Cerebral oximetry as a biomarker of postoperative delirium in cardiac surgery patients

Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials

“…Observational studies have previously shown an association between low cerebral oxygen saturation and postoperative delirium. 3,60 Others have shown that the severity or duration of postoperative delirium may ultimately be related to subsequent POCD. 61 While our analysis did not confirm these results, it is quite possible our pooled analysis included too few patients to adequately assess for postoperative delirium.…”

“…1,2 It is thought to be particularly beneficial in the perioperative setting when hemodynamic fluctuations often occur that can lead to postoperative complications such as cognitive impairment or delirium. [2][3][4][5][6] Anesthesiologists have utilized cerebral oximetry monitoring in an attempt to optimize both blood pressure and oxygen delivery to maintain adequate cerebral perfusion and decrease the incidence of these neurocognitive complications. 2,5 Several observational studies have pointed to the predictive value of cerebral oxygenation monitoring for both short-and long-term functional outcomes.…”

A systematic review of neuroimaging in delirium: predictors, correlates and consequences

“…Oximetry measurements in delirious patients following cardiothoracic surgery ( N = 30) suggested that higher ScO 2 decreased the odd of delirium occurrence over time (OR 0.73; p < 0.001) whilst peripheral oxygen saturations did not (OR 1.01; p = 0.871). In addition, higher ScO 2 inversely correlated with delirium severity ( p < 0.001; Mailhot et al, ).…”

Dynamic cerebral autoregulation: A marker of post-operative delirium?

“…Evidence of this susceptibility is provided by previous neurophysiological studies demonstrating major differences in the EEG of patients with PD following cardiothoracic surgery (van der Kooi et al, 2015). Importantly, the contribution of CA has considerable potential to improve existing models for the prediction of PD that have not included cerebral hemodynamic parameters (Rudolph et al, 2009;Luetz et al, 2016;Mailhot et al, 2016) and therefore warrants further investigation.…”

“…Cardiac surgery with CPB can provoke fluctuations in cerebral blood flow (CBF) that can lead to cerebral ischemia or hyperperfusion (Scolletta et al, 2015;Caldas et al, 2017). Excessive cerebral microembolic load, endothelial injury, a compromised bloodbrain barrier, impairment of cerebral autoregulation and changes in cerebral oxygenation are potential factors for CBF disturbances, during or after CABG, and might also contribute to delirium susceptibility (Moody et al, 1995;Plaschke et al, 2010;Siepe et al, 2011;Brown, 2014;Hori et al, 2014;Mailhot et al, 2016). However, the role of CBF regulatory mechanisms, both before, during and after surgery, is still unknown and the mechanisms underlying PD are not elucidated.…”