title: Critical care strategies to improve neurocognitive outcome in thoracic surgery.
abstract: OBJECTIVE
  This review focuses on neurocognitive outcome with respect to potential pathophysiological inflammatory mechanisms of thoracic surgery and one-lung ventilation, risk factors of postoperative delirium and postoperative cognitive dysfunction (POCD) as well as anti-inflammatory strategies.
  
  
  RESULTS
  Neurocognitive dysfunction is associated with increased mortality and disability. The incidence of postoperative delirium and POCD is often underestimated in the perioperative care setting. Both are threatening complications after major surgery and independently associated with an increased morbidity and mortality. Nevertheless, in thoracic surgery, the clinical relevance of neurocognitive dysfunction is still underestimated. Currently, there has been a growing interest in inflammation as a cause of the pathogenesis of postoperative delirium and POCD. Furthermore, thoracic surgery often requires one-lung ventilation, which is accompanied with important physiological disturbances, and leads to a pulmonary arteriovenous shunt with the decrease of arterial oxygen content and an exaggerated activation of inflammatory processes. As inflammation is involved in brain dysfunction, anti-inflammatory strategies in the perioperative setting seem to be potential neuroprotective targets concerning specially high-risk patients undergoing thoracic surgery under one-lung ventilation.
  
  
  CONCLUSIONS
  There is evidence that important key strategies improve neurocognitive outcome after thoracic surgery. This includes adequate risk stratification, the anesthetic management and postoperative critical care strategies.
authors.affiliation: Department of Anesthesiology, Ludwig Maximilian-University Munich, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Tomasi
authors.forename: Vera
authors.initials: V
authors.lastname: von Dossow-Hanfstingl
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D003422:Critical Care / Q000379:methods*; D003693:Delirium / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control; D015994:Incidence; D007431:Intraoperative Complications / Q000517:prevention & control; D009422:Nervous System Diseases / Q000209:etiology* / Q000517:prevention & control*; D061810:One-Lung Ventilation; D011183:Postoperative Complications / Q000517:prevention & control* / Q000523:psychology*; D019616:Thoracic Surgical Procedures / Q000379:methods*
chemical_list: D000893:Anti-Inflammatory Agents