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A prospective, observational study of cerebrovascular autoregulation and its association with delirium following cardiac surgery
Author(s) -
Chan B.,
Aneman A.
Publication year - 2019
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.14457
Subject(s) - medicine , delirium , cerebral autoregulation , anesthesia , intensive care unit , odds ratio , prospective cohort study , cardiac surgery , intensive care , bispectral index , autoregulation , organic mental disorders , cardiology , blood pressure , intensive care medicine , sedation
Summary This aim of this prospective observational cohort study was to evaluate any association between postoperatively impaired cerebrovascular autoregulation and the onset of delirium following cardiac surgery. Previous studies have shown that impaired intra‐operative cerebrovascular autoregulation during cardiopulmonary bypass is associated with delirium. However, postoperative changes in cerebrovascular autoregulation and its association with delirium have not been investigated. One‐hundred and eight consecutive adult cardiac surgical patients without baseline cognitive dysfunction or aphasia were included in the study. Cerebrovascular autoregulation was assessed by the Pearson correlation between near‐infrared spectroscopy‐derived cerebral tissue oxygen saturation and mean arterial pressure to derive the tissue oximetry index. Cerebrovascular autoregulation was monitored for a minimum of 90 min on postoperative day 0 and postoperative day 1. Delirium was assessed throughout intensive care unit admission using the confusion assessment method for the intensive care unit. We observed delirium in 24 of the 108 patients studied. The mean ( SD ) tissue oximetry index was higher in delirious patients on postoperative day 0 compared with non‐delirious patients; 0.270 (0.199) vs. 0.180 (0.142), p = 0.044, but not on postoperative day 1; 0.130 (0.160) vs. 0.150 (0.130), p = 0.543. All patients showed improvement in tissue oximetry index on postoperative day 1 compared with postoperative day 0. Logistic regression analysis demonstrated tissue oximetry index on postoperative day 0 to be independently associated with delirium; odds ratio 1.05 (95% CI 1.01–1.10), p = 0.043. In conclusion, we found an association between impaired cerebrovascular autoregulation, measured by near‐infrared spectroscopy, and delirium in the early postoperative period.