Reduced Cerebral Perfusion Pressure during Lung Transplant Surgery Is Associated with Risk, Duration, and Severity of Postoperative Delirium.
Reduced Cerebral Perfusion Pressure during Lung Transplant Surgery Is Associated with Risk, Duration, and Severity of Postoperative Delirium.
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DOI：
10.1513/annalsats.201507-454oc
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发表时间：
2016-02
影响因子：
8.3
通讯作者：
Patrick J. Smith;J. Blumenthal;Benson M. Hoffman;S. Rivelli;S. Palmer;R. D. Davis;J. Mathew
中科院分区：
文献类型：
--
作者：
Patrick J. Smith;J. Blumenthal;Benson M. Hoffman;S. Rivelli;S. Palmer;R. D. Davis;J. Mathew
理论依据谵妄在肺移植后很常见，与较差的临床结局相关。肺移植受者术中血流动力学改变可能导致术后谵妄的程度尚未研究。目的研究肺移植受者术中血流动力学变化对神经行为结局的影响。方法：在2013年3月至11月的一系列连续患者中评估了肺移植术期间的术中血流动力学功能。术中每分钟评估所有患者的脑灌注压。肺移植后，使用意识模糊评估方法和谵妄评定量表监测患者谵妄的存在和严重程度，直至出院。测量和主要结果63例患者接受肺移植，其中23例（37%）随后发生谵妄。较低的脑灌注压与谵妄风险增加相关（比值比[OR]，每降低10 mm Hg为2.08; 95%置信区间[CI]，1.02-4.24; P = 0.043），谵妄持续时间较长（OR，每降低10 mm Hg延长1.7 d; 95% CI，1.1-2.7; P = 0.022），谵妄严重程度更高（B = -0.81; 95% CI，-1.47至-0.15; P = 0.017）。结论：肺移植期间的高脑灌注压与移植后更大的谵妄风险相关，以及更长的谵妄持续时间和严重程度，与人口统计学和医学预测因素无关。
RATIONALE Delirium is common following lung transplant and is associated with poorer clinical outcomes. The extent to which intraoperative hemodynamic alterations may contribute to postoperative delirium among lung transplant recipients has not been examined. OBJECTIVES To examine the impact of intraoperative hemodynamic changes on neurobehavioral outcomes among lung transplant recipients. METHODS Intraoperative hemodynamic function during lung transplant was assessed in a consecutive series of patients between March and November 2013. Intraoperative cerebral perfusion pressure was assessed every minute in all patients. Following lung transplant, patients were monitored for the presence and severity of delirium using the Confusion Assessment Method and the Delirium Rating Scale until hospital discharge. MEASUREMENTS AND MAIN RESULTS Sixty-three patients received lung transplants, of whom 23 (37%) subsequently developed delirium. Lower cerebral perfusion pressure was associated with increased risk of delirium (odds ratio [OR], 2.08 per 10-mm Hg decrease; 95% confidence interval [CI], 1.02-4.24; P = 0.043), longer duration of delirium (OR, 1.7 d longer per 10-mm Hg decrease; 95% CI, 1.1-2.7; P = 0.022), and greater delirium severity (b = -0.81; 95% CI, -1.47 to -0.15; P = 0.017). CONCLUSIONS Poorer cerebral perfusion pressure during lung transplant is associated with greater risk for delirium following transplant, as well as greater duration and severity of delirium, independent of demographic and medical predictors.