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.
OBJECTIVE
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.


METHODS
Prospective, observational study.


METHODS
University hospital.


METHODS
The study included 110 patients undergoing cardiac surgery.


METHODS
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.


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 Diagnostic and Statistical Manual of Mental Disorders-IV-TR 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 v 23.4±16.13 mmHgxh; p = 0.031) and positively correlated with the Delirium Rating Scale score on postoperative day 2 (r = 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.
Division of Cardiac Surgery, Department of Surgery.
Daijiro
D
Hori
Department of Anesthesiology & Critical Care Medicine.
Laura
L
Max
Department of Anesthesiology & Critical Care Medicine.
Andrew
A
Laflam
Department of Anesthesiology & Critical Care Medicine.
Charles
C
Brown
Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD.
Karin J
KJ
Neufeld
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Hideo
H
Adachi
Division of Cardiac Surgery, Department of Surgery.
Christopher
C
Sciortino
Division of Cardiac Surgery, Department of Surgery.
John V
JV
Conte
Division of Cardiac Surgery, Department of Surgery.
Duke E
DE
Cameron
Department of Anesthesiology & Critical Care Medicine.
Charles W
CW
Hogue
Division of Cardiac Surgery, Department of Surgery. Electronic address: kmandal2@jhmi.edu.
Kaushik
K
Mandal
D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003693:Delirium / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors
cardiac surgery; cardiopulmonary bypass; cerebral autoregulation; cerebral blood flow; delirium; hemodynamics; perioperative care