心脏手术中股静脉搏动与神经认知障碍

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-02-01 DOI:10.1016/j.cjco.2024.11.002

Ali Hammoud RN, MSc , Tanya Mailhot RN, PhD , Melissa Parent MD , Karel Huard MD , Olivier Lachance MD , Patrick Tawil MD , Alexander Calderone MD , Sylvie Levesque MSc , Stéphanie Jarry RN, MSc , William Beaubien-Souligny MD, PhD , Étienne J. Couture MD , André Y. Denault MD, PhD

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引用次数: 0

摘要

背景：神经认知障碍和静脉充血在心脏手术中是相关的。股静脉（FV）多普勒允许无创评估静脉充血。本研究旨在探讨心脏手术术后神经认知障碍与FV脉搏的关系。方法采用回顾性和前瞻性队列资料进行二次分析。术后进入重症监护病房（ICU）时测量FV多普勒和神经认知障碍。FV脉搏指数≥50%为异常。使用重症监护谵妄评分检查表（ICDSC）评估神经认知障碍的存在。采用描述性统计分析和逻辑回归检验FV多普勒脉搏与神经认知障碍的关系。结果两组共分析273例患者，其中FV脉搏指数≥50%的患者155例（57%）。与FV多普勒正常相比，脉搏多普勒异常与神经认知障碍的存在相关(57 vs 43%，优势比[OR]， 1.73；95%可信区间[CI]， 1.06-2.81)。心室搏动也与年龄、卒中发生率、插管时间延长和ICU住院时间延长有关。结论心脏手术患者sfv脉搏跳动与神经认知障碍及术后并发症有关。FV多普勒技术简单快速，提供了预测与静脉充血有关的并发症的潜力，如谵妄。未来有必要进行更大样本的多中心研究，以巩固这些发现。临床注册号：nct04092855和NCT05038267。

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Femoral Vein Pulsatility and Neurocognitive Disorder in Cardiac Surgery

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Femoral Vein Pulsatility and Neurocognitive Disorder in Cardiac Surgery

Background

Neurocognitive disorder and venous congestion are related in cardiac surgery. Femoral vein (FV) Doppler allows noninvasive assessment of venous congestion. This study aims to associate postoperative neurocognitive disorder in cardiac surgery with FV pulsatility.

Method

A secondary analysis was conducted using data from retrospective and prospective cohorts. FV Doppler and neurocognitive disorder were measured upon admission to the intensive care unit (ICU) after surgery. An index of FV pulsatility of ≥ 50% was considered abnormal. The presence of neurocognitive disorder was assessed using the Intensive Care Delirium Score Checklist (ICDSC). Descriptive statistical analyses and logistic regression were used to test the association between FV Doppler pulsatility and neurocognitive disorder.

Results

A total of 273 patients from both cohorts were analyzed, 155 (57%) patients had FV pulsatility indexes ≥ 50%. Abnormal pulsatile Doppler was associated with the presence of neurocognitive disorder compared with normal FV Doppler profile (57 vs 43%, odds ratio [OR], 1.73; 95% confidence interval [CI], 1.06-2.81). FV pulsatility was also associated with age, higher rate of stroke, prolongation of intubation duration and a longer ICU stay.

Conclusions

FV pulsatility is associated with the presence of neurocognitive disorder and postoperative complications in cardiac surgery. The FV Doppler technique is simple and fast, offering the potential to anticipate complications related to venous congestion, such as delirium. Future multicentre studies with larger samples will be necessary to consolidate these findings.