Neurocognitive changes are the most common complication after cardiac surgery, ranging from acute postoperative delirium to prolonged postoperative neurocognitive disorder. Changes in cognition are distressing to patients and families and associated with worse outcomes overall. This review outlines definitions and diagnostic criteria, risk factors for, and mechanisms of Perioperative Neurocognitive Disorders and offers strategies for preoperative screening and perioperative prevention and management of neurocognitive complications.
FriedTRTinettiMAgostiniJIannoneLTowleV. Health outcome prioritization to elicit preferences of older persons with multiple health conditions. Patient Educ Couns. 2011;83(2):278-282. doi:10.1016/j.pec.2010.04.032
2.
MartinBJButhKJAroraRCBaskettRJ. Delirium: A cause for concern beyond the immediate postoperative period. Ann Thorac Surg. 2012;93(4):1114-1120. doi:10.1016/j.athoracsur.2011.09.011
3.
RudolphJLInouyeSKJonesRN, et al.Delirium: An independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc. 2010;58(4):643-649. doi:10.1111/j.1532-5415.2010.02762.x
4.
SaczynskiJSMarcantonioERQuachL, et al.Cognitive trajectories after postoperative delirium. N Engl J Med. 2012;367(1):30-39. doi:10.1056/NEJMoa1112923
5.
HamiltonGMWheelerKDi MicheleJLaluMMMcIsaacDI. A systematic review and meta-analysis examining the impact of incident postoperative delirium on mortality. Anesthesiology. 2017;127(1):78-88. doi:10.1097/ALN.0000000000001660
SteinmetzJSiersmaVKessingLVRasmussenLSISPOCD Group. Is postoperative cognitive dysfunction a risk factor for dementia? A cohort follow-up study. Br J Anaesth. 2013;110(suppl 1):i92-i97. doi:10.1093/bja/aes466
8.
EveredLSilbertBKnopmanDS, et al.Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Br J Anaesth. 2018;121(5):1005-1012. doi:10.1016/j.bja.2017.11.087
9.
GaudreauJDGagnonPHarelFTremblayARoyMA. Fast, systematic, and continuous delirium assessment in hospitalized patients: The nursing delirium screening scale. J Pain Symptom Manage. 2005;29(4):368-375. doi:10.1016/j.jpainsymman.2004.07.009
10.
ElyEWInouyeSKBernardGR, et al.Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-2710.
11.
NeufeldKJLeoutsakosJSSieberFE, et al.Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly. Br J Anaesth. 2013;111(4):612-618. doi:10.1093/bja/aet167
12.
BergeronNDuboisMJDumontMDialSSkrobikY. Intensive care delirium screening checklist: Evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859-864.
13.
JarvelaKPorkkalaHKarlssonSMartikainenTSelanderTBendelS. Postoperative delirium in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2018;32(4):1597-1602. doi:10.1053/j.jvca.2017.12.030
14.
KazmierskiJKowmanMBanachM, et al.Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS Study. J Psychosom Res. 2010;69(2):179-185. doi:10.1016/j.jpsychores.2010.02.009
15.
RudolphJLJonesRNLevkoffSE, et al.Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation. 2009;119(2):229-236. doi:10.1161/CIRCULATIONAHA.108.795260
16.
LipowskiZJ. Transient cognitive disorders (delirium, acute confusional states) in the elderly. Am J Psychiatry. 1983;140(11):1426-1436. doi:10.1176/ajp.140.11.1426
17.
LipowskiZJ. Delirium in the elderly patient. N Engl J Med. 1989;320(9):578-582. doi:10.1056/NEJM198903023200907
18.
PetersonJFPunBTDittusRS, et al.Delirium and its motoric subtypes: A study of 614 critically ill patients. J Am Geriatr Soc. 2006;54(3):479-484. doi:10.1111/j.1532-5415.2005.00621.x
19.
McPhersonJAWagnerCEBoehmLM, et al.Delirium in the cardiovascular ICU: Exploring modifiable risk factors. Crit Care Med. 2013;41(2):405-413. doi:10.1097/CCM.0b013e31826ab49b
20.
