PMID- 33741137
OWN - NLM
STAT- MEDLINE
DCOM- 20210511
LR  - 20220503
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Print)
IS  - 0007-0912 (Linking)
VI  - 126
IP  - 5
DP  - 2021 May
TI  - Cerebral autoregulation in the operating room and intensive care unit after 
      cardiac surgery.
PG  - 967-974
LID - S0007-0912(21)00045-3 [pii]
LID - 10.1016/j.bja.2020.12.043 [doi]
AB  - BACKGROUND: Cerebral autoregulation monitoring is a proposed method to monitor 
      perfusion during cardiac surgery. However, limited data exist from the ICU as 
      prior studies have focused on intraoperative measurements. Our objective was to 
      characterise cerebral autoregulation during surgery and early ICU care, and as a 
      secondary analysis to explore associations with delirium. METHODS: In patients 
      undergoing cardiac surgery (n=134), cerebral oximetry values and arterial BP were 
      monitored and recorded until the morning after surgery. A moving Pearson's 
      correlation coefficient between mean arterial proessure (MAP) and near-infrared 
      spectroscopy signals generated the cerebral oximetry index (COx). Three metrics 
      were derived: (1) globally impaired autoregulation, (2) MAP time and duration 
      outside limits of autoregulation (MAP dose), and (3) average COx. Delirium was 
      assessed using the 3-Minute Diagnostic Interview for CAM-defined Delirium 
      (3D-CAM) and the Confusion Assessment Method for the ICU (CAM-ICU). 
      Autoregulation metrics were compared using chi(2) and rank-sum tests, and 
      associations with delirium were estimated using regression models, adjusted for 
      age, bypass time, and logEuroSCORE. RESULTS: The prevalence of globally impaired 
      autoregulation was higher in the operating room vs ICU (40% vs 13%, P<0.001). The 
      MAP dose outside limits of autoregulation was similar in the operating room and 
      ICU (median 16.9 mm Hgxh; inter-quartile range [IQR] 10.1-38.8 vs 16.9 mm Hgxh; 
      IQR 5.4-35.1, P=0.20). In exploratory adjusted analyses, globally impaired 
      autoregulation in the ICU, but not the operating room, was associated with 
      delirium. The MAP dose outside limits of autoregulation in the operating room and 
      ICU was also associated with delirium. CONCLUSIONS: Metrics of cerebral 
      autoregulation are altered in the ICU, and may be clinically relevant with 
      respect to delirium. Further studies are needed to investigate these findings and 
      determine possible benefits of autoregulation-based MAP targeting in the ICU.
CI  - Copyright (c) 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Nakano, Mitsunori
AU  - Nakano M
AD  - Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical 
      University, Saitama, Japan.
FAU - Nomura, Yohei
AU  - Nomura Y
AD  - Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical 
      University, Saitama, Japan.
FAU - Whitman, Glenn
AU  - Whitman G
AD  - Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University 
      School of Medicine, Baltimore, MD, USA.
FAU - Sussman, Marc
AU  - Sussman M
AD  - Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University 
      School of Medicine, Baltimore, MD, USA.
FAU - Schena, Stefano
AU  - Schena S
AD  - Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University 
      School of Medicine, Baltimore, MD, USA.
FAU - Kilic, Ahmet
AU  - Kilic A
AD  - Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University 
      School of Medicine, Baltimore, MD, USA.
FAU - Choi, Chun W
AU  - Choi CW
AD  - Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University 
      School of Medicine, Baltimore, MD, USA.
FAU - Akiyoshi, Kei
AU  - Akiyoshi K
AD  - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University 
      School of Medicine, Baltimore, MD, USA.
FAU - Neufeld, Karin J
AU  - Neufeld KJ
AD  - Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School 
      of Medicine, Baltimore, MD, USA.
FAU - Lawton, Jennifer
AU  - Lawton J
AD  - Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University 
      School of Medicine, Baltimore, MD, USA.
FAU - Colantuoni, Elizabeth
AU  - Colantuoni E
AD  - Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 
      Baltimore, MD, USA.
FAU - Yamaguchi, Atsushi
AU  - Yamaguchi A
AD  - Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical 
      University, Saitama, Japan.
FAU - Wen, Matthew
AU  - Wen M
AD  - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University 
      School of Medicine, Baltimore, MD, USA.
FAU - Smielewski, Peter
AU  - Smielewski P
AD  - Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
FAU - Brady, Ken
AU  - Brady K
AD  - Department of Anesthesiology, Northwestern University Feinberg School of 
      Medicine, Chicago, IL, USA.
FAU - Bush, Brian
AU  - Bush B
AD  - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University 
      School of Medicine, Baltimore, MD, USA.
FAU - Hogue, Charles W
AU  - Hogue CW
AD  - Department of Anesthesiology, Northwestern University Feinberg School of 
      Medicine, Chicago, IL, USA.
FAU - Brown, Charles H 4th
AU  - Brown CH 4th
AD  - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University 
      School of Medicine, Baltimore, MD, USA. Electronic address: cbrownv@jhmi.edu.
LA  - eng
GR  - K76 AG057020/AG/NIA NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
DEP - 20210323
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
SB  - IM
MH  - Aged
MH  - Arterial Pressure/*physiology
MH  - Cardiac Surgical Procedures/*methods
MH  - Cerebrovascular Circulation/*physiology
MH  - Delirium/*physiopathology
MH  - Female
MH  - Homeostasis/physiology
MH  - Humans
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Intraoperative/methods
MH  - Operating Rooms
MH  - Oximetry
PMC - PMC8132879
OTO - NOTNLM
OT  - cardiac surgery
OT  - cerebral autoregulation
OT  - delirium
OT  - geriatrics
OT  - intensive care unit
EDAT- 2021/03/21 06:00
MHDA- 2021/05/12 06:00
PMCR- 2022/05/01
CRDT- 2021/03/20 05:49
PHST- 2020/01/28 00:00 [received]
PHST- 2020/12/14 00:00 [revised]
PHST- 2020/12/24 00:00 [accepted]
PHST- 2021/03/21 06:00 [pubmed]
PHST- 2021/05/12 06:00 [medline]
PHST- 2021/03/20 05:49 [entrez]
PHST- 2022/05/01 00:00 [pmc-release]
AID - S0007-0912(21)00045-3 [pii]
AID - 10.1016/j.bja.2020.12.043 [doi]
PST - ppublish
SO  - Br J Anaesth. 2021 May;126(5):967-974. doi: 10.1016/j.bja.2020.12.043. Epub 2021 
      Mar 23.