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Article: Effect of motor subtypes of delirium in the intensive care unit on fast-track failure after cardiac surgery

TitleEffect of motor subtypes of delirium in the intensive care unit on fast-track failure after cardiac surgery
Authors
Keywordscardiac surgical procedures
delirium
postoperative complications
Issue Date2018
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/jtcvs
Citation
The Journal of Thoracic and Cardiovascular Surgery, 2018, v. 155 n. 1, p. 268-275.e1 How to Cite?
AbstractObjective: The purpose of the study was to evaluated the association between motor subtypes of postoperative delirium in the intensive care unit (ICU) and fast-track failure (a composite outcome of prolonged stay in ICU more than 48 hours, ICU readmission and 30-day mortality) after cardiac surgery. Methods: This was a secondary analysis of a prospective cohort study of 600 consecutive adults undergoing cardiac surgery at a university hospital in Hong Kong (July 2013 - July 2015). The motor subtypes of delirium were classified using the Richmond Agitation Sedation Score and Confusion Assessment Method-ICU assessments performed by trained bedside nurses. A generalized estimating equation was used to estimate a common relative risk (RR) of fast-track failure (FTF) associated with motor subtypes. Results: The incidence of hypoactive, hyperactive and mixed motor subtypes were 4.3% (n = 26), 4.0% (n = 24) and 5.5% (n = 33), respectively. Fast-track failure occurred in 88 (14.7%) patients. There was an association between delirium (all subtypes) and FTF (P = .048); hyperactive delirium (RR 1.95; 95% CI, 0.96 - 3.94), hypoactive delirium (RR 2.79; 95% CI, 1.34 - 5.84) and mixed delirium (RR 2.55; 95% CI, 1.11 - 5.88). Among the individual components of FTF, hypoactive and mixed subtypes were associated with prolonged stay in ICU (both P = .001). Conclusions: Patients with pure hypoactive delirium had a similar risk of developing FTF as other motor subtypes. Differentiation of motor subtypes is unlikely to be clinically important for prognostication of FTF but treatment strategies should address individual subtypes.
Persistent Identifierhttp://hdl.handle.net/10722/248091
ISSN
2019 Impact Factor: 4.451
2015 SCImago Journal Rankings: 2.369
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLee, A-
dc.contributor.authorMu, JL-
dc.contributor.authorChiu, CH-
dc.contributor.authorJoynt, G-
dc.date.accessioned2017-10-18T08:37:40Z-
dc.date.available2017-10-18T08:37:40Z-
dc.date.issued2018-
dc.identifier.citationThe Journal of Thoracic and Cardiovascular Surgery, 2018, v. 155 n. 1, p. 268-275.e1-
dc.identifier.issn0022-5223-
dc.identifier.urihttp://hdl.handle.net/10722/248091-
dc.description.abstractObjective: The purpose of the study was to evaluated the association between motor subtypes of postoperative delirium in the intensive care unit (ICU) and fast-track failure (a composite outcome of prolonged stay in ICU more than 48 hours, ICU readmission and 30-day mortality) after cardiac surgery. Methods: This was a secondary analysis of a prospective cohort study of 600 consecutive adults undergoing cardiac surgery at a university hospital in Hong Kong (July 2013 - July 2015). The motor subtypes of delirium were classified using the Richmond Agitation Sedation Score and Confusion Assessment Method-ICU assessments performed by trained bedside nurses. A generalized estimating equation was used to estimate a common relative risk (RR) of fast-track failure (FTF) associated with motor subtypes. Results: The incidence of hypoactive, hyperactive and mixed motor subtypes were 4.3% (n = 26), 4.0% (n = 24) and 5.5% (n = 33), respectively. Fast-track failure occurred in 88 (14.7%) patients. There was an association between delirium (all subtypes) and FTF (P = .048); hyperactive delirium (RR 1.95; 95% CI, 0.96 - 3.94), hypoactive delirium (RR 2.79; 95% CI, 1.34 - 5.84) and mixed delirium (RR 2.55; 95% CI, 1.11 - 5.88). Among the individual components of FTF, hypoactive and mixed subtypes were associated with prolonged stay in ICU (both P = .001). Conclusions: Patients with pure hypoactive delirium had a similar risk of developing FTF as other motor subtypes. Differentiation of motor subtypes is unlikely to be clinically important for prognostication of FTF but treatment strategies should address individual subtypes.-
dc.languageeng-
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/jtcvs-
dc.relation.ispartofThe Journal of Thoracic and Cardiovascular Surgery-
dc.rightsPosting accepted manuscript (postprint): © <year>. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/-
dc.subjectcardiac surgical procedures-
dc.subjectdelirium-
dc.subjectpostoperative complications-
dc.titleEffect of motor subtypes of delirium in the intensive care unit on fast-track failure after cardiac surgery-
dc.typeArticle-
dc.identifier.emailMu, JL: jinglan@hku.hk-
dc.identifier.doi10.1016/j.jtcvs.2017.08.139-
dc.identifier.pmid29110954-
dc.identifier.scopuseid_2-s2.0-85032172490-
dc.identifier.hkuros279951-
dc.identifier.volume155-
dc.identifier.issue1-
dc.identifier.spage268-
dc.identifier.epage275.e1-
dc.identifier.isiWOS:000422751300096-
dc.publisher.placeUnited States-

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