Dynamic cerebral autoregulation: A marker of post-operative delirium?

Clin Neurophysiol. 2019 Jan;130(1):101-108. doi: 10.1016/j.clinph.2018.11.008. Epub 2018 Nov 22.

Abstract

Objective: We investigated the potential association of cerebral autoregulation (CA) with postoperative delirium (PD), a common complication of cardiac surgery with cardiopulmonary bypass (CPB).

Methods: In patients undergoing coronary artery bypass graft (CABG) surgery with CPB, cerebral blood flow velocity (CBFV) and blood pressure (BP) were continuously recorded during 5-min preoperatively (T1), after 24 h (T2), and 7 days after procedure (T3). Prospective multivariate logistic regression analysis was performed to determine the independent risk factors of PD. Autoregulation index (ARI) was calculated from the CBFV response to a step change in BP derived by transfer function analysis.

Results: In 67 patients, mean age 64.3 ± 9.5 years, CA was depressed at T2 as shown by values of ARI (3.9 ± 1.7), compared to T1 (5.6 ± 1.7) and T3 (5.5 ± 1.8) (p < 0.001). Impaired CA was found in 37 (55%) patients at T2 and in 7 patients (20%) at T3. Lower ARI at T1 and T2 were predictors of PD (p = 0.003).

Conclusion: Dynamic CA was impaired after CABG surgery with CPB and was a significant independent risk factor of PD.

Significance: Assessment of CA before and after surgery could have considerable potential for early identification of patients at risk of PD, thus reducing poor outcomes and length of stay.

Clinical trials registration: www.clinicaltrials.gov (NCT02143544, April 30, 2014).

Keywords: Cardiac surgery; Cardiopulmonary bypass; Cerebral blood flow; Left ventricular ejection fraction.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Cerebrovascular Circulation / physiology*
  • Coronary Artery Bypass / adverse effects*
  • Coronary Artery Bypass / trends
  • Delirium / diagnosis
  • Delirium / epidemiology*
  • Delirium / physiopathology
  • Female
  • Homeostasis / physiology*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / physiopathology
  • Prospective Studies

Associated data

  • ClinicalTrials.gov/NCT02143544