Caterina Sampaolesi, Erika Casarotta, Giacomo Gresti, Giulia Mariotti, Leonardo Pisani, Diego Veccia, Marco Di Eusanio, Pietro Giorgio Malvindi, Abele Donati, Christopher Maria Münch
{"title":"泵上冠状动脉旁路移植手术期间脑血流变化与术后谵妄之间的关联。","authors":"Caterina Sampaolesi, Erika Casarotta, Giacomo Gresti, Giulia Mariotti, Leonardo Pisani, Diego Veccia, Marco Di Eusanio, Pietro Giorgio Malvindi, Abele Donati, Christopher Maria Münch","doi":"10.1177/02676591241239823","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative delirium (POD) has a major impact on patient recovery after cardiac surgery. Although its pathophysiology remains unclear, there could be a correlation between cerebral blood flow (CBF) variations during cardio-pulmonary bypass (CPB) and POD. Our study aimed to evaluate whether variations in on-pump CBF, compared to pre-anesthesia and pre-CPB values, are associated with POD following coronary artery bypass grafting (CABG) surgery.</p><p><strong>Methods: </strong>This prospective observational cohort study included 95 adult patients undergoing elective on-pump CABG surgery. Right middle cerebral artery blood flow velocity (MCAV) was assessed using Transcranial Doppler before anesthesia induction, before CPB and every fifteen minutes during CPB. Pre-anesthesia and pre-CPB values were chosen as baselines. Individual values, measured during CPB, were converted as percentage changes relative to these baselines and named as %MCAV<sub>0</sub> and %MCAV<sub>1</sub>, respectively. POD was assessed using the Confusion Assessment Method for ICU (CAM-ICU) during the first 48 post-operative hours and with the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) on the fifth post-surgical day.</p><p><strong>Results: </strong>Overall POD incidence was 17.9%. At 30 minutes of CPB, %MCAV<sub>0</sub> was higher in POD group than in no-POD group (<i>p</i> = .05). %MCAV<sub>0</sub> at 45 minutes of CPB was significantly higher in POD group (87 (±17) %) than in no-POD group (68 (±24) %), <i>p</i> = .04. %MCAV<sub>1</sub> at 30 and 45 minutes of CPB were higher in POD group than in no-POD group, at the limit of statistical significance. We found %MCAV<sub>1</sub> > 100% in POD group, but not in no-POD group.</p><p><strong>Conclusions: </strong>Significant differences in %MCAV<sub>0</sub> became evident after 30 minutes of CPB, whereas differences in %MCAV<sub>1</sub> at 45 minutes of CPB were at limit of statistical significance. In POD group %MCAV<sub>1</sub> was higher than 100% at 30 and 45 minutes of CPB, which is supposed to be a sign of cerebral hyperperfusion. Monitoring CBF during CPB could have prognostic value for POD.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"440-449"},"PeriodicalIF":1.1000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The association between cerebral blood flow variations during on-pump coronary artery bypass grafting surgery and postoperative delirium.\",\"authors\":\"Caterina Sampaolesi, Erika Casarotta, Giacomo Gresti, Giulia Mariotti, Leonardo Pisani, Diego Veccia, Marco Di Eusanio, Pietro Giorgio Malvindi, Abele Donati, Christopher Maria Münch\",\"doi\":\"10.1177/02676591241239823\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Postoperative delirium (POD) has a major impact on patient recovery after cardiac surgery. Although its pathophysiology remains unclear, there could be a correlation between cerebral blood flow (CBF) variations during cardio-pulmonary bypass (CPB) and POD. Our study aimed to evaluate whether variations in on-pump CBF, compared to pre-anesthesia and pre-CPB values, are associated with POD following coronary artery bypass grafting (CABG) surgery.</p><p><strong>Methods: </strong>This prospective observational cohort study included 95 adult patients undergoing elective on-pump CABG surgery. Right middle cerebral artery blood flow velocity (MCAV) was assessed using Transcranial Doppler before anesthesia induction, before CPB and every fifteen minutes during CPB. Pre-anesthesia and pre-CPB values were chosen as baselines. Individual values, measured during CPB, were converted as percentage changes relative to these baselines and named as %MCAV<sub>0</sub> and %MCAV<sub>1</sub>, respectively. POD was assessed using the Confusion Assessment Method for ICU (CAM-ICU) during the first 48 post-operative hours and with the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) on the fifth post-surgical day.