Delirium is an acute cognitive disorder caused by a variety of factors which lead to cerebral cortical dysfunction. At present the studies on the pathophysiology of delirium is still very few. But studies on serum biomarker of delirium can help to elucidate the pathophysiological mechanism of delirium, and the studies are significant for delirium diagnosis, severity classification and prediction of long-term outcome. This review examines three major groups of delirium related serum biomarkers: ① risk markers: those that are present or elevated prior to disease onset, including serum chemistries, genetic markers and so on; ② disease markers: those markers elevate with delirium onset and fall when delirium recovery, including acetylcholine and serum anticholinergic activity, serotonin, serum amino acids, and melatonin, interleukin, C-reactive protein; and ③ end products: those that rise in proportion to the consequences of disease, including S-100ß and neuron specific enolase. The three markers mentioned above are helpful to further investigate the mechanism of delirium.
Objective To investigate the clinical features, etiology and treatment strategies of patients with delirium in emergency intensive care unit ( EICU) . Methods Patients with delirium during hospitalization between January 2010 and January 2012 were recruited from respiratory group of EICU of Beijing Anzhen Hospital. Over the same period, same amount of patients without delirium were randomly collected as control. The clinical datawere retrospectively analyzed and compared. Results The incidence of delirium was 7.5% ( 42/563) . All delirium patients had more than three kinds of diseases including lung infections, hypertension, coronary heart disease, respiratory failure, heart failure, renal failure, hyponatremia, etc. 50% of delirium patients received mechanical ventilation ( invasive/noninvasive) . The mortality of both the delirium patients and the control patients was 11.9% ( 5 /42) . However, the patients with delirium exhibited longer hospital stay [ 14(11) d vs. 12(11) d, P gt;0. 05] and higher hospitalization cost [ 28, 389 ( 58,999) vs. 19, 373( 21, 457) , P lt;0.05] when compared with the control group. 52.4% ( 22/42) of delirium patients were associated with primary disease. 9. 5% ( 4/42) were associated with medication. 38. 1% (16/42) were associated with ICU environment and other factors. Conclusions Our data suggest that the causes of delirium in ICU are complex. Comprehensive treatment such as removal of the relevant aggravating factors, treating underlying diseases, enhancing patient communication, and providing counseling can shorten their hospital stay, reduce hospitalization costs, and promote rehabilitation.
Postoperative delirium is one of the most common postoperative complications in elderly patients, affecting the outcome of approximately half of surgical patients. The pathogenesis of postoperative delirium is still unclear, but multivariate models of the etiology of postoperative delirium are well-validated and widely accepted, and 40% of postoperative delirium can be effectively prevented by targeting predisposing factors. Benzodiazepines have long been considered as predisposing factors for postoperative delirium. Although benzodiazepines are widely used in clinical practice, most relevant guidelines recommend avoiding the use of benzodiazepines in the perioperative period to reduce the incidence of postoperative delirium. Controversy exists regarding the association of benzodiazepine use with postoperative delirium. This article discusses the results of studies on perioperative benzodiazepines and postoperative delirium.
