title: Reduced Cerebral Perfusion Pressure during Lung Transplant Surgery Is Associated with Risk, Duration, and Severity of Postoperative Delirium.
abstract: BACKGROUND
  Delirium is common following lung transplant and is associated with poorer clinical outcomes. The extent to which intraoperative hemodynamic alterations may contribute to postoperative delirium among lung transplant recipients has not been examined.
  
  
  OBJECTIVE
  To examine the impact of intraoperative hemodynamic changes on neurobehavioral outcomes among lung transplant recipients.
  
  
  METHODS
  Intraoperative hemodynamic function during lung transplant was assessed in a consecutive series of patients between March and November 2013. Intraoperative cerebral perfusion pressure was assessed every minute in all patients. Following lung transplant, patients were monitored for the presence and severity of delirium using the Confusion Assessment Method and the Delirium Rating Scale until hospital discharge.
  
  
  RESULTS
  Sixty-three patients received lung transplants, of whom 23 (37%) subsequently developed delirium. Lower cerebral perfusion pressure was associated with increased risk of delirium (odds ratio [OR], 2.08 per 10-mm Hg decrease; 95% confidence interval [CI], 1.02-4.24; P = 0.043), longer duration of delirium (OR, 1.7 d longer per 10-mm Hg decrease; 95% CI, 1.1-2.7; P = 0.022), and greater delirium severity (b = -0.81; 95% CI, -1.47 to -0.15; P = 0.017).
  
  
  CONCLUSIONS
  Poorer cerebral perfusion pressure during lung transplant is associated with greater risk for delirium following transplant, as well as greater duration and severity of delirium, independent of demographic and medical predictors.
authors.affiliation: 1 Department of Psychiatry and Behavioral Sciences.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Smith
authors.affiliation: 1 Department of Psychiatry and Behavioral Sciences.
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.affiliation: 1 Department of Psychiatry and Behavioral Sciences.
authors.forename: Benson M
authors.initials: BM
authors.lastname: Hoffman
authors.affiliation: 1 Department of Psychiatry and Behavioral Sciences.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Rivelli
authors.affiliation: 2 Department of Medicine.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Palmer
authors.affiliation: 3 Department of Surgery, and.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Davis
authors.affiliation: 4 Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Mathew
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D002496:Central Venous Pressure; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015331:Cohort Studies; D003693:Delirium / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
keywords: cerebral perfusion pressure; delirium; lung transplantation