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Delirium in the cardiac surgical ICU

Brown, Charles H.

Current Opinion in Anesthesiology: April 2014 - Volume 27 - Issue 2 - p 117–122
doi: 10.1097/ACO.0000000000000061

Purpose of review Evidence is emerging that delirium is associated with both short-term and long-term morbidity and mortality. This review highlights the epidemiology, outcomes, prevention and treatment strategies associated with delirium after cardiac surgery.

Recent findings The incidence of delirium after cardiac surgery is estimated to be 26–52%, with a significant percentage being hypoactive delirium. It is clear that without an appropriate structured test for delirium, the incidence of delirium will be underrecognized clinically. Delirium after cardiac surgery is associated with poor outcomes, including increased long-term mortality, increased risk of stroke, poor functional status, increased hospital readmissions and substantial cognitive dysfunction for 1 year following surgery. The effectiveness of prophylactic antipsychotics to reduce the risk of delirium is controversial, with data from recent small studies in noncardiac surgery potentially showing a benefit. Although antipsychotic medications are often used to treat delirium, the evidence that antipsychotics in cardiac surgery patients reduce duration of delirium or improve long-term outcomes following delirium is poor.

Summary Clinicians in the ICU must recognize the impact of delirium in predicting long-term outcomes for patients. Further research is needed in determining interventions that will be effective in preventing and treating delirium in cardiac surgical setting.

Department of Anesthesiology and Critical Care Medicine, The John Hopkins School of Medicine, Baltimore, Maryland, USA

Correspondence to Charles H. Brown, IV, MD, MHS, Department of Anesthesiology and Critical Care Medicine, The John Hopkins School of Medicine, Zayed 6208, 1800 Orleans St., Baltimore, MD 21287, USA. Tel: +1 410 955 7519; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.