ObjectiveTo explore the relevant risk factors for postoperative delirium (POD) in elderly patients undergoing radical colon cancer surgery, and provide a basis for formulating postoperative prevention and treatment measures for POD. MethodsA total of 128 elderly patients diagnosed with colon cancer and underwent radical colon cancer surgery at Xindu District People’s Hospital in Chengdu from January 2018 to December 2021 were included as the study subjects. Patients were divided into two groups according to the score of Delirium Assessment Scale (4AT Scale). The basic data, main perioperative clinical data and laboratory indicators of the two groups were collected, and univariate and logistic regression analysis were carried out to determine the potential risk factors of POD in elderly patients with colon cancer after radical operation. ResultsAccording to the results of the 4AT scale score, a total score of ≥4 points was used as the threshold for determining patient POD. Among 128 patients, there were 29 patients (22.66%) with POD and 99 patients (77.34%) without POD. ① General data comparison: There was no significant difference between the two groups in gender, body mass index, years of education, hypertension, diabetes, smoking history and drinking history (P>0.05), but there was significant difference in age, preoperative mini-mental state examination (MMSE) score and American Society of Anesthesiologists (ASA) grade (P<0.05). ② Comparison of main clinical data during the perioperative period: There was no statistically significant difference between the two groups of patients in ICU treatment, nonsteroidal anti-inflammatory drug treatment, visual analogue scale, and intraoperative hypotension (P>0.05), but there was a statistically significant difference in operative time, anesthesia time, intraoperative blood loss, and dexmedetomidine treatment (P<0.05). ③ Comparison of preoperative laboratory indicators: There was no statistically significant difference between the two groups of patients in terms of hemoglobin, serum albumin, white blood cell count, prognostic nutritional index, neutrophil/lymphocyte ratio, D-dimer, and albumin to fibrinogen ratio (P>0.05). ④ The results of logistic regression analysis showed that low preoperative MMSE score [OR=0.397, 95%CI (0.234, 0.673)], long surgical time [OR=1.159, 95%CI (1.059, 1.267) ], and long anesthesia time [OR=1.138, 95%CI (1.057, 1.226) ] were independent risk factors for the occurrence of POD in elderly colon cancer patients undergoing radical surgery. ConclusionPreoperative MMSE score, operative time, and anesthesia time are closely related to the occurrence of POD in elderly colon cancer radical surgery, worth implementing key perioperative management in clinical practice to prevent and manage POD.
ObjectiveTo systematically evaluate the risk prediction models for postoperative delirium in adults with cardiac surgery. MethodsThe SinoMed, CNKI, Wanfang, VIP, PubMed, EMbase, Web of Science, and Cochrane Library databases were searched to collect studies on risk prediction models for postoperative delirium in cardiac surgery published up to January 29, 2025. Two researchers screened the literature according to inclusion and exclusion criteria, used the PROBAST bias tool to assess the quality of the literature, and conducted a meta-analysis of common predictors in the model using Stata 17.0 software. ResultsA total of 21 articles were included, establishing 45 models with 28733 patients. Age, cardiopulmonary bypass time, history of diabetes, history of cerebrovascular disease, and gender were the top five common predictors. The area under the curve (AUC) of the 45 models ranged from 0.6 to 0.926. Fourteen out of the 21 studies had good applicability, while the applicability of the remaining seven was unclear; 20 studies had a high risk of bias. Meta-analysis showed that the incidence of postoperative delirium in adults with cardiac surgery was 18.6% [95%CI (15.7%, 21.6%)], and age [OR=1.04 (1.04, 1.05), P<0.001], history of cerebrovascular disease [OR=1.76 (1.46, 2.06), P<0.001], gender [OR=1.73 (1.43, 2.03), P<0.001], minimum mental state examination score [OR=1.00 (0.82, 1.17), P<0.001], and length of ICU stay [OR=5.59 (4.29, 6.88), P<0.001] weer independent influencing factors of postoperative delirium after cardiac surgery. ConclusionThe risk prediction models for postoperative delirium after cardiac surgery have good predictive performance, but there is a high overall risk of bias. In the future, large-sample, multicenter, high-quality prospective clinical studies should be conducted to construct the optimal risk prediction model for postoperative delirium in adults with cardiac surgery, aiming to identify and prevent the occurrence of postoperative delirium as early as possible.
ObjectiveTo evaluate the quality of guidelines for the management of delirium in adult patients in the last ten years, so as to provide references for updating, selection, implementation guidelines and delirium management optimization.MethodsWe searched guidelines from databases including PubMed, EMbase, WanFang Data and CNKI, and websites of guidelines from January 1st 2010 to September 1st 2019. Guidelines were comprehensively screened, evaluated based on AGREE Ⅱ and data was independently extracted by two researchers.ResultsGuidelines of NICE, RNAO and SIGN had higher scores, while CSCCM’s and IPS’s gained lower. Among domains of AGREE Ⅱ, Domain I (scope and purpose) and IV (clarity of presentation) scored the highest, with a minimum of Domain Ⅱ (stakeholder involvement) and V (applicability). Delirium management focused on screening, prediction, prevention and treatment both pharmacologically and non-pharmacologically, and information support.ConclusionsFuture development of delirium guidelines should follow the methodology of guideline development, update or adjustment, and dedicate to every domain, especially domain of application. Medical staffs can establish our own domestic guidelines based on high quality guidelines, to promote knowledge translation and delirium management.
