Key result
Patients who developed postoperative delirium after cardiac surgery had significantly lower preoperative cerebrovascular reserve capacity compared to those without delirium (median breath-hold index 0.26 vs 0.83, p=0.002).
Why the study?
Postoperative delirium is common after cardiac surgery with CPB, but whether impaired cerebrovascular reserve capacity is associated with delirium remains unknown.
Is impaired cerebrovascular reserve capacity associated with postoperative delirium in patients undergoing cardiac surgery with cardiopulmonary bypass?
Cohort (n=42)
No
Is impaired cerebrovascular reserve capacity associated with postoperative delirium in patients undergoing cardiac surgery with cardiopulmonary bypass?
Absolute Event Rate: 0.26% vs 0.83%
p-value: p=0.002
Impaired preoperative cerebrovascular reserve capacity and lower cognitive scores are associated with an increased risk of postoperative delirium after cardiac surgery.
Impaired preoperative cerebrovascular reserve may flag delirium risk after cardiac surgery; hypothesis-generating and requires validation before any clinical use.
Introduction: Postoperative delirium is a common complication after cardiac surgery with cardiopulmonary bypass (CPB). Compromised regulation of the cerebral circulation may be a predisposing factor for delirium. However, the potential relationship between cerebrovascular reserve capacity and delirium is unknown. The aim of this study was to investigate if impaired cerebrovascular reserve capacity was associated with postoperative delirium. Methods: Forty-two patients scheduled for cardiac surgery with CPB were recruited consecutively. All patients underwent preoperative transcranial Doppler (TCD) ultrasound with calculation of breath-hold index (BHI). BHI < 0.69 indicated impaired cerebrovascular reserve capacity. In addition, patients were examined with preoperative neuropsychological tests such as MMSE (Mini Mental State Examination) and AQT (A Quick Test of cognitive speed). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) in which a score of ≥2 was considered as delirium. Results: Six patients (14%) scored high for postoperative delirium and all demonstrated impaired preoperative cerebrovascular reserve capacity. Median (25th−75th percentile) BHI in patients with postoperative delirium was significantly lower compared to the non-delirium group [0.26 (−0.08–0.44) vs. 0.83 (0.57–1.08), p = 0.002]. Preoperative MMSE score was lower in patients who developed postoperative delirium (median, 25th−75th percentile; 26.5, 24–28 vs. 28.5, 27–29, p = 0.024). Similarly, patients with postoperative delirium also displayed a slower performance during the preoperative cognitive speed test AQT color and form (mean ± SD; 85.8 s ± 19.3 vs. 69.6 s ± 15.8, p = 0.043). Conclusion: The present findings suggest that an extended preoperative ultrasound protocol with TCD evaluation of cerebrovascular reserve capacity and neuropsychological tests may be valuable in identifying patients with increased risk of developing delirium after cardiac surgery.
No takes yet. Share an insight, caveat, or question.
Bydén et al. (2021) conducted a cohort in Postoperative delirium (n=42). Postoperative delirium vs. No postoperative delirium was evaluated on Median preoperative breath-hold index (BHI) (p=0.002). Patients who developed postoperative delirium after cardiac surgery had significantly lower preoperative cerebrovascular reserve capacity compared to those without delirium (median breath-hold index 0.26 vs 0.83, p=0.002).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: