Clinical Features of Postoperative Delirium in Patients Who Underwent Cardiac Surgery

Background: the increasing number of cardiac surgeries in older patients with serious cardiovascular diseases, the frequent development of postoperative delirium, its unfavorable prognosis, and underdiagnosis of certain types of delirium determined the relevance of this study. The aim was to identify clinical types of postoperative delirium in patients who underwent cardiac surgery. Patients and Methods: a total of 157 patients participated in prospective observational study of clinical types of postoperative delirium in patients undergoing cardiac surgery. The study was conducted at the cardiac surgery and cardiology intensive care departments of the Sverdlovsk Regional Clinical Hospital No.1. Clinical, psychopathological, psychometric, and statistical methods were used. Results: 31 patients (19.7% of the total number of operated patients who participated in this study) with delirium were identified in the early postoperative period. Based on the psychometric (total scores of the Confusion Assessment Method Intensive Care Unit and Richmond Agitation-Sedation Scale) and clinical and psychopathological assessment of the patients’ condition, clinical heterogeneity of postoperative delirium was revealed. Different types of delirium were determined including hypoactive type in 87.1% f, mixed in 9.7% and hyperactive delirium in 3.2% of cases. The syndromic structure of hyperactive and hypoactive postoperative delirium is different. Discussion: different syndromic structure of hyperactive and hypoactive types of delirium allow us to assume the different pathogenetic mechanisms. This may partially explain the insufficient sensitivity of the diagnostic tools used. Conclusion: improvement of the typology of delirium in cardiac surgery patients is necessary to predict the development of postoperative delirium and develop methods for its prevention.

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