SelnesOAGoldsboroughMABorowiczLMJrEngerCQuaskeySAMcKhannGM. Determinants of cognitive change after coronary artery bypass surgery: A multifactorial problem. Ann Thorac Surg. 1999;67(6):1669-1676. doi:10.1016/s0003-4975(99)00258-1
21.
NewmanMFKirchnerJLPhillips-ButeB, et al.Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344(6):395-402. doi:10.1056/NEJM200102083440601
BrownCHProbertJHealyR, et al.Cognitive decline after delirium in patients undergoing cardiac surgery. Anesthesiology. 2018;129(3):406-416. doi:10.1097/ALN.0000000000002253
24.
RasmussenLSLarsenKHouxP, et al.The assessment of postoperative cognitive function. Acta Anaesthesiol Scand. 2001;45(3):275-289.
25.
MurkinJMNewmanSPStumpDABlumenthalJA. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg. 1995;59(5):1289-1295.
26.
MonkTGWeldonBCGarvanCW, et al.Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1):18-30. doi:10.1097/01.anes.0000296071.19434.1e
27.
MollerJTCluitmansPRasmussenLS, et al.Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351(9106):857-861.
GreavesDPsaltisPJRossTJ, et al.Cognitive outcomes following coronary artery bypass grafting: A systematic review and meta-analysis of 91,829 patients. Int J Cardiol. 2019;289:43-49. doi:10.1016/j.ijcard.2019.04.065
30.
BergerMTerrandoNSmithSKBrowndykeJNNewmanMFMathewJP. Neurocognitive function after cardiac surgery: From phenotypes to mechanisms. Anesthesiology. 2018;129(4):829-851. doi:10.1097/ALN.0000000000002194
31.
LingehallHCSmulterNSLindahlE, et al.Preoperative cognitive performance and postoperative delirium are independently associated with future dementia in older people who have undergone cardiac surgery: A longitudinal cohort study. Crit Care Med. 2017;45(8):1295-1303. doi:10.1097/CCM.0000000000002483
32.
ItagakiASakuradaKMatsuhamaMYajimaJYamashitaTKohzukiM. Impact of frailty and mild cognitive impairment on delirium after cardiac surgery in older patients. J Cardiol. 2020;76(2):147-153. doi:10.1016/j.jjcc.2020.02.007
33.
GreavesDPsaltisPJDavisDHJ, et al.Risk factors for delirium and cognitive decline following coronary artery bypass grafting surgery: A systematic review and meta-analysis. J Am Heart Assoc. 2020;9(22):e017275. doi:10.1161/JAHA.120.017275
34.
ChenHMoLHuHOuYLuoJ. Risk factors of postoperative delirium after cardiac surgery: A meta-analysis. J Cardiothorac Surg. 2021;16(1):113. doi:10.1186/s13019-021-01496-w
35.
GosseltANSlooterAJBoerePRZaalIJ. Risk factors for delirium after on-pump cardiac surgery: A systematic review. Crit Care. 2015;19:346. doi:10.1186/s13054-015-1060-0
36.
KotfisKSzylinskaAListewnikM, et al.Early delirium after cardiac surgery: An analysis of incidence and risk factors in elderly (≥65 years) and very elderly (≥80 years) patients. Clin Interv Aging. 2018;13:1061-1070. doi:10.2147/CIA.S166909
37.
Ordonez-VelascoLMHernandez-LeivaE. Factors associated with delirium after cardiac surgery: A prospective cohort study. Ann Card Anaesth. 2021;24(2):183-189. doi:10.4103/aca.ACA_43_20
38.
JungPPereiraMAHiebertB, et al.The impact of frailty on postoperative delirium in cardiac surgery patients. J Thorac Cardiovasc Surg. 2015;149(3):869-875. doi:10.1016/j.jtcvs.2014.10.118
39.
OgawaMIzawaKPSatomi-KobayashiS, et al.Preoperative exercise capacity is associated with the prevalence of postoperative delirium in elective cardiac surgery. Aging Clin Exp Res. 2018;30(1):27-34. doi:10.1007/s40520-017-0736-5
40.
HayashiKOshimaHShimizuM, et al.Preoperative 6-minute walk distance is associated with postoperative cognitive dysfunction. Ann Thorac Surg. 2018;106(2):505-512. doi:10.1016/j.athoracsur.2018.03.010
41.
