Dynamic Cerebral Autoregulation: A Marker of Post-Operative Delirium?

Publication date: Available online 22 November 2018

Source: Clinical Neurophysiology

Author(s): Juliana R. Caldas, Ronney B. Panerai, Edson Bor-Seng-Shu, Graziela SR Ferreira, Ligia Camara, Passos RH, Marcelo de-Lima-Oliveira, Filomena RBG Galas, Juliano P. Almeida, Ricardo C. Nogueira, Natalia Mian, Fabio A. Gaiotto, Thompson G. Robinson, Ludhmila A. Hajjar

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-minutes preoperatively (T1), after 24h (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).

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