</p><p><strong>Results: </strong>Overall POD incidence was 17.9%. At 30 minutes of CPB, %MCAV<sub>0</sub> was higher in POD group than in no-POD group (<i>p</i> = .05). %MCAV<sub>0</sub> at 45 minutes of CPB was significantly higher in POD group (87 (±17) %) than in no-POD group (68 (±24) %), <i>p</i> = .04. %MCAV<sub>1</sub> at 30 and 45 minutes of CPB were higher in POD group than in no-POD group, at the limit of statistical significance. We found %MCAV<sub>1</sub> > 100% in POD group, but not in no-POD group.</p><p><strong>Conclusions: </strong>Significant differences in %MCAV<sub>0</sub> became evident after 30 minutes of CPB, whereas differences in %MCAV<sub>1</sub> at 45 minutes of CPB were at limit of statistical significance. In POD group %MCAV<sub>1</sub> was higher than 100% at 30 and 45 minutes of CPB, which is supposed to be a sign of cerebral hyperperfusion. Monitoring CBF during CPB could have prognostic value for POD.</p>\",\"PeriodicalId\":49707,\"journal\":{\"name\":\"Perfusion-Uk\",\"volume\":\" \",\"pages\":\"440-449\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Perfusion-Uk\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/02676591241239823\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/3/15 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perfusion-Uk","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/02676591241239823","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/15 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
The association between cerebral blood flow variations during on-pump coronary artery bypass grafting surgery and postoperative delirium.
Introduction: Postoperative delirium (POD) has a major impact on patient recovery after cardiac surgery. Although its pathophysiology remains unclear, there could be a correlation between cerebral blood flow (CBF) variations during cardio-pulmonary bypass (CPB) and POD. Our study aimed to evaluate whether variations in on-pump CBF, compared to pre-anesthesia and pre-CPB values, are associated with POD following coronary artery bypass grafting (CABG) surgery.
Methods: This prospective observational cohort study included 95 adult patients undergoing elective on-pump CABG surgery. Right middle cerebral artery blood flow velocity (MCAV) was assessed using Transcranial Doppler before anesthesia induction, before CPB and every fifteen minutes during CPB. Pre-anesthesia and pre-CPB values were chosen as baselines. Individual values, measured during CPB, were converted as percentage changes relative to these baselines and named as %MCAV0 and %MCAV1, respectively. POD was assessed using the Confusion Assessment Method for ICU (CAM-ICU) during the first 48 post-operative hours and with the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) on the fifth post-surgical day.
Results: Overall POD incidence was 17.9%. At 30 minutes of CPB, %MCAV0 was higher in POD group than in no-POD group (p = .05). %MCAV0 at 45 minutes of CPB was significantly higher in POD group (87 (±17) %) than in no-POD group (68 (±24) %), p = .04. %MCAV1 at 30 and 45 minutes of CPB were higher in POD group than in no-POD group, at the limit of statistical significance. We found %MCAV1 > 100% in POD group, but not in no-POD group.
Conclusions: Significant differences in %MCAV0 became evident after 30 minutes of CPB, whereas differences in %MCAV1 at 45 minutes of CPB were at limit of statistical significance. In POD group %MCAV1 was higher than 100% at 30 and 45 minutes of CPB, which is supposed to be a sign of cerebral hyperperfusion. Monitoring CBF during CPB could have prognostic value for POD.
期刊介绍：
Perfusion is an ISI-ranked, peer-reviewed scholarly journal, which provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use in modern cardiac surgery. The journal is at the forefront of international research and development and presents an appropriately multidisciplinary approach to perfusion science.
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