• Tanya Mailhot, Sylvie Cossette, Jean Lambert, William Beaubien-Souligny, Alexis Cournoyer, Eileen O'Meara, Marc-André Maheu-Cadotte, Guillaume Fontaine, Josée Bouchard, Yoan Lamarche, Aymen Benkreira, Antoine Rochon, and André Denault.
• Faculty of Nursing, Faculty of Medicine, Université de Montréal, Montreal Heart Institute Research Center, 5000 Bélanger St, S-2490, Montreal, Quebec, H1T 1C8, Canada. Electronic address: t.mailhot@umontreal.ca.
• J. Cardiothorac. Vasc. Anesth. 2019 Jan 1; 33 (1): 93-101.

ObjectiveTo assess a novel hypothesis to explain delirium after cardiac surgery through the relationship between cumulative fluid balance and delirium. This hypothesis involved an inflammatory process combined with a hypervolemic state, which could lead to venous congestion reaching the brain.DesignRetrospective case-control (1:1) cohort study.SettingUniversity-affiliated tertiary cardiology center.ParticipantsCardiac surgery intensive care unit (ICU) patients.InterventionsNone.Measurements And Main ResultsCumulative fluid balance was evaluated at 3 times: (1) upon arrival at the ICU after surgery, (2) 24 hours post-ICU arrival, and (3) 48 hours post-ICU arrival. A generalized estimated equation was used to model the association between cumulative fluid balance and delirium occurrence 24 hours later. Covariates were selected based on the statistical differences between cases and controls on delirium risk factors and clinical characteristics. The cohort included 346 patients, of which 39 (11%), 104 (30%), and 142 patients (41%) presented delirium at 24, 48, and 72 hours post-ICU arrival, respectively. The effect of time had an odds ratio (OR) of 2.14, 95% confidence interval (CI) 1.603 to 2.851, and a p value < 0.001. The cumulative fluid balance was associated with delirium occurrence (OR 1.20, 95% CI: 1.066-1.355, p = .003). History of neurological disorder, having both hearing and visual impairment, type of procedure, perioperative cerebral oximetry, mean pulmonary artery pressure pre-cardiopulmonary bypass (CPB), and mean arterial pressure post-CPB also contributed to delirium in the model.ConclusionDelirium is associated with a cumulative fluid balance, but the extent through which this plays an etiologic role remains to be determined.Copyright © 2018 Elsevier Inc. All rights reserved.

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