Relative cerebral hyperperfusion during cardiopulmonary bypass is associated with risk for postoperative delirium: a cross-sectional cohort study

Thudium, Marcus; Ellerkmann, Richard K.; Heinze, Ingo; Hilbert, Tobias

doi:10.1186/s12871-019-0705-y

Cited by 26 publications

(30 citation statements)

References 43 publications

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“…In a recently published study by Thudium et al a relationship was found between cerebral hyperperfusion and post cardiac surgery delirium. In the study the authors examined right middle cerebral artery blood flow during CBP using the transcranial Doppler [21]. In our study we did not plan to measure cerebral blood flow, but the cardiac index during CBP was similar in both groups, with and without postoperative delirium (mean CI=2,5 l/min/m 2 , P=0.69).…”

Section: Discussionmentioning

confidence: 88%

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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Section: Discussionmentioning

confidence: 88%

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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“…Denault has recently proposed a modi ed NIRS algorithm in which ultrasound imaging plays a role in hemodynamic evaluation and cerebral imaging in case of increased intracranial pressure. (12) We suggest that ultrasound should become even more central in cerebral monitoring to con rm NIRS ndings and to evaluate cerebral hemodynamics.…”

Section: Discussionmentioning

confidence: 98%

Neuromonitoring with Intermittent Transcranial Doppler Sonography and Continuous Near Infrared Spectroscopy in Aortic Arch Surgery: An Observational Study

Thudium¹,

Kornilov²,

Hilbert³

et al. 2020

Preprint

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Background Aortic Arch repair for aortic dissection is still associated with a high mortality rate. Adequate means of neuromonitoring to guide cerebral hemodynamics, especially during selective anterior cerebral perfusion (SACP) are desirable. It is possible that this cannot be achieved by one monitoring modality alone. It was the objective of this study to investigate an easy multimodal monitoring setup consisting of EEG, near infrared spectroscopy (NIRS) and transcranial doppler sonography. Methods Patients with surgery for aortic dissection were included. In addition to standard hemodynamic monitoring, patients received continuous bilateral NIRS, processed EEG with bispectral index (BIS) and intermittent transcranial doppler sonography of the medial cerebral artery (MCA) with a standard B-mode ultrasound device. Doppler measurements were taken bilaterally before cardiopulmonary bypass (CPB), during CPB and during the selective brain perfusion phase in regular intervals Results Six patients with aortic dissection could be included. Two patients died, one in the operating room and one on ICU. Four patients survived without neurological deficit. Two, however, suffered from transient postoperative delirium. Multimodal monitoring led to change in CPB flow or cannula repositioning in 3 patients (50%). Left sided mean flow velocities of the MCA significantly decreased during selective brain perfusion (p = 0.028), as did BIS values (p = 0.028) Conclusions Multimodal monitoring consisting of BIS, NIRS and B-Mode transcranial sonography can have an impact on hemodynamic management in aortic arch operations. More research is needed to establish target parameters of cerebral perfusion.

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“…This study stated that blood flow velocity changes and pulsatility play an important role in postoperative neurologic outcomes [ 6 ]. Thudium M. indicated that relative cerebral hyperperfusion also disrupts cerebral autoregulation and might play a significant role in dNCR development [ 4 ]. Individual values were normalized to the pre-bypass baseline value, and MCA BFV > 100% was defined as cerebral hyperperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Many researchers have identified that neuropsychological complications emerge from insufficient cerebral perfusion [ 4 , 5 , 6 , 7 ]. Transcranial Doppler sonography (TCD) could provide information about middle cerebral artery (MCA) blood flow velocity (BFV) during surgery to detect hypoperfusion episodes and cerebral embolism.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Delayed Neurocognitive Recovery According to Brain Biomarkers and Cerebral Blood Flow Velocity

et al. 2020

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Background and Objectives: The aim of this study is to identify risk factors for the development of delayed neurocognitive recovery (dNCR). Materials and Methods: 140 patients underwent neurocognitive evaluations (Adenbrooke, MoCa, trial making, and CAM test) and middle cerebral artery (MCA) blood flow velocity (BFV) measurements, one day before cardiac surgery. BFV was re-evaluated after anesthesia induction, before the beginning, middle, end, and after cardiopulmonary bypass (CPB) and postsurgery. To measure glial fibrillary acidic protein (GFAP) and neurofilament heavy chain (Nf-H), blood samples were collected after anesthesia induction, 24 and 48 h after the surgery. Neurocognitive evaluation was repeated 7–10 days after surgery. According to the results, patients were divided into two groups: with dNCR (dNCR group) and without dNCR (non-dNCR group). Results: 101 patients completed participation in this research. GFAP increased in both the non-dNCR group (p < 0.01) and in the dNCR group (p < 0.01), but there was no difference between the groups (after 24 h, p 0.342; after 48 h, p 0.273). Nf-H increased in both groups (p < 0.01), but there was no difference between them (after 24 h, p = 0.240; after 48 h, p = 0.597). MCA BFV was significantly lower in the dNCR group during the bypass (37.13 cm/s SD 7.70 versus 43.40 cm/s SD 9.56; p = 0.001) and after surgery (40.54 cm/s SD 11.21 versus 47.6 cm/s SD 12.01; p = 0.003). Results of neurocognitive tests correlated with CO2 concentration (Pearson’s r 0.40, p < 0.01), hematocrit (r 0.42, p < 0.01), MCA BFV during bypass (r 0.41, p < 0.01), and age (r −0.533, p < 0.01). The probability of developing dNCR increases 1.21 times with every one year of increased age (p < 0.01). The probability of developing dNCR increases 1.07 times with a decrease of BFV within 1 cm/s during bypass (p = 0.02). Conclusion: Risk factors contributing to dNCR among the tested patients were older age and middle cerebral artery blood flow velocity decrease during bypass.

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Relative cerebral hyperperfusion during cardiopulmonary bypass is associated with risk for postoperative delirium: a cross-sectional cohort study

Cited by 26 publications

References 43 publications

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

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

Neuromonitoring with Intermittent Transcranial Doppler Sonography and Continuous Near Infrared Spectroscopy in Aortic Arch Surgery: An Observational Study

Risk Factors for Delayed Neurocognitive Recovery According to Brain Biomarkers and Cerebral Blood Flow Velocity

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