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Carotid artery blood flow velocities during open-heart surgery and its association with delirium: A prospective, observational pilot study.

ABSTRACT: The aim of this prospective observational single-centre pilot study was to evaluate the association between alterations in carotid artery blood flow velocities during cardiac surgery and postoperative delirium.Carotid artery blood flow velocity was determined perioperatively at 5 different timepoints by duplex sonography in 36 adult cardiac surgical patients. Delirium was assessed using the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist. Additionally, blood flow velocities in the middle cerebral arteries, differences in regional cerebral tissue oxygenation and quantity and quality of microemboli were measured.Delirium was detected in 7 of 36 patients. After cardiopulmonary bypass carotid artery blood flow velocities increased by +23?cm/second (95% confidence interval (CI) 9-36?cm/second) in non-delirious patients compared to preoperative values (P?=?.002), but not in delirious patients (+3?cm/second [95% CI -25 to 32?cm/second], P?=?.5781). Middle cerebral artery blood flow velocities were higher at aortic de-cannulation in non-delirious patients (29?cm/second [inter-quartile range (IQR), 24-36?cm/second] vs 12?cm/second [IQR, 10-19?cm/second]; P?=?.017). Furthermore, brain tissue oxygenation was higher in non-delirious patients during surgery.Our results suggest that higher cerebral blood flow velocities after aortic de-clamping and probably also improved brain oxygenation might be beneficial to prevent postoperative delirium.

SUBMITTER: Bernardi MH

PROVIDER: S-EPMC6922412 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Carotid artery blood flow velocities during open-heart surgery and its association with delirium: A prospective, observational pilot study.

Bernardi Martin H MH Wahrmann Martin M Dworschak Martin M Kietaibl Clemens C Ristl Robin R Edlinger-Stanger Maximilian M Lassnigg Andrea A Hiesmayr Michael J MJ Weber Ulrike U

Medicine 20191201 50

The aim of this prospective observational single-centre pilot study was to evaluate the association between alterations in carotid artery blood flow velocities during cardiac surgery and postoperative delirium.Carotid artery blood flow velocity was determined perioperatively at 5 different timepoints by duplex sonography in 36 adult cardiac surgical patients. Delirium was assessed using the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist. Additionally, ...[more]

PMID: 31852087

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Project description:Background and purposeThe implantation of carotid artery stents prevents recurrent ischemic stroke in patients with carotid stenosis. This study aimed to investigate associations between change of ophthalmic artery flow (COAF) post carotid stenting and recurrent ischemic stroke, as well as the link toward the anterior and posterior circulations and patients' prognosis after carotid stenting.MethodsThis retrospective, longitudinal cohort study recruited 87 left side carotid stenosed ischemic stroke patients undergoing left side carotid stenting between year of 2009 and 2013, and patients were followed up to 9 years after carotid procedures. Clinical data were derived from medical records. The primary outcome was stroke recurrence. Predictive factors were stenosis > 50% in one intracranial artery and ROAF. Kaplan-Meier and Cox regression analyses were used to identify risk factors associated with stroke recurrence.ResultsAmong 87 included patients undergone left side carotid stent treatment, 44 had stroke recurrence within 3 years after carotid stenting. The recurrence group had significantly greater proportions of COAF after stenting (p = 0.001), and middle cerebral artery (MCA) and basilar artery or vertebral artery (BA/VA) stenosis > 50% (all p < 0.001) than the no-recurrence group. Survival was significantly shorter in patients with COAF than in those without (p < 0.01). Regression analysis showed that COAF was associated with stroke recurrence (HR: 3.638, 95% CI 1.54-8.62, p = 0.003). The recurrence rate was highest in patients with bilateral MCA stenosis > 50% (100%), followed by left MCA stenosis > 50% plus BA/VA stenosis > 50% (83.33%) or COAF (82.14%). Patients with bilateral MCA stenosis < 50% had no recurrence within 3-year follow-up.ConclusionsPrognosis after carotid stenting is poorer for patients with MCA stenosis > 50%, BA/VA stenosis > 50% and/or COAF. Carotid duplex and magnetic resonance angiography provide definitive information for prognosis prediction.

Dataset Information

Carotid artery blood flow velocities during open-heart surgery and its association with delirium: A prospective, observational pilot study.

Publications

Carotid artery blood flow velocities during open-heart surgery and its association with delirium: A prospective, observational pilot study.

Similar Datasets

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