The Impact of Postoperative Mechanical Ventilation Duration on Visual and Auditory Hallucinations After Cardiac Surgery: Insights from the VAACS Study.
Mohammad Alnees, Nizar Abu Hamdeh, Duha Najajra, Abdalaziz Darwish, Alaa Dabash, Yahya Z Fraitekh, Kareem Ibraheem, Mohammad Masu'd, Reem J Saad, Nasim Abukaresh, Izzeddin Swidan, Mohammed Alra'e, Amal M Shawabka, Taha Z Makhlouf, Mahdi Awwad, Wafiq Othman, Ruzan Jamaleddin, Nouraldin Hih, Mousa Bsharat, Mohammed Aburemaileh, Anwar Zahran, Basem Bali, Osama Ewidat, Mohammad Bdair, Laith Ahmad, Omar Qasem Heih, Qais Salahat, Hasan Alkhatib, Ameen Abu Awad, Hamza Abdul-Hafez, Michael Matarweh, Oday Nana, Kasem Hamoudy, Haitham Abu Khadija
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Abstract
Objectives: To determine whether postoperative mechanical ventilation duration is associated with the risk and timing of visual and auditory hallucinations after adult cardiac surgery.
Design: Prospective multicenter cohort study.
Setting: Ten major cardiac surgery centers in the West Bank, Palestine.
Participants: A total of 1,332 adults undergoing coronary artery bypass grafting or valve surgery, stratified by postoperative ventilation duration: ≤6 hours or >6 hours.
Interventions: No experimental intervention was performed; patients were grouped by early versus delayed postoperative extubation.
Measurements and main results: Visual and auditory hallucinations were assessed during the first 7 postoperative days using the Questionnaire for Psychotic Experiences. Cox regression and restricted mean survival time analyses evaluated associations between ventilation duration and hallucination outcomes. Delayed extubation (>6 hours) was associated with lower overall adjusted risk of visual hallucinations (adjusted hazard ratio, 0.70; 95% confidence interval, 0.62-0.80; p < .001) and auditory hallucinations (adjusted hazard ratio, 0.49; 95% confidence interval, 0.31-0.77; p = .002). However, time-varying analysis showed increased immediate postoperative hazard in the delayed-extubation group, with risk declining rapidly over time. Restricted mean survival time analysis showed that auditory hallucination-free time was approximately 0.24 days shorter in patients with delayed extubation (p < .001). Preoperative white blood cell count was the most consistent predictor.
Conclusion: Delayed postoperative extubation was associated with lower overall 7-day hallucination risk but higher immediate postoperative vulnerability, suggesting that the early postextubation period may represent a critical window for targeted monitoring and preventive neuropsychiatric care after cardiac surgery.
期刊介绍：
The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.
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