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Background <p>Delirium is common after cardiac surgery and has been associated with adverse outcomes in critically ill patients. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a validated tool for detecting delirium; however, few studies have explored its association with prolonged mechanical ventilation (PMV) following major cardiac surgery. This study aimed to investigate whether a positive CAM-ICU assessment is associated with PMV and other postoperative outcomes in this population.</p> Methods <p>We conducted a retrospective cohort study of 1,437 adult patients who underwent cardiac surgery in 2022. Delirium was assessed daily using the CAM-ICU during the early postoperative period. PMV was defined as ventilation lasting more than 24&#xa0;h after surgery. Clinical outcomes were analyzed using logistic regression and time-dependent Cox regression, with adjustments made using inverse probability of treatment weighting (IPTW).</p> Results <p>Among 1437 patients, 281 (19.6%) were assessed as CAM-ICU positive in the early postoperative period. After IPTW adjustment, a positive CAM-ICU assessment was significantly associated with increased risk of PMV (odds ratio [OR] 3.60; 95% CI, 2.53–5.10; <i>p</i> &lt; 0.001), reintubation (OR 3.37; 95% CI, 1.52–7.31; <i>p</i> = 0.002), intensive care unit (ICU) readmission (OR 2.53; 95% CI, 1.22–5.03; <i>p</i> = 0.010), and prolonged ICU stay after extubation (OR 2.95; 95% CI, 2.19–3.96; <i>p</i> &lt; 0.001). Neither early death nor all-cause mortality differed significantly between groups after IPTW adjustment. Age-related analyses indicated that predicted ventilator duration was generally longer with a positive CAM-ICU assessment across most age groups, with attenuation of this difference in the very elderly (≥ 80&#xa0;years).</p> Conclusion <p>An early postoperative positive CAM-ICU assessment was associated with higher risks of PMV, reintubation, ICU readmission, and prolonged ICU stay after major cardiac surgery. Routine CAM-ICU screening may help identify patients at risk of prolonged ventilation and enable timely, targeted interventions to improve postoperative respiratory recovery.</p>

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Association between the confusion assessment method for the intensive care unit (CAM-ICU) and prolonged mechanical ventilation following major cardiac surgery

  • 期刊论文

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  • 发表日期：

    2026年1月21日

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  • Joon Young Kim,
  • Young Ae Kang,
  • Pil-Je Kang

摘要

Background

Delirium is common after cardiac surgery and has been associated with adverse outcomes in critically ill patients. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a validated tool for detecting delirium; however, few studies have explored its association with prolonged mechanical ventilation (PMV) following major cardiac surgery. This study aimed to investigate whether a positive CAM-ICU assessment is associated with PMV and other postoperative outcomes in this population.

Methods

We conducted a retrospective cohort study of 1,437 adult patients who underwent cardiac surgery in 2022. Delirium was assessed daily using the CAM-ICU during the early postoperative period. PMV was defined as ventilation lasting more than 24 h after surgery. Clinical outcomes were analyzed using logistic regression and time-dependent Cox regression, with adjustments made using inverse probability of treatment weighting (IPTW).

Results

Among 1437 patients, 281 (19.6%) were assessed as CAM-ICU positive in the early postoperative period. After IPTW adjustment, a positive CAM-ICU assessment was significantly associated with increased risk of PMV (odds ratio [OR] 3.60; 95% CI, 2.53–5.10; p < 0.001), reintubation (OR 3.37; 95% CI, 1.52–7.31; p = 0.002), intensive care unit (ICU) readmission (OR 2.53; 95% CI, 1.22–5.03; p = 0.010), and prolonged ICU stay after extubation (OR 2.95; 95% CI, 2.19–3.96; p < 0.001). Neither early death nor all-cause mortality differed significantly between groups after IPTW adjustment. Age-related analyses indicated that predicted ventilator duration was generally longer with a positive CAM-ICU assessment across most age groups, with attenuation of this difference in the very elderly (≥ 80 years).

Conclusion

An early postoperative positive CAM-ICU assessment was associated with higher risks of PMV, reintubation, ICU readmission, and prolonged ICU stay after major cardiac surgery. Routine CAM-ICU screening may help identify patients at risk of prolonged ventilation and enable timely, targeted interventions to improve postoperative respiratory recovery.