Delirium after cardiac surgery. Incidence, phenotypes, predisposing and precipitating risk factors, and effects

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Background:In cardiac surgical patients little is known about different phenotypes of delirium and how the symptoms fluctuate over time.Objectives:Evaluate risk factors, incidence, fluctuations, phenotypic characteristics and impact on patients' outcomes of delirium.Methods:Prospective longitudinal study. In postoperative intensive care unit 199 patient were assessed three-times a day through an adapted versions of the Intensive Care Delirium Screening Checklist.Results:Delirium and subsyndromal delirium incidence were 30.7% and 31.2%, respectively. Delirium manifested mostly in the hypoactive form and showed a fluctuating trend for several days.Atrial fibrillation, benzodiazepine/opioids dosages, hearing impairment, extracorporeal circulation length, SAPS-II and mean arterial pressure were independent predictors for delirium. Delirium was a statistically significant predictor of chemical/physical restraint use and hospital length of stay.Conclusions:Given the fluctuating and phenotypic characteristics, delirium screening should be a systematic/intentional activity. Multidisciplinary prevention strategies should be implemented to identify and treat the modifiable risk factors.

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