Helena Claesson-Lingehall, Birgitta Olofsson, Yngve Gustafson, Alexander Wahba, Micael Appelblad, Staffan Svenmarker
{"title":"体外循环期间的血流动力学控制与术后谵妄发生率的事后分析。","authors":"Helena Claesson-Lingehall, Birgitta Olofsson, Yngve Gustafson, Alexander Wahba, Micael Appelblad, Staffan Svenmarker","doi":"10.1186/s12871-025-03141-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Delirium is a common neurological complication after cardiac surgery. The purpose of the present study was to analyze the association between hemodynamic fluctuations during cardiopulmonary bypass (CPB) and the incidence of postoperative delirium (POD) in patients undergoing cardiac surgery with CPB.</p><p><strong>Methods: </strong>This post hoc analysis included one-hundred-ninety-five (n = 195) patients aged ≥ 65 years of whom seventy (n = 70) patients developed POD. Intraoperative hemodynamic variables specifically related to the conduct of CPB were digitally recorded at 1-minute intervals. Variables outside the presumed safe boundaries for mean arterial pressure (MAP), systemic perfusion flow index- L/min/BSA (QBSA<sub>I</sub>), systemic venous oxygen saturation (S<sub>V</sub>O<sub>2</sub>) and arterial oxygen delivery- ml/min/BSA (DO<sub>2</sub>) were defined and analyzed with reference to indices of area under the curve (AUC) and the relative proportion of registrations related to POD. POD was diagnosed according to DSM-5 criteria based on a test battery performed preoperatively and repeated twice postoperatively. Statistical tests used to verify observations outside the predefined norm included the Mann-Whitney U test and the chi-squared test.</p><p><strong>Results: </strong>Markers of hemodynamic control during CPB showed significant associations with POD. Both DO<sub>2</sub> (P = 0.02) and QBSA<sub>I</sub> (P < 0.001) identified POD patients outside the predefined upper and lower safety limits. S<sub>V</sub>O<sub>2</sub> values > 84% (P < 0.001) werealso associated with the development of POD. The number of S<sub>V</sub>O<sub>2</sub> registrations below the lower safety limit was negligible, why statistical analysis seemed not useful. No association between MAP and POD registrations was identified.</p><p><strong>Conclusions: </strong>This study revealed a clear association between markers of hemodynamic control and POD. These associations were most pronounced for DO<sub>2</sub> and QBSA<sub>I</sub>. The detected association between high S<sub>V</sub>O<sub>2</sub> and POD warrants further insight.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"267"},"PeriodicalIF":2.6000,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105260/pdf/","citationCount":"0","resultStr":"{\"title\":\"Hemodynamic control during cardiopulmonary bypass and the incidence of postoperative delirium- a post hoc analysis.\",\"authors\":\"Helena Claesson-Lingehall, Birgitta Olofsson, Yngve Gustafson, Alexander Wahba, Micael Appelblad, Staffan Svenmarker\",\"doi\":\"10.1186/s12871-025-03141-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Delirium is a common neurological complication after cardiac surgery. The purpose of the present study was to analyze the association between hemodynamic fluctuations during cardiopulmonary bypass (CPB) and the incidence of postoperative delirium (POD) in patients undergoing cardiac surgery with CPB.</p><p><strong>Methods: </strong>This post hoc analysis included one-hundred-ninety-five (n = 195) patients aged ≥ 65 years of whom seventy (n = 70) patients developed POD. Intraoperative hemodynamic variables specifically related to the conduct of CPB were digitally recorded at 1-minute intervals. Variables outside the presumed safe boundaries for mean arterial pressure (MAP), systemic perfusion flow index- L/min/BSA (QBSA<sub>I</sub>), systemic venous oxygen saturation (S<sub>V</sub>O<sub>2</sub>) and arterial oxygen delivery- ml/min/BSA (DO<sub>2</sub>) were defined and analyzed with reference to indices of area under the curve (AUC) and the relative proportion of registrations related to POD. POD was diagnosed according to DSM-5 criteria based on a test battery performed preoperatively and repeated twice postoperatively. Statistical tests used to verify observations outside the predefined norm included the Mann-Whitney U test and the chi-squared test.</p><p><strong>Results: </strong>Markers of hemodynamic control during CPB showed significant associations with POD. Both DO<sub>2</sub> (P = 0.02) and QBSA<sub>I</sub> (P < 0.001) identified POD patients outside the predefined upper and lower safety limits. S<sub>V</sub>O<sub>2</sub> values > 84% (P < 0.001) werealso associated with the development of POD. The number of S<sub>V</sub>O<sub>2</sub> registrations below the lower safety limit was negligible, why statistical analysis seemed not useful. No association between MAP and POD registrations was identified.</p><p><strong>Conclusions: </strong>This study revealed a clear association between markers of hemodynamic control and POD. These associations were most pronounced for DO<sub>2</sub> and QBSA<sub>I</sub>. The detected association between high S<sub>V</sub>O<sub>2</sub> and POD warrants further insight.</p>\",\"PeriodicalId\":9190,\"journal\":{\"name\":\"BMC Anesthesiology\",\"volume\":\"25 1\",\"pages\":\"267\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-05-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105260/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Anesthesiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12871-025-03141-8\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12871-025-03141-8","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Hemodynamic control during cardiopulmonary bypass and the incidence of postoperative delirium- a post hoc analysis.
Background: Delirium is a common neurological complication after cardiac surgery. The purpose of the present study was to analyze the association between hemodynamic fluctuations during cardiopulmonary bypass (CPB) and the incidence of postoperative delirium (POD) in patients undergoing cardiac surgery with CPB.
Methods: This post hoc analysis included one-hundred-ninety-five (n = 195) patients aged ≥ 65 years of whom seventy (n = 70) patients developed POD. Intraoperative hemodynamic variables specifically related to the conduct of CPB were digitally recorded at 1-minute intervals. Variables outside the presumed safe boundaries for mean arterial pressure (MAP), systemic perfusion flow index- L/min/BSA (QBSAI), systemic venous oxygen saturation (SVO2) and arterial oxygen delivery- ml/min/BSA (DO2) were defined and analyzed with reference to indices of area under the curve (AUC) and the relative proportion of registrations related to POD. POD was diagnosed according to DSM-5 criteria based on a test battery performed preoperatively and repeated twice postoperatively. Statistical tests used to verify observations outside the predefined norm included the Mann-Whitney U test and the chi-squared test.
Results: Markers of hemodynamic control during CPB showed significant associations with POD. Both DO2 (P = 0.02) and QBSAI (P < 0.001) identified POD patients outside the predefined upper and lower safety limits. SVO2 values > 84% (P < 0.001) werealso associated with the development of POD. The number of SVO2 registrations below the lower safety limit was negligible, why statistical analysis seemed not useful. No association between MAP and POD registrations was identified.
Conclusions: This study revealed a clear association between markers of hemodynamic control and POD. These associations were most pronounced for DO2 and QBSAI. The detected association between high SVO2 and POD warrants further insight.
期刊介绍：
BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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