Intensive care unit psychosis after cardiac surgery

Mohammed Elgazzar; Mohammed Elmaghraby; Khaled Sallam; Ahmed Ebada; Anhar Abdelmoteleb

doi:10.35810/ects.v4i5.237

Mohammed Elgazzar Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mohammed Elmaghraby Department of Neurosurgery, Faculty of Medicine, Banha University, Banha, Egypt
Khaled Sallam Department of Neurology, Faculty of Medicine, Banha University, Banha, Egypt
Ahmed Ebada Department of Intensive Care, Faculty of Medicine, Banha University, Banha, Egypt
Anhar Abdelmoteleb Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

DOI: https://doi.org/10.35810/ects.v4i5.237

Keywords: Elderly, Delirium, Cardiac surgery, Mortality, Psychosis

Abstract

Background: Postoperative psychosis after cardiac surgery is associated with increased morbidity, length of hospital stay, and mortality. We aimed to assess the risk factors and outcomes of postoperative psychosis after cardiac surgery. Methods: This research is a retrospective observational case-control study that included 100 patients divided into two groups. Group 1 included 50 patients with postoperative psychosis, and Group 2 included 50 patients with no postoperative psychosis. Data were collected from the Cardiac Surgery Department database from October 2020 to April 2021.

Results: The mean age was 67.94 ± 11.69 years in patients with psychosis and 68.98 ± 10.19 years in the control (P= 0.636). Males patients presented 66% (n= 33) in patients with psychosis versus 70% (n= 35) in the control group. Cardiopulmonary bypass (144.9 ± 35.61 vs. 109.1 ± 17.19 min, P˂0.001) and ischemic times (61.96 ± 15.93 vs. 50.52 ± 9.62 min, P˂0.001) were significantly longer in patients with psychosis. The mean arterial pressure (MAP) (61.93± 13.44 vs. 80.78 ± 5.91 mmHg, P˂0.001) and oxygen saturation (79.82 ± 8.81 vs. 90.12 ± 4.91%; P˂0.001) were significantly lower in patients with psychosis. Central venous pressure was 11.76± 2.33 in patients with psychosis versus 3.58± 1.70 mmHg in the control group (P˂0.001). ICU was significantly longer in patients with psychosis (4.82 ±2.14 vs. 1.62 ± 0.55 days; P˂0.001), while there was no difference in the hospital stay. By multivariable analysis, lower MAP was an independent predictor of postoperative psychosis (OR: 0.930 (95% CI: 0.737–0.999), P= 0.045).

Conclusion: Low mean arterial pressure could predict postoperative psychosis. Proper blood pressure control could decrease the incidence of psychosis after cardiac surgery.