Document Type : Original Article

Authors

1 Students Research Center, Nursing Faulty, Baqiyatallah University of Medical Sciences, Tehran, Iran.

2 Trauma research center, Nursing Faulty Baqiyatallah University of Medical Sciences, Tehran, Iran.

3 Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

4 Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.

10.30491/tm.2022.374345.1535

Abstract

Background: Postoperative delirium (POD), a highly prevalent syndrome after cardiac surgery, is characterized by a rapid decline in brain function with inattention, disorganized thinking, and an altered level of consciousness. It is clinically important because it is associated with severe negative consequences. This study aimed to develop a protocol to improve the prevention of postoperative delirium in cardiac surgery.
Methods: This multiphase design study consists of two phases. The first phase was the scoping review to identify risk factors associated with POD in cardiac surgery. The second phase included three consecutive rounds of expert panels based on a Delphi method to obtain consensus from experts in determining and using these risk factors to develop a protocol. Scoping review was performed using the Arksey and O'Malley framework. Literature searches using PubMed/MEDLINE, Scopus, Web of Science, and ProQuest databases were conducted from inception to 24 January 2022. Two independent investigators performed the selection of studies and data extraction via checklists. In the second phase, based on two Delphi rounds, risk factors with a significant effect on postoperative delirium in cardiac surgery were identified according to the consensus of experts (≥75% agreement). In the third round of the expert panel, only modifiable factors that could be improved based on existing conditions and context were used to develop a protocol.
Results: The final protocol was developed based on twenty pharmacological and non-pharmacological interventions to prevent POD in three stages pre-, intra-, and post-cardiac surgery.  
Conclusion: Interventions such as prescribed melatonin instead of benzodiazepines, dexmedetomidine treatment, preoperative educate patients' candidates for cardiac surgery, nurses training, using arterial filters and pre-bypass filters in the perfusion circuit, prevention of intraoperative hyperglycemia, cerebral oximetry and temperature management during CPB and some interventions in ICU-OH can reduce the POD in cardiac surgery.

Keywords