Projection of Visual Material on Postoperative Delirium in Patients Undergoing Cardiac Surgery

Study Overview
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Brief Summary
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The aim is to evaluate the impact of visual projection of images of relatives or loved ones in patients undergoing cardiac surgery in the immediate postoperative period, and its influence on the incidence and development of postoperative delirium. A randomized, double-blind clinical trial was designed in the immediate postoperative period of adult patients undergoing cardiac surgery. CONSORT guidelines were followed. A control group and an intervention group were established. In the intervention group, the patients underwent a visual projection, while the usual unit treatment was carried out with the control group. Sociodemographic, anthropometric, anesthetic, and surgical variables were also recorded. The postoperative delirium assessment scale used was the Confusion Assessment Method for the Intensive Care Unit scale (CAM-ICU). The projection of visual material could reduce the incidence of postoperative delirium in patients undergoing cardiac surgery, although it cannot be established that it is effective as a treatment once the pathology is already established. The results obtained suggest that the visual projection of images is an effective and economical tool to address an increasingly incidental problem due to the aging of the population.

Official Title
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Projection of Visual Material on Postoperative Delirium in Patients Undergoing Cardiac Surgery

Conditions
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Delirium, Postoperative Delirium, Cardiac Surgery

Intervention / Treatment
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* Behavioral: Projection of Visual Material on Postoperative Delirium in Patients Undergoing Cardiac Surgery
* Behavioral: the usual unit treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing heart surgery (aortic valve replacement, mitral valve replacement and/or coronary bypass) in the immediate postoperative period during their stay in the cardiac resuscitation unit. Over 18 years of age Exclusion Criteria: Not being sedated for at least 24 hours. Leven of consciousness. Spanish speaker.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Control group<br>In the control group, after the surgical intervention and 30 minutes after the patient's extubation the CAM-ICU scale is administered, recording its value as R0. The following day, at 9:00 a.m., another nurse uses the CAM-ICU scale, noting its value as R1. If postoperative delirium was detected during the day and night, the unit's usual treatment was followed: administration of haloperidol and/or dexmedetomidine. | Behavioral: the usual unit treatment<br>* CAM-ICU scale is administered to the Control group. No visual material is used.<br>|
| Active Comparator: Intervention group<br>In the intervention group, patients and/or companions are asked to provide visual material, which could consist of photographs of loved ones and/or places known to the patient. 30 minutes after the extubation of the patients, the CAM-ICU scale is administered, recording its value as R0. At night, the projection of images provided by the patient are replaced by a nocturnal visual projection (night sky with stars and moon), ensuring that the patient is able to identify that it was nighttime. Finally, at 9:00 a.m., a nurse who had not worked at night and therefore did not know which patients had received the intervention, administers the CAM-ICU scale again, recording its value as R1. | Behavioral: Projection of Visual Material on Postoperative Delirium in Patients Undergoing Cardiac Surgery<br>* Patients are randomized into two groups (control group and intervention group). Initially, all patients are administered the Mini-Mental State Examination scale (MMSE) to assess their initial cognitive state and their sociodemographic and anthropometric data. In the intervention group, patients and/or companions are asked to provide visual material, which could consist of photographs of loved ones and/or places known to the patient. 30 minutes after the extubation of the patients, the CAM-ICU scale is administered. In the control group, after the surgical intervention and 30 minutes after the patient's extubation the CAM-ICU scale is administered.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale | Changes in the scale for the diagnosis of delirium in critical care units were assessed previous and post intervention of visual material projection. The final CAM-ICU-7 score ranges from 0-7 with 7 being most severe. CAM-ICU-7 scores were further categorized as 0-2: no delirium, 3-5: mild to moderate delirium, and 6-7: severe delirium. | 2 times, previous and post intervention, in the first 24 hours after cardiac surgery. This method is applied individually, through study completion, in an average of 1 year. | 
| Mini-Mental State Examination (MMSE) scale | Initially, regardless of the group to which they belonged, all patients were administered the MMSE scale to assess their initial cognitive state and their sociodemographic and anthropometric data were collected. The maximum score for the MMSE is 30. A score of 25 or higher is classed as normal. If the score is below 24, the result is usually considered to be abnormal, indicating possible cognitive impairment. | Baseline (Beginning of the experiment) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cardiac surgery, delirium, intensive care, visual material, mental health