Syed M. Ali Hassan MD , Shubh K. Patel , Miriam S. Badross , Nitish K. Dhingra MD , Raj Verma , Meena Verma , Ryuta Seguchi MD, PhD , Bobby Yanagawa MD, PhD , Jessica Spence MD, PhD , C. David Mazer MD , Ahmad Alli MD, Mmed , Subodh Verma MD, PhD , Rakesh C. Arora MD, PhD
{"title":"当代心脏手术患者术后谵妄的预防与处理。","authors":"Syed M. Ali Hassan MD , Shubh K. Patel , Miriam S. Badross , Nitish K. Dhingra MD , Raj Verma , Meena Verma , Ryuta Seguchi MD, PhD , Bobby Yanagawa MD, PhD , Jessica Spence MD, PhD , C. David Mazer MD , Ahmad Alli MD, Mmed , Subodh Verma MD, PhD , Rakesh C. Arora MD, PhD","doi":"10.1053/j.semtcvs.2025.04.008","DOIUrl":null,"url":null,"abstract":"<div><div><span>This review examines the prevention and management of postoperative delirium<span><span> in cardiac surgery patients, a frequent complication linked with significant mortality, morbidity, prolonged hospitalization, and cognitive decline. The aim was to consolidate current evidence on postoperative delirium </span>pathophysiology, risk factors, </span></span>diagnostic<span><span> approaches, and pharmacologic and non-pharmacologic interventions. A PubMed/MEDLINE database review was conducted through October 2024, identifying studies that evaluated the relationship between cardiac surgery and the occurrence of postoperative delirium. The pathogenesis of postoperative delirium is complex, involving </span>neuroinflammation<span><span><span>, neurotransmitter imbalance, and </span>endothelial dysfunction<span>, compounded by baseline vulnerabilities and perioperative stressors. Early screening using tools like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and </span></span>Intensive Care Delirium<span> Screening Checklist<span> (ICDSC) aid in timely detection. Prevention emphasizes non-pharmacologic interventions, such as the Hospital Elder Life Program and the ABCDEF bundle, alongside pharmacologic strategies to minimize high-risk sedatives. Emerging technologies, including intraoperative neurophysiologic monitoring modalities and machine learning models, enhance postoperative delirium risk assessment and enable targeted interventions. Effective postoperative delirium management in cardiac surgery requires a balanced approach incorporating non-pharmacologic and pharmacologic methods. Integration of evidence-based practices and innovative technologies into routine care holds promise for improving patient outcomes. 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Arora MD, PhD\",\"doi\":\"10.1053/j.semtcvs.2025.04.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div><span>This review examines the prevention and management of postoperative delirium<span><span> in cardiac surgery patients, a frequent complication linked with significant mortality, morbidity, prolonged hospitalization, and cognitive decline. The aim was to consolidate current evidence on postoperative delirium </span>pathophysiology, risk factors, </span></span>diagnostic<span><span> approaches, and pharmacologic and non-pharmacologic interventions. A PubMed/MEDLINE database review was conducted through October 2024, identifying studies that evaluated the relationship between cardiac surgery and the occurrence of postoperative delirium. 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Contemporary Prevention and Management of Postoperative Delirium in Cardiac Surgery Patients
This review examines the prevention and management of postoperative delirium in cardiac surgery patients, a frequent complication linked with significant mortality, morbidity, prolonged hospitalization, and cognitive decline. The aim was to consolidate current evidence on postoperative delirium pathophysiology, risk factors, diagnostic approaches, and pharmacologic and non-pharmacologic interventions. A PubMed/MEDLINE database review was conducted through October 2024, identifying studies that evaluated the relationship between cardiac surgery and the occurrence of postoperative delirium. The pathogenesis of postoperative delirium is complex, involving neuroinflammation, neurotransmitter imbalance, and endothelial dysfunction, compounded by baseline vulnerabilities and perioperative stressors. Early screening using tools like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) aid in timely detection. Prevention emphasizes non-pharmacologic interventions, such as the Hospital Elder Life Program and the ABCDEF bundle, alongside pharmacologic strategies to minimize high-risk sedatives. Emerging technologies, including intraoperative neurophysiologic monitoring modalities and machine learning models, enhance postoperative delirium risk assessment and enable targeted interventions. Effective postoperative delirium management in cardiac surgery requires a balanced approach incorporating non-pharmacologic and pharmacologic methods. Integration of evidence-based practices and innovative technologies into routine care holds promise for improving patient outcomes. Ongoing research is essential to optimize postoperative delirium management and standardize practices in high-risk populations.
期刊介绍:
Seminars in Thoracic and Cardiovascular Surgery is devoted to providing a forum for cardiothoracic surgeons to disseminate and discuss important new information and to gain insight into unresolved areas of question in the specialty. Each issue presents readers with a selection of original peer-reviewed articles accompanied by editorial commentary from specialists in the field. In addition, readers are offered valuable invited articles: State of Views editorials and Current Readings highlighting the latest contributions on central or controversial issues. Another prized feature is expert roundtable discussions in which experts debate critical questions for cardiothoracic treatment and care. Seminars is an invitation-only publication that receives original submissions transferred ONLY from its sister publication, The Journal of Thoracic and Cardiovascular Surgery. As we continue to expand the reach of the Journal, we will explore the possibility of accepting unsolicited manuscripts in the future.