Profiles of delirium and the clinical outcomes of patients who underwent coronary artery bypass grafting: a prospective study from China

Abstract

Aims and objectives: To explore the profiles of delirium in coronary artery bypass grafting patients and identify related patient outcomes.

Background: Delirium was assessed previously as a binary result, i.e. present or absent, but little attention was paid to the profiles of delirium, e.g. the subtype, severity, duration and the first episode, and little was known about clinical outcomes.

Design: A prospective study.

Methods: Ninety-five delirious patients who underwent coronary artery bypass grafting were included. Delirium episodes were categorised as hypoactive, hyperactive or mixed type and as mild, moderate or severe. Duration in days and the first episode of delirium in day after surgery were recorded. Patient outcomes were recorded prospectively to determine the effects of delirium profiles.

Results: Mixed-type delirium was most common (44·21%), followed by hyperactive delirium (26·32%) and hypoactive delirium (29·47%). Patients with hypoactive delirium had a longer duration of ventilator use. Severity of delirium measurements revealed 28·42% mild, 51·58% moderate and 20·00% severe. Patients with severe delirium had a longer duration of ventilation use, longer lengths of intensive care unit stay and hospital stay compared to mild and moderate delirium. Delirium duration lasted from 1-5 days. Differences were observed in the length of intensive care unit stay and hospital days across groups of different delirium duration. A total of 73·68% of delirium developed on the first and second postoperative days. The later the first episode of delirium occurred, the longer the duration of delirium was, which also yielded longer lengths of intensive care unit stay.

Conclusion: Hypoactive delirium, severe delirium and delirium of later onset and longer duration were associated with adverse outcomes.

Relevance to clinical practice: Hospital staff should pay attention to hypoactive delirium, take measures properly to decrease the severity and duration of delirium to improve the results of delirious patients.

Keywords: clinical profiles; coronary artery bypass grafting; delirium; nursing; patient outcomes.