Perioperative risk factors for early intensive care delirium following cardiac surgery

Abstract

fast-track cardiac surgery protocols leading to early discharge from the ICU. Early extubation is usually considered one of the main steps in fast-track pathways1 and studies have demonstrated that the application of fast-track anaesthesia resulted in decreased ventilation time. Length of stay (LOS) in the ICU is an important report tool in research and logistics and one of the main factors limiting operating room utilization in cardiac surgery. However, LOS in ICU is not a fully objective measure as patient discharge besides medical factors may be guided by logistics and policy and thus more objective measures are warranted. The need for a faster ICU turnover due to increased demand and reduced resources has led to a continuous search for factors which can reduce the LOS in the ICU2.The present study compares two randomized fast-track protocols with focus on ventilation time, eligible time to discharge from ICU and patient quality of recovery. Method. Sixty cardiac surgery patients acting as control groups from two randomized studies, (nominated A, 2015 and B, 2013) concerning different aspects of fast-track protocols. The control patients in the two studies were treated equally in relevant parameters. The primary endpoints were ventilation time and eligible time to discharge from ICU and secondary outcomes were actual LOS in ICU and quality of recovery. Results. The patient groups were fully comparable in selected demographics and peroperative parameters. The median ventilation time decreased from study B 261 (216-372) to 205 min (139-279) in study A (P1⁄40.019; Mann-Whitney test). The mean eligible time to discharge was not different being 11.4 (8.4-14.6) and 10.5 (6.6-13.6) (P1⁄40.387) respectively nor was the actual median discharge time (21.2 (19.1-23.1) vs 20.4 (18.6-22.1) h) (P1⁄40.234). The quality of recovery evaluated by ICU scores showed statistically significant higher total scores in study A (figure). Higher scores in individual parameters were found in pain and diuresis while sedation scores were lower the first 10 postoperative hours in patients from study A. Conclusion. A reduction in ventilation time was seen between control individuals from the two studies. However the shorter ventilation time did not lead to shorter eligible or actual discharge time and we found some indications of poorer patient quality during recovery. OP-46