The association between cerebral blood flow variations during on-pump coronary artery bypass grafting surgery and postoperative delirium.

Autor: Sampaolesi C; Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.; Cardiosurgical Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy., Casarotta E; Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.; Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy., Gresti G; Cardiosurgical Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy., Mariotti G; Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.; Cardiosurgical Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy., Pisani L; Cardiosurgical Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy., Veccia D; Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.; Cardiosurgical Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy., Di Eusanio M; Cardiosurgical Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy., Malvindi PG; Cardiosurgical Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy., Donati A; Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.; Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy., Münch CM; Cardiosurgical Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.
Jazyk: angličtina
Zdroj: Perfusion [Perfusion] 2024 Mar 15, pp. 2676591241239823. Date of Electronic Publication: 2024 Mar 15.
DOI: 10.1177/02676591241239823
Abstrakt: Introduction: Postoperative delirium (POD) has a major impact on patient recovery after cardiac surgery. Although its pathophysiology remains unclear, there could be a correlation between cerebral blood flow (CBF) variations during cardio-pulmonary bypass (CPB) and POD. Our study aimed to evaluate whether variations in on-pump CBF, compared to pre-anesthesia and pre-CPB values, are associated with POD following coronary artery bypass grafting (CABG) surgery.
Methods: This prospective observational cohort study included 95 adult patients undergoing elective on-pump CABG surgery. Right middle cerebral artery blood flow velocity (MCAV) was assessed using Transcranial Doppler before anesthesia induction, before CPB and every fifteen minutes during CPB. Pre-anesthesia and pre-CPB values were chosen as baselines. Individual values, measured during CPB, were converted as percentage changes relative to these baselines and named as %MCAV 0 and %MCAV 1 , respectively. POD was assessed using the Confusion Assessment Method for ICU (CAM-ICU) during the first 48 post-operative hours and with the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) on the fifth post-surgical day.
Results: Overall POD incidence was 17.9%. At 30 minutes of CPB, %MCAV 0 was higher in POD group than in no-POD group ( p = .05). %MCAV 0 at 45 minutes of CPB was significantly higher in POD group (87 (±17) %) than in no-POD group (68 (±24) %), p = .04. %MCAV 1 at 30 and 45 minutes of CPB were higher in POD group than in no-POD group, at the limit of statistical significance. We found %MCAV 1 > 100% in POD group, but not in no-POD group.
Conclusions: Significant differences in %MCAV 0 became evident after 30 minutes of CPB, whereas differences in %MCAV 1 at 45 minutes of CPB were at limit of statistical significance. In POD group %MCAV 1 was higher than 100% at 30 and 45 minutes of CPB, which is supposed to be a sign of cerebral hyperperfusion. Monitoring CBF during CPB could have prognostic value for POD.
Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze: MEDLINE
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