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The Journal of Thoracic and Cardiovascular Surgery, Vol 77, 586-594, Copyright © 1979 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Postcardiotomy delirium: a critical review

WR Dubin, HL Field and DR Gastfriend

The literature concerning postcardiotomy delirium contains confusing definitions and contradictory results. In a critical review of the subject, we conclude that cardiac status, the severity of physical illness, the complexity of the surgical procedure, and preoperative organic brain disease are the determining factors in postcardiotomy delirium. Preoperative anxiety, denial, and depression also have some correlation. Age, sex, time on bypass, and preoperative psychological profile seem to have no influence on outcome. No psychological etiology for delirium has been proven consistently. The therapeutic influence of preoperative interviews in preventing postoperative psychiatric complications remains equivocal as do theories implicating sensory deprivation in the intensive care unit. Long-term follow-up studies suggest that psychological problems impair functional recovery from heart surgery. The suggested treatment of patients with delirium includes chemotherapy, psychotherapy, and environmental support. Finally we suggest that investigation of biochemical abnormalities in delirium may prove to be a model for clarifying the role of neurotransmitters in functional psychiatric illnesses.




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Copyright © 1979 by The American Association for Thoracic Surgery.