Delirium common after lung transplant, tied to poorer outcomes

By Lorraine L. Janeczko

Delirium is common following lung transplantation and is associated with greater use of medical resources and worse outcomes, new research suggests.

"Physicians should be very vigilant of delirium development in this patient population," said Dr. Yelizaveta Sher of Stanford University School of Medicine in California, who presented the findings May 15 at the annual meeting of the American Psychiatric Association (APA) in Atlanta, Georgia.

"The study was important to do to draw awareness of this problem in this particularly vulnerable population, to get lung transplant clinicians to appreciate the problem and see it first-hand in their patients. I think this and other similar studies can lay the groundwork for potentially preventive studies and interventions, which might potentially improve outcomes," Dr. Sher told Reuters Health.

Dr. Sher and colleagues assessed patients undergoing lung transplantation at their institution over 20 months. They reviewed the electronic medical records daily to identify patients who met Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) criteria for delirium and studied all 163 patients who survived lung transplantation.

During post-transplant hospitalization or within the first 30 days of surgery, whichever was shorter, 72 patients (44.2%) experienced delirium. Patients developed delirium on postoperative day 4, on average, and it lasted for nearly seven days.

Those who experienced delirium had a higher body mass index (26.1 vs. 23.5) and were older (52.9 vs. 48.4 years) than those without delirium.

They also had a longer intensive care unit stay (18.6 vs. 4.2 days), a longer time to extubation (16.9 vs. 1.7 days), a higher in-hospital mortality (13.9% vs 1.1%), and a higher post-transplant mortality during the first year (19.4% vs 8.8%). All these differences were statistically significant.

Overall, 59 patients (36.2% of all patients and 81.9% of all delirious patients) became delirious during the first five days after their transplant, the shortest post-transplant admission duration. These patients had higher average lung allocation score (59 vs. 47.9; p<0.001) and higher body mass index (mean 26.2 vs. 23.7; p=0.01), compared with those without delirium.

"These findings should affect patient care," said Dr. Sher. "Patients and families should be educated about this potential common complication before lung transplant surgery as it might decrease associated distress. Patients should be vigilantly monitored for development of delirium and once diagnosed, delirium should be properly addressed. Patients should receive all nonpharmacological prophylactic interventions to prevent them from developing delirium. We might potentially think about pharmacological interventions, but more research in this area is needed,"

 

"Many questions remain," she added. "We would like to further elucidate the risk factors predisposing patients to delirium to enable us to better predict who is at risk. We would like to investigate whether delirium is associated with mortality in this patient population in a better-designed study. We would like to study whether prophylactic measures actually decrease the incidence of delirium in this patient population."

"And my big question is, if we better treat and hopefully prevent delirium in these patients, would that improve their outcomes?" Dr. Sher said.

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