,91] Anaemia [44,70,81,83,91] Arterial fibrillation [17,26,44,83,90] Abnormally high albumin level [3,44,60,74,100] Cerebral aging [16,81,95] Functional deficit [29,78,89,91] Malnutrition [2,3,…”

Section: Factors Associated With the Onset And Development Of Postoperative Deliriummentioning

confidence: 99%

“…There is a high probability of this condition remaining undiagnosed unless cognitive changes are specifically tested for. Lastly, mixed delirium combines the characteristics of the hyperactive and hypoactive types [30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

“…Postoperative delirium can be classified clinically as a hyperactive, hypoactive, or mixed presentation. The hyperactive form is a subtype of delirium in which there is increased sympathetic nervous system activity, causing symptoms such as oversensitivity to stimuli, perceptual disturbances, psychomotor overactivity, auto-aggression, or physical and verbal aggression towards health-care staff [ 30 ]. Hypoactive delirium is characterized by a diminished response to stimuli, hypersomnia, bradypsychia, and lethargy.…”

Section: Introductionmentioning

confidence: 99%

“…Predisposing factors. ,14,16-19,24,26,30-32,38,40,42,44,45,47,49-51,53,54,58,59,61,67-109] Pre-existing cognitive deterioration [1,3,8,9,14,16,18,31,32,40,45,46,54,60,67,76,78-81,91,94,97,110-116] Pain [2,4,14,30-32,34,69-71,75,79,80,91,100,104,111,117-122] Elevated ASA score[14,19,31,38,40,42,48,49,75,84,88,118] Alcohol abuse[16,23,30,32,44,67,81,90,91,97,101,121] Hypoxemia[23,30,67,70,76,80,91] Male sex[14,18,32,39,49,51,58,87,88,101,103,122] Metabolic disturbances, Water-electrolyte imbalance[16,30,31,75,76,80,…”

mentioning

confidence: 99%

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Projection of visual material on postoperative delirium in patients undergoing cardiac surgery: A double blind randomized clinical trial

Méndez-Martínez,

Casado-Verdejo,

Fernández-Fernández

et al. 2024

Medicine

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Background: Postoperative delirium is a neurobehavioral disorder that can appear after surgery. It is characterized by an altered level of consciousness and impaired cognitive function. The aim of this study was to evaluate the impact of visual projection of images of relatives or loved ones in patients undergoing cardiac surgery in the immediate postoperative period, and its influence on the incidence and development of postoperative delirium. Methods: A randomized, double-blind clinical trial was designed in the immediate postoperative period of adult patients undergoing cardiac surgery. Consolidated Statement of Reporting Trials guidelines were followed. A control group (CG) and an intervention group (IG) were established. In the IG, the patients underwent a visual projection, while the usual unit treatment was carried out with the CG. Sociodemographic, anthropometric, anesthetic, and surgical variables were also recorded. The postoperative delirium assessment scale used was the confusion assessment method for diagnosing delirium in intensive care unit patients. Results: Information was collected from 104 patients undergoing cardiac surgery. Most of the patients included in the study were men (66.35%) and the most performed surgical intervention was aortic valve replacement (34.62%). In the CG, positive patients in postoperative delirium increased from 19.23% to 25%, while in the IG they decreased from 5.77% to 1.92%. The logistic regression analysis presents a prediction model where the variables that influence the model are gender and group membership, meaning that being female and belonging to the IG significantly reduce the presence of delirium. Conclusion: The projection of visual material reduced the incidence of postoperative delirium in patients undergoing cardiac surgery, although it cannot be established that it is effective as a treatment once the pathology is already established.

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Association between preoperative on‐site CCU visits and postoperative delirium in patients undergoing cardiac surgery: A retrospective cohort study

Chen

Fang

et al. 2022

Nursing in Critical Care

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BackgroundPostoperative delirium (POD) is a common complication after cardiac surgery (CS), with symptoms like attention disorders and even delays patients' recovery.AimsTo evaluate the impact of preoperative on‐site visits in the cardiac care unit (CCU) on POD after CS.Study DesignPatients admitted to the CCU with extracorporeal CS were included in the visiting or non‐visiting group according to whether they were on visiting week. The visiting group received a preoperative visit from a nurse‐led multidisciplinary visiting team (including CCU nurses and physicians) 1 week before surgery in addition to standard care. The non‐visiting group received standard care like unstructured information from the CS team and anesthesiologists and so on. The Confusion Assessment Method for the ICU (CAM‐ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) were used to evaluate the POD severity. The incidence, occurrence and duration of POD, as well as the CCU length of stay, postoperative mechanical ventilation duration and length of hospital stay were compared between the two groups.ResultsA total of 735 participants (369 in the visited group and 366 in the unvisited group) were included in this study. Preoperative on‐site visits were associated with a decreased POD incidence (odds ratio [OR]: 0.524, 95% CI: 0.336–0.817), an improved POD severity (OR: 0.578, 95% CI: 0.359–0.932) and a shortening POD duration (OR: 0.972, 95% CI: 0.951–0.994). There was a significant difference between the visiting and non‐visiting groups in the mechanical ventilation duration (OR: 0.987, 95% CI: 0.978–0.996).ConclusionsPreoperative on‐site visits are associated with a reduction in the incidence, duration, and severity of POD, as well as the mechanical ventilation duration of patients.Relevance to Clinical PracticeThis study found that preoperative on‐site visits were associated with the onset, duration, severity and duration of mechanical ventilation of POD. Although many factors influence the occurrence of POD, a multidisciplinary visiting team led by a nurse (including CCU nurses and physicians) can provide early nursing interventions through preoperative visits, better obtain postoperative cooperation from patients, establish a good nurse–patient relationship and provide better health services to patients. In a realistic CCU setting, nurses and physicians can act as educators, assessing patients before surgery, enhancing preoperative education, improving patient familiarity with the CCU environment and teaching sign language communication skills when patients are mechanically ventilated. These findings can therefore provide the basis for effective clinical care to prevent postoperative POD.

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Una complicación quirúrgica escasamente sospechada: la disfunción cognitiva postoperatoria

Cited by 4 publications

References 28 publications

Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review

Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review

Projection of visual material on postoperative delirium in patients undergoing cardiac surgery: A double blind randomized clinical trial

Association between preoperative on‐site CCU visits and postoperative delirium in patients undergoing cardiac surgery: A retrospective cohort study

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