The relationship between pain and delirium among post cardiac surgery patients

‫نقيب ممرض قانوني عماد مطلق صالح مقدادي‬

‫نقيب ممرض قانوني أدهم سامي محمد منسي‬
‫نقيب ممرض قانوني حمزة سالم حماد الوهيبات‬
‫نقيب ممرض قانوني يزن خالد الزعارير‬
‫نقيب ممرض قانوني معاذ إبراهيم نوافلة‬

Abstract

Background: pain inducing factors are numerous post cardiac surgery especially CABAG and

valvar surgeries which are the most performed worldwide, furthermore moderate to severe pain

are experienced, delirium may be presented and tend to be underestimated.

Purpose: the purpose of this study is to identify the relationship between pain and delirium

among post cardiac surgery patients.

Settings: The study was conducted in the surgical ward and CCU in the Royal Medical Services

Hospitals. The study population is the patients over 18 years of age who were admitted for

elective cardiac surgery, according to the hospital policy.

Methodology and design: An observational cross-sectional design was used to assess the

patients' pain and delirium using A Confusion Assessment Method (CAM-ICU) and The

Critical-Care Pain Observation Tool (CPOT).

Sampling and data collection plan: 141 patients whose age above 18 and never had delirium

before surgery was recruited in the study, their pain was screened at rest for baseline data, during

nociceptive procedures, also before and after analgesic. Likewise, delirium will be evaluated

three times a day.

Results: the mean of age of the sample was 62.2; (SD=5.3), 60.3% was male, approximately

28.4% (n=40) of patients developed delirious state post-surgery specifically the intubated

patients during the first 24 hours, nevertheless 66.7% experienced severe pain, most of them
underwent CABAG surgery, however those delirious patients (overall CAM-ICU is positive

during the first 24 hours) were experiencing severe pain with the mean of 6.8 on CPOT; (r=.86,

p<0.005). the pain level, age and the number of analgesics were significant predictors of delirium

with overall, the R2 was .77

Conclusions and recommendations

The phenomena of delirium are complicated and still misunderstood, moreover most cases are

undiagnosed. Pain is difficult to assess in case of delirium and may precipitate delirium in direct

and non-direct way, however pharmacological pain control may precipitate delirium. Therefore,

based suggestion that effective pain management will contribute better delirium outcome.

Moreover, continuous education should be established to deliver optimal care regarding

assessment and treatment of delirium.