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

AI Article Synopsis

  • Postoperative delirium (POD) significantly affects recovery after cardiac surgery, and this study explored the link between variations in cerebral blood flow (CBF) during cardiopulmonary bypass (CPB) and the occurrence of POD in coronary artery bypass grafting (CABG) patients.* -
  • The research included 95 adults and measured right middle cerebral artery blood flow velocity (MCAV) before and during CPB, with POD assessed within the first 48 hours and later on the fifth post-surgery day.* -
  • Findings showed that patients who developed POD had higher %MCAV values during CPB, particularly at 30 and 45 minutes, suggesting a correlation between increased CBF and the incidence of

Article Abstract

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 and %MCAV, 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 was higher in POD group than in no-POD group ( = .05). %MCAV at 45 minutes of CPB was significantly higher in POD group (87 (±17) %) than in no-POD group (68 (±24) %), = .04. %MCAV 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 > 100% in POD group, but not in no-POD group.

Conclusions: Significant differences in %MCAV became evident after 30 minutes of CPB, whereas differences in %MCAV at 45 minutes of CPB were at limit of statistical significance. In POD group %MCAV 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.

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Source
http://dx.doi.org/10.1177/02676591241239823DOI Listing

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