Cardiac Disease
Conditions
Keywords
Cardiac surgery, postoperative delirium, regional anesthesia, enhanced recovery after surgery
Brief summary
PostOperative Delirium (POD) is the most common neuropsychiatric complication following cardiac surgery and may be related to morphine consumption. PostOperative Delirium (POD) prolongs hospital and intensive care unit (ICU) length of stay (LOS) and increases morbidity and mortality. No study has been conducted to demonstrate the effect of regional anesthesia using catheters inserted before sternotomy.
Detailed description
This study investigate the effect of an enhanced recovery protocol using regional anesthesia on PostOperative Delirium (POD) onset.
Interventions
OTHERcollection of datas
collection of datas: * Post-operative occurrence (within the first 48 hours after extubation) of post-operative delirium via the CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) scale result * Post-operative hypoxemia defined as a PaO2/FiO2 ratio \< 300 in the first 48 hours after extubation * reflex ileus defined as the absence of gas and/or matter in the first 48 hours after extubation, * total morphine consumption in the first 48 hours after surgery * pain at 24 hours and 48 hours after surgery * post-operative nausea and vomiting, major complications (neurological, respiratory, cardiac, infectious) * mortality 30 days after surgery
Sponsors
Centre Hospitalier Universitaire de Saint Etienne
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Age over 18 * Admitte for scheduled cardiac surgery with sternotomy under cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG), surgical correction of valve disease (aortic, mitral or tricuspid) or combined surgery (coronary artery bypass grafting (CABG) and valve replacement).
Exclusion criteria
* Age over 85, * emergency surgery or heart transplant, * body mass index (BMI) more than 40 kg.m-2 * reoperation * Renal insufficiency with glomerular filtration rate (GFR) less than 30 mL.min-1 * left ventricular ejection fraction less than 30% * respiratory insufficiency with arterial pressure of oxygen less than 60 mmHg * hepatic insufficiency with prothrombin rate less than 30% or cirrhosis * chronic hyperglycemia not controlled * pregnancy * cognitive impairment chronic use of opioids or drug addiction * epilepsy * guardianship * allergy to locals anesthesics or any drugs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Postoperative delirium (POD) assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in the first 48 hours after surgery | Hours: 48 | assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium is diagnosed when criteria 1 and 2 are positive, as well as criteria 3 or 4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Ileus postoperative in the first 48 hours after extubation | Hours: 48 | Data collected in medical record:absence of gas and/or material |
| Total morphine consumption within 48h after extubation | Hours: 48 | Data collected in medical record |
| Pain at 24 hours and 48 hours postoperative | Hours: 24, 48 | Data collected in medical record |
| Number of hypoxemia postoperative in the first 48 hours after extubation | Hours: 48 | Data collected in medical record: PaO2/FiO2 \< 300 |
| major complications (neurological, respiratory, cardiac, infectious) | Hours: 48 | Data collected in medical record. |
| mortality at 30 days after surgery | Day: 30 | Data collected in medical record. |
| postoperative nausea and vomiting | Hours: 48 | Data collected in medical record. |
Countries
France
Outcome results
None listed