Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Harvard

APA

CBE

MLA

Vancouver

Author

Bibtex

@article{9d7d8cc1025d4e5485c6c50baad760be,
title = "The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial",
abstract = "BACKGROUND: Postoperative cognitive dysfunction (POCD) occurs commonly after cardiac surgery. Near-infrared spectroscopy (NIRS) has been used to monitor regional cerebral oxygen saturation (rScO2) in order to minimise the occurrence of POCD by applying dedicated interventions when rScO2 decreases. However, the association between rScO2 intraoperatively and POCD has not been clarified.METHODS: This is a secondary analysis of a randomised trial with physician-blinded NIRS monitoring and cognitive testing at discharge from hospital and at 3 months after surgery. The association between intraoperative rScO2 values and POCD at discharge from hospital and at 3 months after surgery was investigated. The prespecified candidate predictive variable of interest was cumulative time during surgery with rScO2 ≥10{\%} below its preoperative value.RESULTS: One hundred and fifty-three patients had complete NIRS data and neurocognitive assessments at discharge, and 44 of these patients (29{\%}) had POCD. At 3 months, 148 patients had complete data, and 12 (8{\%}) of these patients had POCD. The median time with rScO2 >10{\%} below preoperative values did not differ for patients with and without POCD at discharge (difference=0.0 min; Hodges-Lehmann 95{\%} confidence interval, -3.11-1.47, P=0.88). Other rScO2 time thresholds that were assessed were also not significantly different between those with and without POCD at discharge. This applied both to absolute rScO2 values and relative changes from preoperative values. Similar results were found in relation to POCD at 3 months.CONCLUSIONS: No significant association was found between intraoperative rScO2 values and POCD. These findings bring into question the rationale for attempting to avoid decreases in rScO2 if the motivation is to prevent POCD.CLINICAL TRIAL REGISTRATION: NCT02185885.",
keywords = "cardiac surgery, delayed neurocognitive recovery, neuropsychological tests, postoperative complications, postoperative neurocognitive disoders, spectroscopy, near-infrared, Cognitive Dysfunction/physiopathology, Humans, Middle Aged, Male, Cerebrovascular Circulation, Brain/physiopathology, Monitoring, Intraoperative/methods, Cardiac Surgical Procedures, Spectrophotometry, Infrared, Oximetry/statistics & numerical data, Female, Aged, Postoperative Complications/physiopathology",
author = "Frederik Holmgaard and Vedel, {Anne G} and Rasmussen, {Lars S} and Paulson, {Olaf B} and Nilsson, {Jens C} and Ravn, {Hanne B}",
note = "Copyright {\circledC} 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.",
year = "2019",
month = "8",
day = "1",
doi = "10.1016/j.bja.2019.03.045",
language = "English",
volume = "123",
pages = "196--205",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "2",

}

RIS

TY - JOUR

T1 - The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery

T2 - a secondary analysis of a randomised trial

AU - Holmgaard, Frederik

AU - Vedel, Anne G

AU - Rasmussen, Lars S

AU - Paulson, Olaf B

AU - Nilsson, Jens C

AU - Ravn, Hanne B

N1 - Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - BACKGROUND: Postoperative cognitive dysfunction (POCD) occurs commonly after cardiac surgery. Near-infrared spectroscopy (NIRS) has been used to monitor regional cerebral oxygen saturation (rScO2) in order to minimise the occurrence of POCD by applying dedicated interventions when rScO2 decreases. However, the association between rScO2 intraoperatively and POCD has not been clarified.METHODS: This is a secondary analysis of a randomised trial with physician-blinded NIRS monitoring and cognitive testing at discharge from hospital and at 3 months after surgery. The association between intraoperative rScO2 values and POCD at discharge from hospital and at 3 months after surgery was investigated. The prespecified candidate predictive variable of interest was cumulative time during surgery with rScO2 ≥10% below its preoperative value.RESULTS: One hundred and fifty-three patients had complete NIRS data and neurocognitive assessments at discharge, and 44 of these patients (29%) had POCD. At 3 months, 148 patients had complete data, and 12 (8%) of these patients had POCD. The median time with rScO2 >10% below preoperative values did not differ for patients with and without POCD at discharge (difference=0.0 min; Hodges-Lehmann 95% confidence interval, -3.11-1.47, P=0.88). Other rScO2 time thresholds that were assessed were also not significantly different between those with and without POCD at discharge. This applied both to absolute rScO2 values and relative changes from preoperative values. Similar results were found in relation to POCD at 3 months.CONCLUSIONS: No significant association was found between intraoperative rScO2 values and POCD. These findings bring into question the rationale for attempting to avoid decreases in rScO2 if the motivation is to prevent POCD.CLINICAL TRIAL REGISTRATION: NCT02185885.

AB - BACKGROUND: Postoperative cognitive dysfunction (POCD) occurs commonly after cardiac surgery. Near-infrared spectroscopy (NIRS) has been used to monitor regional cerebral oxygen saturation (rScO2) in order to minimise the occurrence of POCD by applying dedicated interventions when rScO2 decreases. However, the association between rScO2 intraoperatively and POCD has not been clarified.METHODS: This is a secondary analysis of a randomised trial with physician-blinded NIRS monitoring and cognitive testing at discharge from hospital and at 3 months after surgery. The association between intraoperative rScO2 values and POCD at discharge from hospital and at 3 months after surgery was investigated. The prespecified candidate predictive variable of interest was cumulative time during surgery with rScO2 ≥10% below its preoperative value.RESULTS: One hundred and fifty-three patients had complete NIRS data and neurocognitive assessments at discharge, and 44 of these patients (29%) had POCD. At 3 months, 148 patients had complete data, and 12 (8%) of these patients had POCD. The median time with rScO2 >10% below preoperative values did not differ for patients with and without POCD at discharge (difference=0.0 min; Hodges-Lehmann 95% confidence interval, -3.11-1.47, P=0.88). Other rScO2 time thresholds that were assessed were also not significantly different between those with and without POCD at discharge. This applied both to absolute rScO2 values and relative changes from preoperative values. Similar results were found in relation to POCD at 3 months.CONCLUSIONS: No significant association was found between intraoperative rScO2 values and POCD. These findings bring into question the rationale for attempting to avoid decreases in rScO2 if the motivation is to prevent POCD.CLINICAL TRIAL REGISTRATION: NCT02185885.

KW - cardiac surgery

KW - delayed neurocognitive recovery

KW - neuropsychological tests

KW - postoperative complications

KW - postoperative neurocognitive disoders

KW - spectroscopy, near-infrared

KW - Cognitive Dysfunction/physiopathology

KW - Humans

KW - Middle Aged

KW - Male

KW - Cerebrovascular Circulation

KW - Brain/physiopathology

KW - Monitoring, Intraoperative/methods

KW - Cardiac Surgical Procedures

KW - Spectrophotometry, Infrared

KW - Oximetry/statistics & numerical data

KW - Female

KW - Aged

KW - Postoperative Complications/physiopathology

UR - http://www.scopus.com/inward/record.url?scp=85065755050&partnerID=8YFLogxK

U2 - 10.1016/j.bja.2019.03.045

DO - 10.1016/j.bja.2019.03.045

M3 - Journal article

VL - 123

SP - 196

EP - 205

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 2

ER -

ID: 57348548