CaiSLatourJMLinY, et al.Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: A prospective cohort study. Eur J Cardiovasc Nurs. 2020;19(4):310-319. doi:10.1177/1474515119886155
42.
van DijkDSpoorMHijmanR, et al.Cognitive and cardiac outcomes 5 years after off-pump vs on-pump coronary artery bypass graft surgery. JAMA. 2007;297(7):701-708. doi:10.1001/jama.297.7.701
43.
Van DijkDJansenEWHijmanR, et al.Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: A randomized trial. JAMA. 2002;287(11):1405-1412. doi:10.1001/jama.287.11.1405
44.
LamyADevereauxPJPrabhakaranD, et al.Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med. 2013;368(13):1179-1188. doi:10.1056/NEJMoa1301228
45.
KennedyEDChoyKCAlstonRP, et al.Cognitive outcome after on- and off-pump coronary artery bypass grafting surgery: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2013;27(2):253-265. doi:10.1053/j.jvca.2012.11.008
46.
WhitlockELDiaz-RamirezLGSmithAK, et al.Association of coronary artery bypass grafting vs percutaneous coronary intervention with memory decline in older adults undergoing coronary revascularization. JAMA. 2021;325(19):1955-1964. doi:10.1001/jama.2021.5150
47.
SelnesOAGregaMABaileyMM, et al.Cognition 6 years after surgical or medical therapy for coronary artery disease. Ann Neurol. 2008;63(5):581-590. doi:10.1002/ana.21382
48.
SelnesOAGregaMABaileyMM, et al.Do management strategies for coronary artery disease influence 6-year cognitive outcomes?Ann Thorac Surg. 2009;88(2):445-454. doi:10.1016/j.athoracsur.2009.04.061
49.
WesselinkEMKappenTHvan KleiWADielemanJMvan DijkDSlooterAJ. Intraoperative hypotension and delirium after on-pump cardiac surgery. Br J Anaesth. 2015;115(3):427-433. doi:10.1093/bja/aev256
50.
HughesCGBoncykCSCulleyDJ, et al.American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention. Anesth Analg. 2020;130(6):1572-1590. doi:10.1213/ANE.0000000000004641
51.
HollingerASiegemundMGoettelNSteinerLA. Postoperative delirium in cardiac surgery: An unavoidable menace?J Cardiothorac Vasc Anesth. 2015;29(6):1677-1687. doi:10.1053/j.jvca.2014.08.021
52.
SauerACVeldhuijzenDSOttensTHSlooterAJCKalkmanCJvan DijkD. Association between delirium and cognitive change after cardiac surgery. Br J Anaesth. 2017;119(2):308-315. doi:10.1093/bja/aex053
53.
KosterSHensensAGSchuurmansMJvan der PalenJ. Consequences of delirium after cardiac operations. Ann Thorac Surg. 2012;93(3):705-711. doi:10.1016/j.athoracsur.2011.07.006
54.
KosterSHensensAGvan der PalenJ. The long-term cognitive and functional outcomes of postoperative delirium after cardiac surgery. Ann Thorac Surg. 2009;87(5):1469-1474. doi:10.1016/j.athoracsur.2009.02.080
55.
MaldonadoJR. Neuropathogenesis of delirium: Review of current etiologic theories and common pathways. Am J Geriatr Psychiatr. 2013;21(12):1190-1222. doi:10.1016/j.jagp.2013.09.005
VasunilashornSMNgoLInouyeSK, et al.Cytokines and postoperative delirium in older patients undergoing major elective surgery. J Gerontol A Biol Sci Med Sci. 2015;70(10):1289-1295. doi:10.1093/gerona/glv083
58.
LiuXYuYZhuS. Inflammatory markers in postoperative delirium (POD) and cognitive dysfunction (POCD): A meta-analysis of observational studies. PLoS One. 2018;13(4):e0195659. doi:10.1371/journal.pone.0195659
59.
HughesCGPatelMBPandharipandePP. Pathophysiology of acute brain dysfunction: What’s the cause of all this confusion?Curr Opin Crit Care. 2012;18(5):518-526. doi:10.1097/MCC.0b013e328357effa
60.
