Delirium
Conditions
Keywords
Delirium, Autonomic cardiovascular control, Abdominal surgery, Tilt-test
Brief summary
The purpose of this study is to study aspects of autonomic cardiovascular control and the level of stress hormones and inflammatory markers in saliva or serum, in elderly patients exposed to elective, major abdominal surgery, with or without postoperative delirium, to explore the hypothesis that delirium may be the result of aberrant stress responses.
Detailed description
Patients admitted for elective, major, abdominal surgery will be tested with a head-up tilting to 20 degrees for 15 minutes preoperatively and again on the second postoperative day. Haemodynamic variables will be registered by the device TaskForceMonitor which monitors heart rate (HR), electrocardiography (ECG), blood pressure and stroke volume continuously and non-invasively. Background variables (including demographics, comorbidity and simple cognitive tests) and daily variables (including delirium assessments) will be registered. Blood and saliva samples will be drawn preoperatively and postoperatively to measure levels of stress hormones and inflammatory markers.
Interventions
PROCEDUREAbdominal surgery
Patients 65 years or older scheduled for abdominal surgery at Oslo University Hospital
Sponsors
South-Eastern Norway Regional Health Authority
Oslo University Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients 65 years or older scheduled for abdominal surgery at Oslo University Hospital
Exclusion criteria
* Absence of a valid informed consent or assent, or consent from a legal proxy * Patients with atrial fibrillation or a pacemaker rhythm * Polyneuropathy * Current treatment with beta-blockers, calcium-blockers or cholinesterase inhibitors * Competing research project
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in orthostatic cardiovascular responses | Baseline and postoperatively at surgical ward (expected second postoperative day) | Change in orthostatic cardiovascular responses (head-up tilt test) pre- and postoperatively in patients with and without postoperative delirium will be evaluated based on measurements of heart rate, systolic blood pressure (BP), mean BP, diastolic BP, stroke index, total peripheral resistance index, end-diastolic volume index, and acceleration index. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Nottingham Extended Activity of Daily Living (NEADL) Scale | Baseline | Score from 0-66 points. |
| Cumulative Illness Rating Scale | Baseline | Total score from 0-56. |
| Dementia | Baseline | Simple cognitive tests preformed preoperatively, including MMSE, Clock Drawing Test, Trail making A and B and Ten word memory test. Also IQCODE when reliable information is present. |
| Barthel Activities of Daily Living (ADL) Scale | Baseline | Score from 0-20 points |
| Cortisol | Baseline and second postoperative day | Looking for differences in levels of cortisol in saliva (morning samples) pre-and postoperatively in patients developing delirium compared to patients not developing delirium. |
| Severity of delirium | Baseline and a minimum of 2 days after the second tilt-test, an expected average of 5 days | Daily assessing the patient using MDAS (the memorial delirium assessment scale). Total score from 0-30. |
| Gait speed | Baseline | Measuring comfortable gait speed at length of 4 meters, best result of 2 tests. Result in meter per second. |
| Delirium | Baseline and a minimum of 2 days after the second tilt-test, an expected average of 5 days. | Daily assessing the patient using the Confusion Assessment Method (CAM), shortened version. |
Countries
Norway
Outcome results
None listed