Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: a prospective cohort study

被引:13
作者
Cai, Shining [1 ]
Latour, Jos M. [2 ]
Lin, Ying [1 ]
Pan, Wenyan [1 ]
Zheng, Jili [1 ]
Xue, Yan [1 ]
Gao, Jian [3 ]
Lv, Minzhi [3 ]
Zhang, Xiaomin [4 ]
Luo, Zhe [5 ]
Wang, Chunsheng [6 ]
Zhang, Yuxia [1 ]
机构
[1] Zhongshan Hosp, Dept Nursing, Shanghai 200032, Peoples R China
[2] Univ Plymouth, Sch Nursing & Midwifery, Plymouth, Devon, England
[3] Zhongshan Hosp, Dept Biostat, Shanghai 200032, Peoples R China
[4] Fudan Univ, Nursing Sch, Shanghai, Peoples R China
[5] Zhongshan Hosp, Dept Cardiac Surg Intens Care Unit, Shanghai 200032, Peoples R China
[6] Zhongshan Hosp, Dept Cardiac Surg, Shanghai 200032, Peoples R China
关键词
Cardiac surgery; cardiac function; delirium; predictors; intensive care units; POSTOPERATIVE DELIRIUM; RISK-FACTORS; ELDERLY-PATIENTS; HEART-FAILURE; STATEMENT; OUTCOMES; PREVENTION; GUIDELINES; MANAGEMENT; DEMENTIA;
D O I
10.1177/1474515119886155
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Delirium is a common postoperative complication after cardiac surgery. The relationship between delirium and cardiac function has not been fully elucidated. Aims: The aim of this study was to identify the association between preoperative cardiac function and delirium among patients after cardiac surgery. Methods: We prospectively recruited 635 cardiac surgery patients with a planned cardiac intensive care unit admission. Postoperative delirium was diagnosed using the confusion assessment method for the intensive care unit. Preoperative cardiac function was assessed using N-terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association functional classification and left ventricular ejection fraction. Results: Delirium developed in 73 patients (11.5%) during intensive care unit stay. NT-proBNP level (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.52) and New York Heart Association functional classification (OR 2.34, 95% CI 1.27-4.31) were both independently associated with the occurrence of delirium after adjusting for various confounders. The OR of delirium increased with increasing NT-proBNP levels after the turning point of 7.8 (log-transformed pg/ml). The adjusted regression coefficients were 1.19 (95% CI 0.95-1.49, P=0.134) for NT-proBNP less than 7.8 (log-transformed pg/ml) and 2.78 (95% CI 1.09-7.12, P=0.033) for NT-proBNP greater than 7.8 (log-transformed pg/ml). No association was found between left ventricular ejection fraction and postoperative delirium. Conclusion: Preoperative cardiac function parameters including NT-proBNP and New York Heart Association functional classification can predict the incidence of delirium following cardiac surgery. We suggest incorporating an early determination of preoperative cardiac function as a readily available risk assessment for delirium prior to cardiac surgery.
引用
收藏
页码:310 / 319
页数:10
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