Tuesday, 13 September 2016

ANZIC-RC reducing confusion about post-cardiotomy delirium

SPHPM’s Associate Professor Daryl Jones and Dr Carol Hodgson have published a new paper in the Critical Care & Resuscitation Journal about post-cardiotomy delirium.

Post-cardiotomy delirium (POD) is a common complication following from cardiac surgery – with sufferers experiencing a range of symptoms including confusion, agitation, memory disturbances and hallucinations. The precise aetiology of POD is unclear, but four of the most consistent pre-operative clinical factors associated with POD are increasing age, prior stroke, psychiatric illness and cognitive decline. Cardiac surgery is one of the most common reasons for elective admission to the intensive care unit (ICU) in Australia and New Zealand.

There are many challenges in diagnosing POD as not only does the condition fluctuate with time, but it can be classified as hypo-active or hyper-active forms of delirium and can also be a mixed diagnosis of the two forms.

In the paper, researchers identified a number of areas where improving clarity around POD (including standardising pre-clinical tests, developing an optimal diagnostic tool for delirium testing in the ICU and deciphering the relationship between post-operative complications and POD) could help the prevention and treatment of POD after cardiac surgery.

“Patients with delirium are more likely to be older and have chronic disorders of the brain such as cognitive decline and cerebro-vascular disease and while most patients with POD will recover, a minority develop cognitive and functional decline,” the authors said.

Typically, POD is observed in one in five patients following cardiac surgery and the researchers warn that with the increasing age and co-morbidity of cardiac surgical patients, these figures on delirium are likely to increase in the future.

The authors stated that, “Quality improvement initiatives and prospective trials are needed to minimise the incidence and consequences of POD and by doing so there are likely positive flow on effects for the health system; including reduced hospital stays, health budget savings and overall improved health outcomes for cardiac patients.”

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