CerejeiraJFirminoHVaz-SerraAMukaetova-LadinskaEB. The neuroinflammatory hypothesis of delirium. Acta Neuropathol. 2010;119(6):737-754. doi:10.1007/s00401-010-0674-1
61.
SteinbergBMGrossiEASchwartzDS, et al.Heparin bonding of bypass circuits reduces cytokine release during cardiopulmonary bypass. Ann Thorac Surg. 1995;60(3):525-529. doi:10.1016/0003-4975(95)00482-z
62.
ShannKGLikoskyDSMurkinJM, et al.An evidence-based review of the practice of cardiopulmonary bypass in adults: A focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J Thorac Cardiovasc Surg. 2006;132(2):283-290. doi:10.1016/j.jtcvs.2006.03.027
63.
LiuJWangHLiJ. Inflammation and inflammatory cells in myocardial infarction and reperfusion injury: A double-edged sword. Clin Med Insights Cardiol. 2016;10:79-84. doi:10.4137/CMC.S33164
64.
SquiccimarroEStasiALorussoRPaparellaD. Narrative review of the systemic inflammatory reaction to cardiac surgery and cardiopulmonary bypass. Artif Organs. 2022;46(4):568-577. doi:10.1111/aor.14171
65.
HughesCGPandharipandePPThompsonJL, et al.Endothelial activation and blood-brain barrier injury as risk factors for delirium in critically ill patients. Crit Care Med. 2016;44(9):e809-e817. doi:10.1097/CCM.0000000000001739
66.
HughesCGPatelMBBrummelNE, et al.Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability. Intensive Care Med. 2018;44(3):345-355. doi:10.1007/s00134-018-5120-1
67.
WibergSHolmgaardFZetterbergH, et al.Biomarkers of cerebral injury for prediction of postoperative cognitive dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2022;36(1):125-132. doi:10.1053/j.jvca.2021.05.016
68.
LopezMGHughesCGDeMatteoA, et al.Intraoperative oxidative damage and delirium after cardiac surgery. Anesthesiology. 2020;132(3):551-561. doi:10.1097/ALN.0000000000003016
69.
MohantySRosenthalRARussellMMNeumanMDKoCYEsnaolaNF. Optimal perioperative management of the geriatric patient: A best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016;222(5):930-947. doi:10.1016/j.jamcollsurg.2015.12.026
70.
PedenCJMillerTRDeinerSGEckenhoffRGFleisherLAMembers of the Perioperative Brain Health Expert Panel. Improving perioperative brain health: An expert consensus review of key actions for the perioperative care team. Br J Anaesth. 2021;126(2):423-432. doi:10.1016/j.bja.2020.10.037
71.
BorsonSScanlanJMChenPGanguliM. The Mini-Cog as a screen for dementia: Validation in a population-based sample. J Am Geriatr Soc. 2003;51(10):1451-1454. doi:10.1046/j.1532-5415.2003.51465.x
72.
CulleyDJFlahertyDFaheyMC, et al.Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127(5):765-774. doi:10.1097/ALN.0000000000001859
73.
DeckerJKaloostianCLGurvichT, et al.Beyond cognitive screening: Establishing an interprofessional perioperative brain health initiative. J Am Geriatr Soc. 2020;68(10):2359-2364. doi:10.1111/jgs.16720
74.
PartridgeJSMartinFCHarariDDhesiJK. The delirium experience: What is the effect on patients, relatives and staff and what can be done to modify this?Int J Geriatr Psychiatry. 2013;28(8):804-812. doi:10.1002/gps.3900
75.
BergerMSchenningKJBrownCH, et al.Best practices for postoperative brain health: Recommendations from the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg. 2018;127(6):1406-1413. doi:10.1213/ANE.0000000000003841
76.
GamberiniMBolligerDLurati BuseGA, et al.Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery—a randomized controlled trial. Crit Care Med. 2009;37(5):1762-1768. doi:10.1097/CCM.0b013e31819da780
77.
GhaffarySGhaeliPTalasazAH, et al.Effect of memantine on post-operative cognitive dysfunction after cardiac surgeries: A randomized clinical trial. Daru. 2017;25(1):24. doi:10.1186/s40199-017-0190-0
78.
