Journal
BRITISH JOURNAL OF ANAESTHESIA
Volume 113, Issue 6, Pages 1009-1017Publisher
OXFORD UNIV PRESS
DOI: 10.1093/bja/aeu319
Keywords
cardiac surgery; cardiopulmonary bypass; cerebral autoregulation; delirium
Categories
Funding
- Mid-Atlantic Affiliate of the American Heart Association [103363]
- National Institutes of Health [R01HL092259, R01AG033615, R01AG029656-01A1]
- Mentored Career Development Award from the National Institutes of Health [5KL2RR025006, R03 AG042331]
- Jahnigen Career Development Award
- NATIONAL CENTER FOR RESEARCH RESOURCES [KL2RR025006] Funding Source: NIH RePORTER
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [R01HL092259] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE ON AGING [R03AG042331, R01AG033615, R01AG029656] Funding Source: NIH RePORTER
Ask authors/readers for more resources
Background. Mean arterial pressure (MAP) below the lower limit of cerebral autoregulation during cardiopulmonary bypass (CPB) is associated with complications after cardiac surgery. However, simply raising empiric MAP targets during CPB might result in MAP above the upper limit of autoregulation (ULA), causing cerebral hyperperfusion in some patients and predisposing them to cerebral dysfunction after surgery. We hypothesized that MAP above an ULA during CPB is associated with postoperative delirium. Methods. Autoregulation during CPB was monitored continuously in 491 patients with the cerebral oximetry index (COx) in this prospective observational study. COx represents Pearson's correlation coefficient between low-frequency changes in regional cerebral oxygen saturation (measured with near-infrared spectroscopy) and MAP. Delirium was defined throughout the postoperative hospitalization based on clinical detection with prospectively defined methods. Results. Delirium was observed in 45 (9.2%) patients. Mechanical ventilation for >48 h [odds ratio (OR), 3.94; 95% confidence interval (CI), 1.72-9.031 preoperative antidepressant use (OR, 3.0; 95% CI, 1.29-6.96), prior stroke (OR, 2.79; 95% CI, 1.12-6.96), congestive heart failure (OR, 2.68; 95% CI, 1.28-5.62), the product of the magnitude and duration of MAP above an ULA (mm Hg h; OR, 1.09; 95% CI, 1.03-1.15), and age (per year of age; OR, 1.01; 95% CI, 1.01-1.07) were independently associated with postoperative delirium. Conclusions. Excursions of MAP above the upper limit of cerebral autoregulation during CPB are associated with risk for delirium. Optimizing MAP during CPB to remain within the cerebral autoregulation range might reduce risk of delirium.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available