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Association of Hyperoxia During Cardiopulmonary Bypass and Postoperative Delirium in the Pediatric Cardiac ICU
Allison J Weatherly1, Cassandra A Johnson2, Dandan Liu2
1Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN.
Insights
Hyperoxia during cardiopulmonary bypass (CPB) did not increase the risk of postoperative delirium in pediatric cardiac surgery patients. Nutritional status, however, may be a significant factor in delirium risk.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiology
- Neuroscience
Background:
- Pediatric delirium is a common complication following cardiac surgery.
- Factors like cardiopulmonary bypass (CPB) time and mechanical ventilation (MV) are associated with delirium.
- Emerging evidence suggests hyperoxia may negatively impact outcomes in critically ill children.
Purpose of the Study:
- To investigate the association between intraoperative hyperoxia during CPB and the prevalence of postoperative delirium in pediatric cardiac surgery patients.
- To identify potential risk factors for delirium in this population.
Main Methods:
- Secondary analysis of a prospective cohort study.
- Included pediatric patients (≥18 years) undergoing cardiac surgery with CPB.
- Delirium assessed using the Preschool/Pediatric Confusion Assessment Method for the ICU.
Main Results:
- 24% of patients developed delirium within 72 hours post-CPB.
- No significant association was found between hyperoxia (defined by various PaO2 thresholds) and postoperative delirium.
- Exploratory analysis indicated that nutritional status (z score for weight) was associated with delirium risk.
Conclusions:
- Intraoperative hyperoxia during CPB is not associated with an increased risk of postoperative delirium in pediatric cardiac surgery patients.
- Nutritional status may play a role in the development of delirium.
- Further research is needed to fully understand the risk factors for postoperative and ICU delirium.
Objective:
ICU delirium commonly complicates critical illness associated with factors such as cardiopulmonary bypass (CPB) time and the requirement of mechanical ventilation (MV). Recent reports associate hyperoxia with poorer outcomes in critically ill children. This study sought to determine whether hyperoxia on CPB in pediatric patients was associated with a higher prevalence of postoperative delirium.
Design:
Secondary analysis of data obtained from a prospective cohort study.
Setting:
Twenty-two-bed pediatric cardiac ICU in a tertiary children's hospital.
Patients:
All patients (18 yr old or older) admitted post-CPB, with documented delirium assessment scores using the Preschool/Pediatric Confusion Assessment Method for the ICU and who were enrolled in the Precision Medicine in Pediatric Cardiology Cohort from February 2021 to November 2021.
Interventions:
None.
Measurements And Main Results:
Of 148 patients, who underwent cardiac surgery, 35 had delirium within the first 72 hours (24%). There was no association between hyperoxia on CPB and postoperative delirium for all definitions of hyperoxia, including hyperoxic area under the curve above 5 predetermined Pao2 levels: 150 mm Hg (odds ratio [95% CI]: 1.176 [0.605-2.286], p = 0.633); 175 mm Hg (OR 1.177 [95% CI, 0.668-2.075], p = 0.572); 200 mm Hg (OR 1.235 [95% CI, 0.752-2.026], p = 0.405); 250 mm Hg (OR 1.204 [95% CI, 0.859-1.688], p = 0.281), 300 mm Hg (OR 1.178 [95% CI, 0.918-1.511], p = 0.199). In an additional exploratory analysis, comparing patients with delirium within 72 hours versus those without, only the z score for weight differed (mean [sd]: 0.09 [1.41] vs. -0.48 [1.82], p < 0.05). When comparing patients who developed delirium at any point during their ICU stay (n = 45, 30%), MV days, severity of illness (Pediatric Index of Mortality 3 Score) score, CPB time, and z score for weight were associated with delirium (p < 0.05).
Conclusions:
Postoperative delirium (72 hr from CPB) occurred in 24% of pediatric patients. Hyperoxia, defined in multiple ways, was not associated with delirium. On exploratory analysis, nutritional status (z score for weight) may be a significant factor in delirium risk. Further delineation of risk factors for postoperative delirium versus ICU delirium warrants additional study.
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