GlumacSKardumGSodicLSupe-DomicDKaranovicN. Effects of dexamethasone on early cognitive decline after cardiac surgery: A randomised controlled trial. Eur J Anaesthesiol. 2017;34(11):776-784. doi:10.1097/EJA.0000000000000647
79.
GlumacSKardumGSodicL, et al.Longitudinal assessment of preoperative dexamethasone administration on cognitive function after cardiac surgery: A 4-year follow-up of a randomized controlled trial. BMC Anesthesiol. 2021;21(1):129. doi:10.1186/s12871-021-01348-z
80.
MardaniDBigdelianH. Prophylaxis of dexamethasone protects patients from further post-operative delirium after cardiac surgery: A randomized trial. J Res Med Sci. 2013;18(2):137-143.
81.
SauerAMSlooterAJVeldhuijzenDSvan EijkMMDevlinJWvan DijkD. Intraoperative dexamethasone and delirium after cardiac surgery: A randomized clinical trial. Anesth Analg. 2014;119(5):1046-1052. doi:10.1213/ANE.0000000000000248
82.
RoyseCFSaagerLWhitlockR, et al.Impact of methylprednisolone on postoperative quality of recovery and delirium in the steroids in cardiac surgery trial: A randomized, double-blind, placebo-controlled substudy. Anesthesiology. 2017;126(2):223-233. doi:10.1097/ALN.0000000000001433
83.
WhitlockRPDevereauxPJTeohKH, et al.Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): A randomised, double-blind, placebo-controlled trial. Lancet. 2015;386(10000):1243-1253. doi:10.1016/S0140-6736(15)00273-1
84.
BillingsFTHendricksPASchildcroutJS, et al.High-dose perioperative atorvastatin and acute kidney injury following cardiac surgery: A randomized clinical trial. JAMA. 2016;315(9):877-888. doi:10.1001/jama.2016.0548
85.
NeedhamDMColantuoniEDinglasVD, et al.Rosuvastatin versus placebo for delirium in intensive care and subsequent cognitive impairment in patients with sepsis-associated acute respiratory distress syndrome: An ancillary study to a randomised controlled trial. Lancet Respir Med. 2016;4(3):203-212. doi:10.1016/S2213-2600(16)00005-9
86.
PageVJDavisDZhaoXB, et al.Statin use and risk of delirium in the critically ill. Am J Respir Crit Care Med. 2014;189(6):666-673. doi:10.1164/rccm.201306-1150OC
87.
HudetzJAPattersonKMIqbalZ, et al.Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2009;23(5):651-657. doi:10.1053/j.jvca.2008.12.021
88.
AvidanMSMaybrierHRAbdallahAB, et al.Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: An international, multicentre, double-blind, randomised clinical trial. Lancet. 2017;390(10091):267-275. doi:10.1016/S0140-6736(17)31467-8
89.
KlingerRYCooterMBisanarT, et al.Intravenous lidocaine does not improve neurologic outcomes after cardiac surgery: A randomized controlled trial. Anesthesiology. 2019;130(6):958-970. doi:10.1097/ALN.0000000000002668
90.
GoldJPCharlsonMEWilliams-RussoP, et al.Improvement of outcomes after coronary artery bypass. A randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg. 1995;110(5):1302-1311; discussion 1311-4. doi:10.1016/S0022-5223(95)70053-6
91.
VedelAGHolmgaardFRasmussenLS, et al.High-target versus low-target blood pressure management during cardiopulmonary bypass to prevent cerebral injury in cardiac surgery patients: A randomized controlled trial. Circulation. 2018;137(17):1770-1780. doi:10.1161/CIRCULATIONAHA.117.030308
92.
LarsenMHDraegertCVedelAG, et al.Long-term survival and cognitive function according to blood pressure management during cardiac surgery. A follow-up. Acta Anaesthesiol Scand. 2020;64(7):936-944. doi:10.1111/aas.13595
93.
BrownCHNeufeldKJTianJ, et al.Effect of targeting mean arterial pressure during cardiopulmonary bypass by monitoring cerebral autoregulation on postsurgical delirium among older patients: A nested randomized clinical trial. JAMA Surg. 2019;154(9):819-826. doi:10.1001/jamasurg.2019.1163
94.
