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Delirium After Cardiac Surgery and Cumulative Fluid Balance: A Case-Control Cohort Study

Tanya Mailhot1, Sylvie Cossette2, Jean Lambert3

  • 1Faculty of Nursing, Faculty of Medicine, Université de Montréal, Montreal Heart Institute Research Center, 5000 Bélanger St, S-2490, Montreal, Quebec, H1T 1C8, Canada.

Journal of Cardiothoracic and Vascular Anesthesia
|August 21, 2018
PubMed

Insights

Increased fluid balance after cardiac surgery is linked to a higher risk of delirium. Further research is needed to understand the exact role of fluid balance in causing post-cardiac surgery delirium.

Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Neuroscience

Background:

  • Delirium is a common complication following cardiac surgery.
  • The exact mechanisms underlying post-cardiac surgery delirium are not fully understood.
  • A novel hypothesis suggests a link between cumulative fluid balance and delirium via inflammation and hypervolemia.

Purpose of the Study:

  • To investigate the association between cumulative fluid balance and the occurrence of delirium in patients after cardiac surgery.
  • To test a hypothesis linking fluid overload to brain venous congestion and subsequent delirium.

Main Methods:

  • Retrospective case-control study of 346 cardiac surgery intensive care unit (ICU) patients.
  • Cumulative fluid balance assessed at ICU arrival, 24 hours, and 48 hours post-arrival.
  • Generalized estimating equations modeled the association between fluid balance and delirium, controlling for risk factors.

Main Results:

  • Delirium occurred in 11% at 24 hours, 30% at 48 hours, and 41% at 72 hours post-ICU arrival.
  • Cumulative fluid balance was significantly associated with delirium occurrence (OR 1.20, 95% CI: 1.066-1.355, p=0.003).
  • Other contributing factors included neurological history, sensory impairment, procedure type, and hemodynamic parameters.

Conclusions:

  • A significant association exists between cumulative fluid balance and delirium after cardiac surgery.
  • The precise etiological role of cumulative fluid balance in post-cardiac surgery delirium requires further investigation.
  • Fluid management strategies may play a role in delirium prevention.
Abstract

Keywords:
cardiac surgerycardiologycohort studycritical caredeliriumfluid balance

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