Blood Pressure Deviations From Optimal Mean Arterial Pressure During Cardiac Surgery Measured With a Novel Monitor of Cerebral Blood Flow and Risk for Perioperative Delirium: A Pilot Study

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• 作者：Daijiro Hori ; MD^* ; Laura Max ; BSc^&dagger ; ; Andrew Laflam ; BSc^&dagger ; ; Charles Brown ; MD^&dagger ; ; Karin J. Neufeld ; MD^&Dagger ; ; Hideo Adachi ; MD^§ ; ; Christopher Sciortino ; MD ; PhD^* ; John V. Conte ; MD^* ; Duke E. Cameron ; MD^* ; Charles W. Hogue Jr. ; MD^&dagger ; ; Kaushik Mandal ; MD ; MPH ; MS ; FESC ; FRCS (CTh)^* ; ^{kmandal2@jhmi.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：cerebral autoregulation ; cardiopulmonary bypass ; delirium ; cardiac surgery ; hemodynamics ; perioperative care ; cerebral blood flow
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：30
• 期：3
• 页码：606-612
• 全文大小：672 K

文摘

The aim of this study was to evaluate whether excursions of blood pressure from the optimal mean arterial pressure during and after cardiac surgery are associated with postoperative delirium identified using a structured examination.

Design

Prospective, observational study.

Setting

University hospital.

Participants

The study included 110 patients undergoing cardiac surgery.

Interventions

Patients were monitored using ultrasound-tagged near-infrared spectroscopy to assess optimal mean arterial pressure by cerebral blood flow autoregulation monitoring during cardiopulmonary bypass and the first 3 hours in the intensive care unit.

Measurements and Main Results

The patients were tested preoperatively and on postoperative days 1 to 3 with the Confusion Assessment Method or Confusion Assessment Method for the Intensive Care Unit, the Delirium Rating Scale-Revised-98, and the Mini Mental State Examination. Summative presence of delirium on postoperative days 1 through 3, as defined by the consensus panel following m>Diagnostic and Statistical Manual of Mental Disorders-IV-TRm> criteria, was the primary outcome. Delirium occurred in 47 (42.7%) patients. There were no differences in blood pressure excursions above and below optimal mean arterial pressure between patients with and without summative presence of delirium. Secondary analysis showed blood pressure excursions above the optimal mean arterial pressure to be higher in patients with delirium (mean±SD, 33.2±26.51 mmHgxh m>vm> 23.4±16.13 mmHgxh; p = 0.031) and positively correlated with the Delirium Rating Scale score on postoperative day 2 (m>rm> = 0.27, p = 0.011).

Conclusions

Summative presence of delirium was not associated with perioperative blood pressure excursions; but on secondary exploratory analysis, excursions above the optimal mean arterial pressure were associated with the incidence and severity of delirium on postoperative day 2.