11 / Role of peroperative haemodynamic parameters in the development of postoperative delirium after cardiac surgery

2018 ◽  
Author(s):  
Roel Croonen
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Delirium ◽  
Haemodynamic Parameters

scholarly journals Road to recovery: a study protocol quantifying neurological outcome in cardiac surgery patients and the role of cerebral oximetry

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032935
Author(s):  
Joanna S Semrau ◽  
Stephen H Scott ◽  
Andrew G Hamilton ◽  
Dimitri Petsikas ◽  
Darrin M Payne ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Neurological Outcome ◽  
Postoperative Delirium ◽  
Cerebral Oximetry ◽  
Elective Cardiac Surgery ◽  
Peer Review Journal ◽  
Registration Number ◽  
Oral Presentations

IntroductionPatients undergoing cardiac surgery may experience both short-term and long-term postoperative neurological problems. However, the underlying cause of this impairment is unclear. Regional cerebral oxygen saturation (rSO2) levels may play a role in the development of acute dysfunction, known as postoperative delirium, in addition to longer term outcomes after cardiac surgery. Yet the degree of impairment has been difficult to define, partly due to subjective methods of assessments. This study aims to fill this knowledge gap by determining the relationship between rSO2, postoperative delirium and long-term neurological outcome after cardiac surgery using quantitative robotic technology.Methods and analysis95 patients scheduled for elective cardiac surgery will be recruited for this single-centre prospective observational study. Patients will be assessed before as well as 3 and 12 months after their surgery using the Kinarm End-Point Lab and standardised tasks. Intraoperatively, rSO2 and other haemodynamic data will be collected for the duration of the procedure. Following their operation, patients will also be screened daily for delirium during their hospital stay.Ethics and disseminationThis study has been approved by the Health Sciences Research Ethics Board at Queen’s University (DMED-1672–14). The results of this study will be published in a peer-review journal and presented at international and/or national conferences as poster or oral presentations. Participants wishing to know the results of this study will be contacted directly on data publication.Trial registration numberNCT04081649

scholarly journals The Practical Use of White Cell Inflammatory Biomarkers in Prediction of Postoperative Delirium after Cardiac Surgery

2019 ◽  
Vol 9 (11) ◽  
pp. 308 ◽  
Author(s):  
Kotfis ◽  
Ślozowska ◽  
Safranow ◽  
Szylińska ◽  
Listewnik
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Delirium ◽  
Artery Bypass ◽  
Optimal Prediction ◽  
Blood Cell Count ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
The Mean ◽  
And Oxidative Stress

: Introduction: Postoperative delirium (POD) is associated with unfavorable outcomes. It may result from neuroinflammation and oxidative stress. The aim of this study was to evaluate the role of routinely available inflammatory markers derived from white blood cell count (WBC), for prognostic value in diagnosing delirium after cardiac surgery. Methods: We performed an analysis of data collected from patients undergoing planned coronary artery bypass grafting (CABG). Differential WBC and CRP concentration were evaluated preoperatively (T0) and postoperatively at day 1 (T1), 3 (T3), 5 (T5) after CABG. Differences in neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet-to-WBC ratio (PWR) between patients with (Del+) and without delirium (Del−) were evaluated. Patients were screened using CAM-ICU. Results: We included 968 patients in the study. Incidence of delirium was 13.3%. In the group with POD, the majority of patients were men (87/129, 67.44%), and the mean age was 72 years. Preoperative WBC (8.21 ± 3.04 G/l vs. 7.55 ± 1.86 G/l, p = 0.029) were higher and mean platelet count was lower (217.7 ± 69.07 G/l vs. 227.44 ± 59.31 G/l, p = 0.031) in patients with POD. Lower pre-operative PLR values (109.87 ± 46.38 vs. 120.36 ± 52.98, p = 0.026) and PWR values (27.69 7.50 vs. 31.32 9.88 p < 0.001) were found in patients with POD. Association was strongest for PWR and remained significant at T1 (p < 0.001), T3 (p < 0.001) and T5 (p < 0.001). Basing on coefficients of logistic regression a model for optimal prediction of POD was calculated: CARDEL Index = 0.108 × Age + 0.341 × HBA1C − 0.049 × PWR with AUC of 0.742 (p < 0.001). Conclusions: The results of this study show that lower pre-operative levels of PLR and PWR were associated with POD after cardiac surgery. Pre-operative PWR showed strongest correlation with POD and may be a potential new biomarker associated with postoperative delirium. CARDEL prognosis index composed of age, HbA1c and PWR is good at predicting development of delirium after CABG.

Risk factors for stroke after cardiac surgery: The role of screening carotid ultrasonography

2012 ◽  
Vol 60 (S 01) ◽  
Author(s):  
U Boeken ◽  
P Akhyari ◽  
JP Minol ◽  
A Assmann ◽  
A Lichtenberg
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Carotid Ultrasonography

Systemic inflammatory complications in cardiac surgery – role of cytokines and complement

2005 ◽  
Vol 53 (S 3) ◽  
Author(s):  
U Boeken ◽  
P Feindt ◽  
J Litmathe ◽  
D Kindgen-Milles ◽  
S Loer ◽  
...  
Keyword(s):  
Cardiac Surgery

The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

2012 ◽  
Vol 15 (2) ◽  
pp. 84 ◽  
Author(s):  
Canturk Cakalagaoglu ◽  
Cengiz Koksal ◽  
Ayse Baysal ◽  
Gokhan Alici ◽  
Birol Ozkan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Pericardial Tamponade ◽  
Anxiety Level ◽  
Control Group ◽  
Echocardiographic Study ◽  
Number Of Patients ◽  
Hospital Stays

<p><b>Aim:</b> The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).</p><p><b>Materials and Methods:</b> We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.</p><p><b>Results:</b> The 2 groups were not significantly different with respect to demographic and operative data (<i>P</i> > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (<i>P</i> < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (<i>P</i> < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (<i>P</i> = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.</p><p><b>Conclusion:</b> Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.</p>

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