Disturbances in Oxygen Balance During Cardiopulmonary Bypass: A Risk Factor for Postoperative Delirium

Smulter, Nina; Lingehall, Helena Claesson; Gustafson, Yngve; Engström, Karl Gunnar; Appelblad, Micael; Svenmarker, Staffan

doi:10.1053/j.jvca.2017.08.035

Cited by 25 publications

(19 citation statements)

References 36 publications

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“…PD is a common complication for patients following cardiac 30,31 and major non-cardiac surgeries. 32 Previous studies determined several risk factors associated with PD, including advanced age, low education level, preoperative cognitive dysfunction, smoking, cardiac or macrovascular surgery, major non-cardiac surgeries, perioperative use of sedative and analgesic drugs, postoperative imperfect analgesia, among others.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

Wang

Zhang

Luo

et al. 2020

Can. J. Neurol. Sci.

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Background: Post-cardiac surgery patients exhibit a higher incidence of postoperative delirium (PD) compared to non-cardiac surgery patients. Patients with various cardiac diseases suffer from preoperative sleep disorder (SPD) induced by anxiety, depression, breathing disorder, or other factors. Objective: To examine the effect of sleep disorder on delirium in post-cardiac surgery patients. Methods: We prospectively selected 186 patients undergoing selective cardiac valve surgery. Preoperative sleep quality and cognitive function of all eligible participants were assessed through the Pittsburgh Sleep Quality Index (PSQI) and the Montreal Cognitive Assessment, respectively. The Confusion Assessment Method for Intensive Care Unit was used to assess PD from the first to seventh day postoperatively. Patients were divided into two groups according to the PD diagnosis: (1) No PD group and (2) the PD group. Results: Of 186 eligible patients, 29 (15.6%) were diagnosed with PD. A univariate analysis showed that gender (p = 0.040), age (p = 0.009), SPD (p = 0.008), intraoperative infusion volume (p = 0.034), postoperative intubation time (p = 0.001), and intensive care unit stay time (p = 0.009) were associated with PD. A multivariate logistic regression analysis demonstrated that age (odds ratio (OR): 1.106; p = 0.001) and SPD (OR: 3.223; p = 0.047) were independently associated with PD. A receiver operating characteristic curve demonstrated that preoperative PSQI was predictive of PD (area under curve: 0.706; 95% confidence interval: 0.595–0.816). A binomial logistic regression analysis showed that there was a significant association between preoperative 6 and 21 PSQI scores and PD incidence (p = 0.009). Conclusions: Preoperative SPD was significantly associated with PD and a main predictor of PD.

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Section: Discussionmentioning

confidence: 99%

Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

Wang

Zhang

Luo

et al. 2020

Can. J. Neurol. Sci.

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“…Delirium is a marker for a vulnerable brain 13,15 and typically reflects an imbalance between key central neurotransmitters, 16 the specific genesis is usually difficult to isolate due to a multifactorial origin. 13 The use of CPB probably exacerbates this process, explained by inflammatory reactions, 17 disturbances of cerebral oxygenation 18 and blood flow control. 19 Alterations of the normal concentration of electrolytes, 12,20 with a possible link to the composition of the CPB prime, should also be acknowledged.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids

et al. 2018

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Use of hyperosmolar CPB prime resulted in a dramatic and instant elevation of the plasma osmolality. Rapid changes in plasma osmolality are associated with organ dysfunction (e.g. osmotic demyelination syndrome), therefore, effects on plasma osmolality related to the CPB prime composition should be recognised. Influence on organ function and clinical outcome warrants further investigations. - Clinical Trials.gov (NCT03060824). Changes in Plasma Osmolality Related to the Use of Cardiopulmonary Bypass With Hyperosmolar Prime. URL: https://clinicaltrials.gov/ct2/show/NCT03060824?term=cpb&cond=osmolality&rank=1.

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“…The role of low oxygen concentration in the development of delirium has been previously described. Severe hypoxia during CPB is one of the risk factors for postoperative delirium [8] and intraoperative cerebral oxygen desaturation and disturbances in the oxygen supply-demand balance may contribute to acute brain failure [7,9]. One of the main tasks for the anesthesiologist during cardiac surgery is to prevent cellular hypoxia and high concentrations of oxygen are often administered.…”

Section: Introductionmentioning

confidence: 99%

Intra-operative hyperoxia and the risk of delirium in elderly patients after cardiac surgery

Kupiec

Adamik

Forkasiewicz-Gardynik

et al. 2020

Aging

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Delirium is a common complication after cardiac surgery. The aim of our study was to determine the impact of hyperoxia episodes occurring during cardiopulmonary bypass (CBP) on the rate of delirium episodes in the postoperative period. 93 patients, aged ≥ 65, who underwent elective cardiac surgery (CBP <90 minutes) were enrolled. The occurrence of delirium episodes was examined every 12 hours for three days after surgery. Eleven patients (11.8%) developed postoperative delirium (POD (+)) and 83 did not (POD (-)). More incidences of severe hyperoxia (PaO2 ≥ 26.6kPa) during CBP were observed in the POD (+) group: 64% had ≥ 2 episodes of hyperoxia, 27% ≥ 3, and 18% ≥ 4, while in the POD (-) group: 42%, 13% and 1%, respectively (P=0.02). Patients in the POD (+) group had a higher maximum PaO2 during CBP than the POD (-) group (37 ± 5.8 vs 31.6 ± 6.6 kPa; P=0.01) and a higher mean PaO2 (30.1 ± 4.5 vs 26.1 ± 5.6 kPa; P=0.01). The optimal maximum PaO2 cutoff point for the occurrence of delirium was 33.2 kPa (AUC 0.72, P=0.001, sensitivity 75%, specificity 38%). We conclude that CBP hyperoxia episodes may be a risk factor associated with the occurrence of postoperative delirium.

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Disturbances in Oxygen Balance During Cardiopulmonary Bypass: A Risk Factor for Postoperative Delirium

Cited by 25 publications

References 36 publications

Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids

Intra-operative hyperoxia and the risk of delirium in elderly patients after cardiac surgery

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