Abstract
Objective:
to detect the incidence of postoperative delirium in critically ill patients admitted to a surgical intensive care unit and to evaluate the predisposing and precipitating factors associated with postoperative delirium in critically ill patients admitted to a surgical intensive care unit.
Method:
this is a prospective cohort study of 157 critically ill surgical patients. Fisher’s exact test and Chi-square test were used for the association between factors and the occurrence of delirium, the Wilcoxon test for numerical variables, and the logistic regression model for the analysis of predisposing and precipitating factors.
Results:
the incidence of delirium was 28% (n=44). Age was a significant predisposing factor (p=0.001), followed by the length of surgery (p<0.001), blood transfusion (p=0.043), administration of crystalloids (p=0.008), and anti-inflammatory drugs (p=0.037), which were the precipitating factors identified. The best-adjusted models were: age, length of surgery, non-administration of anti-emetics, use of sufentanil, and blood transfusion.
Conclusion:
delirium is a frequent condition in critically ill adults undergoing surgery and the existence of precipitating and predisposing factors is relevant to the outcome, with the anesthetic-surgical procedure as the catalyst event.
Descriptors:
Delirium; Emergence Delirium; Neurosciense Nursing; Postoperative Care; Measures of Association, Exposure, Risk or Outcome; Critical Care
Highlights:
(1) It elucidates precipitating factors considered unusual in the literature.
(2) It corroborates the relational hypothesis of neurotransmitters for the occurrence of delirium.
(3) It develops an adjusted model for early identification of susceptible individuals.
(4) Evidence that the use of opioids (sufentanil) has a greater impact on delirium.
(5) Adds complementarity to the nursing diagnosis of acute confusion.