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Title: | Association between postoperative delirium and postoperative cerebral oxygen desaturation in older patients after cardiac surgery | Authors: | EERTMANS, Ward DE DEYNE, Cathy GENBRUGGE, Cornelia Marcus, Berend Bouneb, Sofian Beran, Maud Fret, Tom GUTERMANN, Herbert BOER, Willem VANDER LAENEN, Margot HEYLEN, Rene MESOTTEN, Dieter VANELDEREN, Pascal JANS, Frank |
Issue Date: | 2020 | Publisher: | ELSEVIER SCI LTD | Source: | BRITISH JOURNAL OF ANAESTHESIA, 124 (2) , p. 146 -153 | Abstract: | Background: Near-infrared spectroscopy non-invasively measures regional cerebral oxygen saturation. Intraoperative cerebral desaturations have been associated with worse neurological outcomes. We investigated whether perioperative cerebral desaturations are associated with postoperative delirium in older patients after cardiac surgery. Methods: Patients aged 70 yr and older scheduled for on-pump cardiac surgery were included between 2015 and 2017 in a single-centre, prospective, observational study. Baseline cerebral oxygen saturation was measured 1 day before surgery. Throughout surgery and after ICU admission, cerebral oxygen saturation was monitored continuously up to 72 h after operation. The presence of delirium was assessed using the confusion assessment method for the ICU. Association with delirium was evaluated with unadjusted analyses and multivariable logistic regression. Results: Ninety-six of 103 patients were included, and 29 (30%) became delirious. Intraoperative cerebral oxygen saturation was not significantly associated with postoperative delirium. The lowest postoperative cerebral oxygen saturation was lower in patients who became delirious (P=0.001). The absolute and relative postoperative cerebral oxygen saturation decreases were more marked in patients with delirium (13 [6]% and 19 [9]%, respectively) compared with patients without delirium (9 [4]% and 14 [5]%; P=0.002 and P=0.001, respectively). These differences in cerebral oxygen saturation were no longer present after excluding cerebral oxygen saturation values after patients became delirious. Older age, previous stroke, higher EuroSCORE II, lower preoperative Mini-Mental Status Examination, and more substantial absolute postoperative cerebral oxygen saturation decreases were independently associated with postoperative delirium incidence. Conclusions: Postoperative delirium in older patients undergoing cardiac surgery is associated with absolute decreases in postoperative cerebral oxygen saturation. These differences appear most detectable after the onset of delirium. | Notes: | Eertmans, W (reprint author), Hasselt Univ, Dept Med & Life Sci, Diepenbeek, Belgium.; Eertmans, W (reprint author), Ziekenhuis Oost Limburg, Dept Anaesthesiol Intens Care Emergency Med & Pai, Genk, Belgium. ward.eertmans@zol.be |
Keywords: | cardiac surgery;cerebral oxygen saturation;delirium;intensive care unit;near-infrared spectroscopy;neurological outcome;postoperative delirium | Document URI: | http://hdl.handle.net/1942/30698 | ISSN: | 0007-0912 | e-ISSN: | 1471-6771 | DOI: | 10.1016/j.bja.2019.09.042 | ISI #: | WOS:000507373200013 | Rights: | 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2021 |
Appears in Collections: | Research publications |
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