HoriDBrownCOnoM, et al.Arterial pressure above the upper cerebral autoregulation limit during cardiopulmonary bypass is associated with postoperative delirium. Br J Anaesth. 2014;113(6):1009-1017. doi:10.1093/bja/aeu319
95.
HogueCWBrownCHHoriD, et al.Personalized blood pressure management during cardiac surgery with cerebral autoregulation monitoring: A randomized trial. Semin Thorac Cardiovasc Surg. 2021;33(2):429-438. doi:10.1053/j.semtcvs.2020.09.032
96.
LeendersJOverdevestEvan StratenBGolabH. The influence of oxygen delivery during cardiopulmonary bypass on the incidence of delirium in CABG patients; A retrospective study. Perfusion. 2018;33(8):656-662. doi:10.1177/0267659118783104
97.
de Tournay-JetteEDupuisGBhererLDeschampsACartierRDenaultA. The relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction in elderly patients after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2011;25(1):95-104. doi:10.1053/j.jvca.2010.03.019
98.
EertmansWDe DeyneCGenbruggeC, et al.Association between postoperative delirium and postoperative cerebral oxygen desaturation in older patients after cardiac surgery. Br J Anaesth. 2020;124(2):146-153. doi:10.1016/j.bja.2019.09.042
99.
TianLJYuanSZhouCHYanFX. The effect of intraoperative cerebral oximetry monitoring on postoperative cognitive dysfunction and ICU stay in adult patients undergoing cardiac surgery: An updated systematic review and meta-analysis. Front Cardiovasc Med. 2021;8:814313. doi:10.3389/fcvm.2021.814313
100.
ThieleRHShawADBartelsK, et al.American society for enhanced recovery and perioperative quality initiative joint consensus statement on the role of neuromonitoring in perioperative outcomes: Cerebral near-infrared spectroscopy. Anesth Analg. 2020;131(5):1444-1455. doi:10.1213/ANE.0000000000005081
101.
LefebvrePJScheenAJ. The postprandial state and risk of cardiovascular disease. Diabet Med. 1998;15(suppl 4):S63-S68. doi:10.1002/(sici)1096-9136(1998120)15:4+<s63::aid-dia737>3.3.co;2-z
ZhangXYanXGormanJHoffmanSNZhangLBoscarinoJA. Perioperative hyperglycemia is associated with postoperative neurocognitive disorders after cardiac surgery. Neuropsychiatr Dis Treat. 2014;10:361-370. doi:10.2147/NDT.S57761
104.
SaagerLDuncanAEYaredJP, et al.Intraoperative tight glucose control using hyperinsulinemic normoglycemia increases delirium after cardiac surgery. Anesthesiology. 2015;122(6):1214-1223. doi:10.1097/ALN.0000000000000669
105.
Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-1297. doi:10.1056/NEJMoa0810625
106.
OhCSParkSWan HongSKangWSYoonTGKimSH. Postoperative delirium in patients undergoing off-pump coronary artery bypass grafting according to the anesthetic agent: A retrospective study. J Cardiothorac Vasc Anesth. 2017;31(6):1988-1995. doi:10.1053/j.jvca.2017.02.047
107.
ShinHJChoiSLNaHS. Prevalence of postoperative delirium with different combinations of intraoperative general anesthetic agents in patients undergoing cardiac surgery: A retrospective propensity-score-matched study. Medicine (Baltim). 2021;100(33):e26992. doi:10.1097/MD.0000000000026992
108.
JiaoXFLinXMNiXF, et al.Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials. PLoS One. 2019;14(10):e0224562. doi:10.1371/journal.pone.0224562
FritzBAMaybrierHRAvidanMS. Intraoperative electroencephalogram suppression at lower volatile anaesthetic concentrations predicts postoperative delirium occurring in the intensive care unit. Br J Anaesth. 2018;121(1):241-248. doi:10.1016/j.bja.2017.10.024
111.
WhitlockELTorresBALinN, et al.Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg. 2014;118(4):809-817. doi:10.1213/ANE.0000000000000028
112.
TangCJJinZSandsLP, et al.ADAPT-2: A randomized clinical trial to reduce intraoperative EEG suppression in older surgical patients undergoing major noncardiac surgery. Anesth Analg. 2020;131(4):1228-1236. doi:10.1213/ANE.0000000000004713
113.
BrownCHEdwardsCLinC, et al.Spinal anesthesia with targeted sedation based on bispectral index values compared with general anesthesia with masked bispectral index values to reduce delirium: The SHARP randomized controlled trial. Anesthesiology. 2021;135(6):992-1003. doi:10.1097/ALN.0000000000004015
114.
WildesTSMickleAMBen AbdallahA, et al.Effect of electroencephalography-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery: The ENGAGES randomized clinical trial. JAMA. 2019;321(5):473-483. doi:10.1001/jama.2018.22005
115.
KunstGGaugeNSalaunkeyK, et al.Intraoperative optimization of both depth of anesthesia and cerebral oxygenation in elderly patients undergoing coronary artery bypass graft surgery-A randomized controlled pilot trial. J Cardiothorac Vasc Anesth. 2020;34(5):1172-1181. doi:10.1053/j.jvca.2019.10.054
116.
PrakanrattanaUPrapaitrakoolS. Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care. 2007;35(5):714-719.
117.
HakimSMOthmanAINaoumDO. Early treatment with risperidone for subsyndromal delirium after on-pump cardiac surgery in the elderly: A randomized trial. Anesthesiology. 2012;116(5):987-997. doi:10.1097/ALN.0b013e31825153cc
118.
DjaianiGSilvertonNFedorkoL, et al.Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery: A randomized controlled trial. Anesthesiology. 2016;124(2):362-368. doi:10.1097/ALN.0000000000000951
119.
LiuXXieGZhangK, et al.Dexmedetomidine vs propofol sedation reduces delirium in patients after cardiac surgery: A meta-analysis with trial sequential analysis of randomized controlled trials. J Crit Care. 2017;38:190-196. doi:10.1016/j.jcrc.2016.10.026
120.
TuranADuncanALeungS, et al.Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): A randomised placebo-controlled trial. Lancet. 2020;396(10245):177-185. doi:10.1016/S0140-6736(20)30631-0
121.
SubramaniamBShankarPShaefiS, et al.Effect of intravenous acetaminophen vs placebo combined with propofol or dexmedetomidine on postoperative delirium among older patients following cardiac surgery: The DEXACET randomized clinical trial. JAMA. 2019;321(7):686-696. doi:10.1001/jama.2019.0234
122.
SiddiqiNHarrisonJKCleggA, et al.Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016;3:CD005563. doi:10.1002/14651858.CD005563.pub3
123.
InouyeSKBogardusSTJrCharpentierPA, et al.A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669-676. doi:10.1056/NEJM199903043400901
124.
MarcantonioERFlackerJMWrightRJResnickNM. Reducing delirium after hip fracture: A randomized trial. J Am Geriatr Soc2001;49(5):516-522. doi:10.1046/j.1532-5415.2001.49108.x
125.
RestonJTSchoellesKM. In-facility delirium prevention programs as a patient safety strategy: A systematic review. Ann Intern Med. 2013;158(5 Pt 2):375-380. doi:10.7326/0003-4819-158-5-201303051-00003
126.
MorandiABrummelNEElyEW. Sedation, delirium and mechanical ventilation: The ‘ABCDE’ approach. Curr Opin Crit Care. 2011;17(1):43-49. doi:10.1097/MCC.0b013e3283427243
127.
BalasMCVasilevskisEEOlsenKM, et al.Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-1036. doi:10.1097/CCM.0000000000000129
128.
Barnes-DalyMAPhillipsGElyEW. Improving hospital survival and reducing brain dysfunction at Seven California Community Hospitals: Implementing PAD guidelines via the ABCDEF bundle in 6,064 patients. Crit Care Med. 2017;45(2):171-178. doi:10.1097/CCM.0000000000002149
129.
PunBTBalasMCBarnes-DalyMA, et al.Caring for critically ill patients with the ABCDEF bundle: Results of the ICU liberation collaborative in over 15,000 adults. Crit Care Med. 2019;47(1):3-14. doi:10.1097/CCM.0000000000003482