Risk Factors And Short-term Prognosis Of Postoperative Delirium For Patients In Cardiac Surgery Intensive Care Unit

ObjectivesTo analyze the current status and risk factors of postoperative delirium(POD)and the effects of POD on the short-term prognosis among Cardiac Surgery Intensive Care Unit(CSICU)patients.To identify patients with high-risk of POD and to provide a basis for further preventive intervention measures,it is helpful to optimize the management of CSICU and to improve the prognosis of patients.MethodsThis is a prospective longitudinal study.316 patients after cardiac surgery from January to May 2019 in a tertiary Class A general hospital were selected as study subjects.Delirium was assessed by Confusion Assessment Method for the Intensive Care Unit,and data were collected using self-designed questionnaire,Acute Physiology and Chronic Health Evaluation ?(APACHE ?),Critical-Care Pain Observation Tool(CPOT),Pittsburgh Sleep Quality Index Scale(PSQI)and Intensive Care Unit Environmental Stressor Scale(ICUESS).Data were analyzed by SPSS22.0,risk factors of POD in CSICU patients were analyzed by univariate and multivariate Logistic regression analysis,the ROC curve was used to describe the efficacy of prediction model and risk factors in predicting POD,?2 test,Mann-Whitney U and Kruskal-Wallis test was used to analyze the effect of POD on short-term prognosis of CSICU patients.Results1.A total of 316 subjects were included,postoperative delirium occurred in 81 patients(25.6%).The cases of hyperactive,hypoactive,and mixed type were 10(12.3%),42(51.9%),and 29(35.8%),respectively.POD usually began at 25.70h(20.67h,38.12h)after cardiac surgery and lasted for 5.00(3.00,7.00)days.The duration of mixed POD was up to 6.00(4.00,8.00)days.2.Univariate analysis showed that:POD group and non-POD group were significantly different in terms of age,severity of illness,type of surgery,time of cardiopulmonary bypass,circulatory arrest and invasive mechanical ventilation,days of CSICU hospitalization,Use of sedatives,hypoxemia,hypernatremia,mean postoperative pain score,sleep quality score,and environmental stressor score in ICU(P<0.05).3.The results of Logistic regression showed that:severity of illness(OR=1.257,95%CI=1.018-1.553),circulatory arrest time>15 minutes(OR=6.943,95%CI=1.288-37.429),average postoperative pain score(OR=2.918,95%CI=1.749?4.867),sleep quality score(OR=1.147,95%CI=1.038?1.267),and the ICU environment pressure source score(OR=1.161,95%CI=1.110?1.214)were independent risk factors for POD in CSICU patients.4.ROC curve analysis results showed that:The area under the curve of the prediction model was 0.945,and the sensitivity and specificity of the model were 0.815 and 0.923 respectively.The area under the curve of severity of illness,circulatory arrest time>15 minutes,postoperative pain mean score,sleep quality score and ICU environmental pressure source score were 0.745?0.617?0.758?0.837?0.910 respectively.The optimal cut-off values(sensitivity,specificity)of severity of illness,postoperative pain mean score,sleep quality score and ICU environmental pressure source score were 9 points(0.864,0.515),3 points(0.840,0.609),14 points(0.704,0.843)and 72 points(0.901,0.779)respectively.5.There were statistically significant differences in invasive mechanical ventilation time(Z=-5.317,P<0.001),ICU hospitalization days(Z=-6.356,P<0.001),total hospitalization days(Z=-3.054,P=0.002),and hospital mortality(?2=11.742,P=0.001)between POD and non-POD groups.6.The three types of POD had statistically significant differences in delirium duration(?2=9.078,P=0.011),mortality(?2=8.021,P=0.018),and no statistically significant differences in invasive mechanical ventilation,ICU hospitalization days and total hospitalization days(P>0.05).Conclusions1.The incidence of POD in CSICU patients was higher(25.6%),and the main type was hypoactive.2.Severity of illness,circulatory arrest time>15 minutes,postoperative pain,poor sleep quality,and environmental stress in ICU were independent risk factors for POD in CSICU patients.The predictive model of postoperative delirium diagnosis had high predictive value.Patients with severity of illness score>9 points,circulatory arrest time>15 minutes,mean score of postoperative pain>3 points,sleep quality score>14 points,and environmental stressor score>72 points in the ICU were more likely to have POD.Analysis of risk factors facilitated the identification of POD in high-risk patients,early assessment and intervention of delirium risk factors can help reduce delirium and facilitate management of delirrium.3.POD had a poor short-term prognosis,longer invasive mechanical ventilation,longer stay in CSICU and hospital,and a higher mortality.Mixed POD of the three types had the worst short-term prognosis.It is guided that clinical staff pay attention to the early evaluation of POD and its types,and take different preventive intervention measures for different types of POD,and make early prevention,early diagnosis and early treatment.