Impacto de la proyección de material visual sobre el delirio postoperatorio en pacientes sometidos a cirugía cardíaca

Abstract

Introduction: Postoperative delirium is a neurobehavioral disorder that can occur after surgery, and is characterized by an altered level of consciousness and cognitive function. It is a state in which patients show temporal-spatial disorientation, increased or decreased psychomotor activity and sleep-wake cycle disorders. Its onset is sudden, fluctuating and reversible, and cannot be explained by a previous or ongoing neurocognitive disorder and it manifests in a short period of time (hours or days). Its pathophysiology is unknown and there is no specific treatment capable of resolving cognitive impairment. Objective: The general objective of this study was to evaluate the impact of the visual projection of images of relatives or loved ones in patients undergoing cardiac surgery in the immediate postoperative period on the incidence and development of postoperative delirium. Material and methods: We carried out a randomized clinical trial that enrolled patients undergoing cardiac surgery during their stay in the resuscitation unit of the Complejo Asistencial Universitario de León in the immediate postoperative period. Patients were randomly divided into a control group and an intervention group. The intervention group received a visual projection of images of loved ones during the day and a projection with night images during the night. The control group received usual nursing care. The sample was randomized and double-blinded. The CAM-ICU scale was used for the diagnosis of the participants, which was applied 30 minutes after the patient's extubation and on the morning of the following day. Results: Information was collected from 104 patients who underwent cardiac surgery, 52 belonging to the control group and 52 to the intervention group. The mean age of the participants was 67.28 years, 66.35% were men, and 63.46% had previously been diagnosed with delirium. The average obtained in the Mini-Mental State Examination was 28.96 points. No statistically significant differences were found between the development of postoperative delirium and sociodemographic factors, personal history, or surgical or anesthetic variables. The overall effect of screening reduced the number of positives on the CAM-ICU scale, so that 14 positive patients (14/102; 13.5%) were identified, 13 from the control group (13/52; 25%) and 1 from the intervention group (1/52; 1.92%), which was statistically significant (p<0.001) and suggests that the intervention is effective in preventing the pathology. The results obtained from the follow-up of patients in the intervention group showed no statistically significant differences between baseline and follow-up determinations (McNemar's Chi-square = 2, p = 0.157). These data indicate that, despite reducing the number of positives, it is not possible to state that the intervention is effective in treating postoperative delirium. Conclusions: Visual projection in the immediate postoperative period of cardiac surgery is an economical and effective method for preventing postoperative delirium. The incidence of postoperative delirium in cardiac surgery patients increased from 19.23% to 25% in the control group and decreased from 5.77% to 1.92% in the intervention group in the initial and final determinations of the CAM-ICU scale.