ObjectiveTo analyze whether hypernatremia within 48 hours after cardiac surgery will increase the incidence of delirium which developed 48 hours later after surgery (late-onset delirium).MethodsWe conducted a retrospective analysis of 3 365 patients, including 1 918 males and 1 447 females, aged 18-94 ( 60.53±11.50) years, who were admitted to the Department of Cardiothoracic and Vascular Surgery of Nanjing First Hospital and underwent cardiac surgery from May 2016 to May 2019.ResultsA total of 155 patients developed late-onset delirium, accounting for 4.61%. The incidence of late-onset delirium in patients with hypernatremia was 9.77%, the incidence of late onset delirium in patients without hypernatremia was 3.45%, and the difference was statistically different (P<0.001). The odds ratio (OR) of hypernatremia was 3.028 (95% confidence interval: 2.155-4.224, P<0.001). The OR adjusted for other risk factors including elderly patients, previous history of cerebrovascular disease, operation time, cardiopulmonary bypass time, lactate, hemoglobin≥100 g/L, prolonged mechanical ventilation, left ventricular systolic function, use of epinephrine, use of norepinephrine was 1.524 (95% confidence interval: 1.031-2.231, P=0.032).ConclusionHypernatremia within 48 hours after cardiac surgery may increase the risk of delirium in later stages.
Postoperative delirium (POD) is a common postoperative complication. Dysregulation of gut flora is involved in POD through mechanisms such as neuroinflammation, oxidative stress, deposition of β-amyloid, and aberrant production of metabolites of gut flora. Therefore, interventions to regulate gut flora, such as probiotics, prebiotics, and faecal microbiota transplantation, can alleviate cognitive dysfunction. This article reviews the mechanisms of gut flora in POD and its prevention and treatment strategies, with the aim of providing new ideas for the clinical prevention and treatment of POD.
ObjectivesTo systematically review the delirium risk prediction models in intensive care unit (ICU) patients.MethodsThe Cochrane Library, PubMed, Web of Science, Ovid, VIP, WanFang Date and CNKI databases were electronically searched to collect studies on delirium risk prediction models in intensive care unit patients from inception to December, 2018. Two reviewers independently screened literature, extracted data, evaluated the included studies according to the CHARMS checklist, and then systematic review was performed to evaluate the risk prediction models.ResultsA total of 9 studies were included, of which 7 were prospective studies. Six models were internally validated. All studies reported the area under receiver operating characteristic curve (AUROC) over 0.7 (0.739-0.926). The reduction of cognitive reserve and increased blood urea nitrogen were the most commonly reported predisposing and precipitating factors of delirium among all prediction models. Methodologically, the absence or unreported of the blind method, to a certain extent, partially increase the risk of bias.ConclusionsNine prediction models all have great power in early identifying and screening patients who are at high risk of developing ICU delirium. On the basis of judiciously selecting a practical prediction model for clinical practice or carrying out a large sample-size prospective cohort study to construct the localized prediction model, stratified prevention strategies should be formulated and implemented according to the risk stratification results to reduce the incidence of ICU delirium and accelerate the rational allocation of medical resources for delirium prevention.
Delirium is an acute, transient, usually reversible, fluctuating disturbance in consciousness, attention, cognition, and perception. Delirium after cardiac operations is associated with increased morbidity, reduced cognitive functioning, increased short-term and long-term mortality, longer hospitalization and higher hospitalization cost. The diagnosis, prevention and treatment of delirium are of great importance for perioperative care of patients undergoing cardiac surgery. Effective delirium screening tools are very helpful for the recognition and monitoring of delirium after cardiac surgery. In recent years, there has been many new strategies for the treatment, nursing care and prevention of delirium after cardiac surgery. This review focuses on the incidence, risk factors, diagnostic methods, treatment and preventive strategies of delirium after cardiac surgery.