Relative cerebral hyperperfusion during cardiopulmonary bypass is associated with risk for postoperative delirium: a cross-sectional cohort study.

ABSTRACT:

Background

Our objective was to evaluate if changes in on-pump cerebral blood flow, relative to the pre-bypass baseline, are associated with the risk for postoperative delirium (POD) following cardiac surgery.

Methods

In 47 consecutive adult patients, right middle cerebral artery blood flow velocity (MCAV) was assessed using transcranial Doppler sonography. Individual values, measured during cardiopulmonary bypass (CPB), were normalized to the pre-bypass baseline value and termed MCAV_rel. An MCAV_rel?>?100% was defined as cerebral hyperperfusion. Prevalence of POD was assessed using the Confusion Assessment Method for the Intensive Care Unit.

Results

Overall prevalence of POD was 27%. In the subgroup without POD, 32% of patients had experienced relative cerebral hyperperfusion during CPB, compared to 67% in the subgroup with POD (p?rel was 90 (±21) % in the no-POD group vs. 112 (±32) % in the POD group (p?bas) below the median MCAV_bas of the whole cohort, prevalence of POD was 17% when MCAV_rel during CPB was kept below 100%, but increased to 53% when these patients actually experienced relative cerebral hyperperfusion.

Conclusions

Our results suggest a critical role for cerebral hyperperfusion in the pathogenesis of POD following on-pump open-heart surgery, recommending a more individualized hemodynamic management, especially in the population at risk.

SUBMITTER: Thudium M 

PROVIDER: S-EPMC6408763 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature