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ICU Delirium in Cardiac Patients
Hina Faisal1, Souha Farhat2, Navneet K Grewal3
1Center for Critical Care, Houston Methodist Hospital, Weill Cornell Graduate School of Medical Sciences, Houston, Texas, US.
Insights
Delirium is common in critically ill cardiac patients, increasing risks and costs. Early recognition and management in the intensive care unit (ICU) are crucial for better patient outcomes.
Area of Science:
- Critical Care Medicine
- Cardiology
- Neuroscience
Background:
- Delirium is a frequent complication in critically ill cardiac patients, impacting medical and surgical cases.
- It is linked to adverse outcomes including higher mortality, extended hospital stays, and cognitive decline.
- The incidence and presentation of delirium in cardiac patients vary significantly.
Purpose of the Study:
- To provide a comprehensive review of delirium in cardiac intensive care unit (ICU) patients.
- To highlight the presentation, risk factors, pathophysiology, and management strategies.
- To discuss current controversies and future directions in delirium management.
Main Methods:
- Literature review of delirium in critically ill cardiac patients.
- Synthesis of information on incidence, risk factors, and pathophysiology.
- Analysis of current and potential management interventions.
Main Results:
- Delirium in cardiac ICU patients is associated with significant morbidity and mortality.
- While protocols exist, there is a lack of standardized clinical guidelines for management.
- Many cases of ICU delirium in cardiac patients are potentially preventable.
Conclusions:
- Understanding and managing delirium is essential for clinicians caring for critically ill cardiac patients.
- Delirium impacts long-term outcomes, necessitating focused attention and intervention.
- Further research into innovative and standardized therapies is required.
Abstract:
Delirium is a prevalent complication in critically ill medical and surgical cardiac patients. It is associated with increased morbidity and mortality, prolonged hospitalizations, cognitive impairments, functional decline, and hospital costs. The incidence of delirium in cardiac patients varies based on the criteria used for the diagnosis, the population studied, and the type of surgery (cardiac or not cardiac). Delirium experienced when cardiac patients are in the intensive care unit (ICU) is likely preventable in most cases. While there are many protocols for recognizing and managing ICU delirium in medical and surgical cardiac patients, there is no homogeneity, nor are there established clinical guidelines. This review provides a comprehensive overview of delirium in cardiac patients and highlights its presentation, course, risk factors, pathophysiology, and management. We define cardiac ICU patients as both medical and postoperative surgical patients with cardiac disease in the ICU. We also highlight current controversies and future considerations of innovative therapies and nonpharmacological and pharmacological management interventions. Clinicians caring for critically ill patients with cardiac disease must understand the complex syndrome of ICU delirium and recognize the impact of delirium in predicting long-term outcomes for ICU patients.
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