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Published on: March 23, 2018
Target flow deviations on the cardiopulmonary bypass cause postoperative delirium in cardiothoracic surgery-a
Johannes Krefting1, Hagen Gorki1, Markus Hoenicka1
1Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany.
Insights
Cardiopulmonary bypass (CPB) parameters, including total blood volume and minimal blood flow, significantly predict postoperative delirium (POD). Tighter control over CPB flow rates and acid-base balance can reduce POD risk.
Area of Science:
- Cardiology
- Neurosurgery
- Anesthesiology
Background:
- Postoperative delirium (POD) is a frequent complication following cardiac surgery, associated with significant morbidity and mortality.
- Identifying modifiable risk factors during cardiopulmonary bypass (CPB) is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the contribution of CPB parameters to the development of POD using advanced data processing techniques.
- To identify specific CPB operational states that influence POD risk.
Main Methods:
- A cohort study utilizing data from 2014-2019, integrating ICU discharge, CPB protocols, and quality management records.
- Algorithm-based data structuring, imputation of missing values, and multiple logistic regression analysis.
- Development of a minimal adequate model to identify independent predictors of POD.
Main Results:
- POD occurred in 14.4% of patients (456/3163).
- Independent predictors included known factors (male sex, age, comorbidities) and CPB parameters: total blood volume (AOR 1.001) and minimal blood flow (AOR 0.993).
- Higher minimal blood flow was associated with a lower risk of POD.
Conclusions:
- CPB data processing effectively identifies operational states influencing POD.
- Strict adherence to perfusion limits and controlled blood flow during CPB are key to reducing POD risk.
Objectives:
Postoperative delirium (POD) is common, costly and associated with long-term morbidity and increased mortality. We conducted a cohort study to assess the contribution of cardiopulmonary bypass (CPB) to the development of POD by means of algorithm-based data processing.
Methods:
A database was compiled from 3 datasets of patients who underwent cardiac surgery between 2014 and 2019: intensive care unit discharge files, CPB protocols and medical quality management records. Following data extraction and structuring using novel algorithms, missing data were imputed. Ten independent imputations were analysed by multiple logistic regression with stepwise deletion of factors to arrive at a minimal adequate model.
Results:
POD was diagnosed in 456/3163 patients (14.4%). In addition to known demographic risk factors and comorbidities like male sex, age, carotid disease, acute kidney failure and diabetes mellitus, cardiopulmonary parameters like total blood volume at the CPB [adjusted odds ratio (AOR) 1.001; confidence interval (CI) 1.1001-1.002] were independent predictors of POD. Higher values of the minimal blood flow were associated with a lower risk of POD (AOR 0.993; CI 0.988-0.997). Flow rates at least 30% above target did emerge in the minimal adequate model as a potential risk factor, but the confidence interval suggested a lack of statistical significance (AOR 1.819; 95% CI: 0.955-3.463).
Conclusions:
CPB data processing proved to be a useful tool for obtaining compact information to better identify the roles of individual operational states. Strict adherence to perfusion limits along with tighter control of blood flow and acid-base balance during CPB may help to further decrease the risk of POD.
