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Assessment of postoperative risk factors for EEG abnormalities in routine clinical management after paediatric
Meng-Yao Li1,2,3, Xiao-Bin Lou1,2,3, Yan-Qin Cui1,2
1Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China.
Insights
Electroencephalogram (EEG) abnormalities after pediatric cardiopulmonary bypass (CPB) are linked to several factors. Epinephrine emerged as the most significant risk factor for these EEG changes in children.
Area of Science:
- Pediatric Cardiology
- Neurophysiology
- Critical Care Medicine
Background:
- Identifying postoperative risk factors for electroencephalogram (EEG) abnormalities following pediatric cardiopulmonary bypass (CPB) is crucial for improving patient outcomes.
- Routine clinical management post-CPB necessitates a thorough understanding of EEG changes and their associated risk factors.
Purpose of the Study:
- To investigate the characteristics of EEG abnormalities after pediatric CPB.
- To identify the key risk factors associated with these EEG abnormalities in a clinical setting.
Main Methods:
- EEG and cerebral oxygen saturation (ScO2) were monitored in 96 pediatric patients for 72 hours post-CPB.
- Clinical data including hemodynamic parameters, blood gases, drug dosages, inflammatory markers (CRP, NT-proBNP), and demographic information were collected.
- Statistical analysis, including univariable and multivariable regression, was performed to identify correlations between clinical variables and EEG findings.
Main Results:
- Seizures occurred in 20.8% of patients, and background abnormalities were observed in 69.8%.
- Patients with EEG abnormalities exhibited worse clinical outcomes.
- Multivariable regression identified epinephrine, lactate, and temperature as significant risk factors for seizures, while epinephrine and lactate remained significant for background abnormalities.
Conclusions:
- Several perioperative risk factors are associated with EEG abnormalities after pediatric CPB.
- Epinephrine was identified as the most significant and consistent risk factor contributing to EEG abnormalities in this patient population.
Objectives:
The postoperative risk factors for electroencephalogram(EEG) abnormalities after paediatric cardiopulmonary bypass (CPB) remain to be identified. We investigated the characteristics of EEG abnormalities and risk factors in routine clinical management post-CPB.
Methods:
EEG and cerebral oxygen saturation (ScO2) were monitored in 96 patients (aged 3 days, 37 months, median 5 months) for 72 h post-CPB. Clinical measurements included 4-hourly arterial and central venous pressure, arterial blood gases, doses of inotropic and vasoactive drugs, daily C-reactive protein (CRP) and NT-proB-type Natriuretic Peptide (NT-proBNP). Demographics, STAT categories and outcomes (duration of mechanical ventilation,CICU stay) were recorded. Un.
Results:
Seizures occurred in 20 patients (20.8%) beginning at 0-48 hand lasting 10 min-31 h; background abnormalities occurred in 67 (69.8%) beginning at 0-8 h and lasting 4-48 h. Patients with EEG abnormalities had worse outcomes. In univariable regression, seizures positively correlated with STAT categories, CPB time, temperature, blood pressure, central venous pressure, NT-proBNP, CRP, lactate and epinephrine, negatively with ScO2 and PaCO2 (P < 0.001 for lactate and epinephrine, P < 0.1 for the remaining). The degree of background abnormalities positively correlated with STAT categories, CPB time, operative time, central venous pressure, milrinone, negatively with blood pressure (P = 0.0003-0.087); it negatively correlated with lower dose of epinephrine (P < 0.001) and positively with higher dose (P = 0.03l). In multivariable regression, seizures positively correlated with epinephrine, lactate and temperature; the background abnormality correlations remain significant except for milrinone and operative time (P < 0.001 for epinephrine, P < 0.05 for the remaining).
Conclusions:
Numerous perioperative risk factors are associated with EEG abnormalities post-CPB. The most significant and consistent risk factor is epinephrine.
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