Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial

Julika Schoen, Joscha Meyerrose, Hauke Paarmann, Matthias Heringlake, Michael Hueppe, Klaus-Ulrich Berger, Julika Schoen, Joscha Meyerrose, Hauke Paarmann, Matthias Heringlake, Michael Hueppe, Klaus-Ulrich Berger

Abstract

Introduction: Postoperative delirium is an important problem in patients undergoing major surgery. Cerebral oximetry is a non-invasive method to detect imbalances in the cerebral oxygen supply/demand-ratio. Low preoperative cerebral oxygen saturation (ScO₂) levels have been associated with postoperative delirium in non-cardiac surgery patients. The present prospective observational study determines the relationship between pre- and intra-operative ScO₂ levels and postoperative delirium in patients undergoing on-pump cardiac surgery.

Methods: After approval of the local ethical committee and written informed consent, N = 231 patients scheduled for elective/urgent cardiac surgery were enrolled. Delirium was assessed by the confusion-assessment-method for the intensive care unit (CAM-ICU) on the first three days after surgery. ScO₂ was obtained on the day before surgery, immediately before surgery and throughout the surgical procedure. Preoperative cognitive function, demographic, surgery related, and intra- and post-operative physiological data were registered.

Results: Patients with delirium had lower pre- and intra-operative ScO₂ readings, were older, had lower mini-mental-status-examination(MMSE) scores, higher additive EuroScore and lower preoperative haemoglobin-levels. The binary logistic regression identified older age, lower MMSE, neurological or psychiatric disease and lower preoperative ScO₂ as independent predictors of postoperative delirium.

Conclusions: The presented study shows that a low preoperative ScO₂ is associated with postoperative delirium after on-pump cardiac surgery.

Figures

Figure 1
Figure 1
Recruitment of patients during the 3-month study period. CAM-ICU, confusion assessment method for the intensive care unit; RASS, Richmond Agitation Sedation Scale.
Figure 2
Figure 2
Intraoperative changes in ScO2 in patients with or without delirium classified by normal or low preoperative ScO2. Delta ScO2base, difference between preoperative regional cerebral oxygen saturation with oxygen supplementation and minimal intraoperative regional cerebral oxygen saturation; ScO2base, regional cerebral oxygen saturation with supplemental oxygen.
Figure 3
Figure 3
Comparison between receiver operating characteristic curves for preoperative oxygen-supplemented ScO2 and minimal intraoperative ScO2 on delirium. ScO2, regional cerebral oxygen saturation; ScO2min, minimal intraoperative regional cerebral oxygen saturation; ScO2base, regional cerebral oxygen saturation with patient breathing 4 L per minute supplemental oxygen.
Figure 4
Figure 4
Mini-Mental Status Examination scores in patients with different educational levels. ANOVA, analysis of variance; MMSE, Mini-Mental Status Examination.

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