The Protocol of Hypertonic Sodium Chloride on prevention of Delirium After Surgery

Abstract

CONCLUSION AND SUGGESTIONS: In this study, interventional application protocol to determine the effects of hypertonic sodium chloride in preventing postoperative delirium was analysed on patients over 65 who underwent orthopaedic and cardiovascular surgery. i. According the results with this applied protocol, POD development incidence (6,6%) on HSC group decreased significantly compared to the SC group (40%). ii. It was out of expectation for study that from 50 patients who enrolled in the study with hypertonic sodium chloride application, POD development was seen only 3 of them. It is found that presence of the risk factors for pre-in-post delirium was higher than other patients since the average of these three people who developed delirium was 80 and above. iii. In general it was determined that the patients who developed delirium in both groups had chronic diseases, and among these diseases there were diabetes and hypertension most, there were continuous multiple drug use, too. iv. It was found that as a result of the application of hypertonic sodium chloride of inflammatory cytokines involved in the development of POD, development of delirium was prevented by decreasing the level of cytokines in blood of the experimental group after surgery. However, it was also found that level of cytokines was higher on control group that applied sodium chloride; therefore, incidence of delirium development was also high. v. With hypertonic sodium chloride application, severity of delirium was also reduced beside incidence of POD, and severe delirium was never developed in the group that was applied hypertonic sodium chloride.It was determined that hypertonic sodium chloride has a modulator effect on the neuro-inflammatory processes that become active after surgery, and it prevent the delirium development. vi. It was identified that recognition and preventing of the risk factors that effective in delirium development on pre-in-post operative periods is important to prevent and reduce of delirium that can be seen after surgery. vii. In this national level clinical study that requires a multidisciplinary team approach, the role of the nurse in the study and the importance of the success that they contributed to the study were determined. Based on these results; i. Measurement of inflammatory cytokines guides preventive interventions on foreseeing, recognition and monitoring the process on delirium development. Therefore, it is suggested that measurement of serum cytokines after surgery as a supportive to delirium diagnosis tools may be beneficial at the level of protection. ii. Conducting interdisciplinary study that includes wider patient groups and nurses by supporting application protocol of this study and getting evidence-based results are suggested. iii. On the behalf of delirium diagnosis, it is also suggested that scales should be developed, nurses should be trained and these screening methods should be added to their daily routines. iv. It is believed that this study guides the researchers who will use randomized controlled clinical trial from epidemiological research as a method of research. For this purpose, testing this intervention protocol on studies that will be conducted on similar or different patient groups is recommended.