TY - JOUR
T1 - Delirium After TAVR: Crosspassing the Limit of Resilience
AU - van der Wulp, Kees
AU - van Wely, Marleen H.
AU - Rooijakkers, Max J. P.
AU - Brouwer, Marc A.
AU - van den Boogaard, Mark
AU - Pickkers, Peter
AU - Olde Rikkert, Marcel G. M.
AU - van Mieghem, Nicolas M.
AU - Baan, Jan
AU - Morshuis, Wim J.
AU - van Royen, Niels
PY - 2020/11/9
Y1 - 2020/11/9
N2 - Patients who undergo transcatheter aortic valve replacement often are frail and elderly. Delirium is a frequently observed complication, associated with impaired recovery, prolonged hospital stay, and mortality. In different hospital settings, interventions that reduced the incidence of delirium resulted in improved clinical outcome and reduced costs. In that context, prevention, early recognition, and timely interventions could be the next step toward better outcomes of transcatheter aortic valve replacement. This review is focused on awareness and recognition of delirium, including predisposing “vulnerability” factors (such as cognitive impairment and carotid artery disease) and “trigger” factors (such as anesthesia, hemodynamic imbalance, and complications). For prevention and treatment, clinicians should focus on sleep hygiene, orientation, pain management, and early mobilization. In case of delirium, a thorough search and treatment of trigger factors is warranted. Future studies should focus on risk assessment, preventive and therapeutic interventions, and their potential benefit in terms of costs and clinical outcomes.
AB - Patients who undergo transcatheter aortic valve replacement often are frail and elderly. Delirium is a frequently observed complication, associated with impaired recovery, prolonged hospital stay, and mortality. In different hospital settings, interventions that reduced the incidence of delirium resulted in improved clinical outcome and reduced costs. In that context, prevention, early recognition, and timely interventions could be the next step toward better outcomes of transcatheter aortic valve replacement. This review is focused on awareness and recognition of delirium, including predisposing “vulnerability” factors (such as cognitive impairment and carotid artery disease) and “trigger” factors (such as anesthesia, hemodynamic imbalance, and complications). For prevention and treatment, clinicians should focus on sleep hygiene, orientation, pain management, and early mobilization. In case of delirium, a thorough search and treatment of trigger factors is warranted. Future studies should focus on risk assessment, preventive and therapeutic interventions, and their potential benefit in terms of costs and clinical outcomes.
KW - TAVR
KW - delirium
KW - prevention
KW - risk factors
KW - treatment
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85094562013&origin=inward
U2 - https://doi.org/10.1016/j.jcin.2020.07.044
DO - https://doi.org/10.1016/j.jcin.2020.07.044
M3 - Review article
C2 - 33153562
SN - 1936-8798
VL - 13
SP - 2453
EP - 2466
JO - JACC. Cardiovascular interventions
JF - JACC. Cardiovascular interventions
IS - 21
ER -