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Predicting postoperative delirium and postoperative cognitive decline with combined intraoperative electroencephalogram monitoring and cerebral near-infrared spectroscopy in patients undergoing cardiac interventions

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Momeni, Mona [UCL] Meyer, Sabrina [UCL] Docquier, Marie-Agnès [UCL] Lemaire, Guillaume [UCL] Kahn, David [UCL] Khalifa, Céline [UCL] Rosal Martins, Maria [UCL] Van Dyck, Michel [UCL] Jacquet, Luc-Marie [UCL] Peeters, André [UCL] Watremez, Christine [UCL]

(eng) Studies have associated electroencephalogram (EEG) suppression with postoperative delirium (POD) and postoperative cognitive decline (POCD). Otherwise, improving cerebral tissue oxygen saturation (rScO2) seems beneficial. No study has evaluated the impact of EEG suppression and decreased rScO2 on the incidence of POD and POCD when the intraoperative management of patients is performed with a depth-of-anesthesia (DOA) monitor and a cerebral oximetry. In this prospective study patients undergoing cardiac interventions were monitored with the NeuroSENSE® DOA monitor and bilateral cerebral oximetry. An algorithm was used to optimize cerebral oxygenation. EEG suppression was presented as total area under the curve (AUC) of suppression ratio (SR) > 0 s (AUCEEGSR>0s). Cerebral desaturation was defined as AUC of 25% drop of oximetry values as compared to baseline. POD was evaluated by the chart review method. POCD was defined as a Z-score ≤ 2 based on Mini Mental State Examination at baseline and day 5 or if the patient reported any cognitive decline at 3 and at 6 months postoperatively. Among the 1616 patients, 1513 underwent normothermic surgery and were further analyzed. POD and POCD were respectively evaluated in 1504 and 1350 patients of whom 303 (20%) and 270 (20%) were respectively diagnosed positive. Having experienced high magnitudes of EEG suppression (fourth quartile of AUCEEGSR>0s) was significantly associated with POD (OR = 2.247; 95% CI = 1.414-3.571; P = 0.001). Low rScO2 at the end of surgery was statistically associated with POCD (OR = 0.981; 95% CI = 0.965-0.997; P = 0.018). The results of our study show that the degree of intraoperative EEG suppression on one hand, and low rScO2 at the end of procedure on the other hand, are associated with respectively POD and POCD in patients undergoing cardiac interventions.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2019
Language Anglais
Journal information "Journal of Clinical Monitoring and Computing" - Vol. 33, no. 6, p. 999-1009 (2019)
Peer reviewed yes
Publisher Springer Nature ((Netherlands) Amsterdam)
issn 1387-1307
e-issn 1573-2614
Publication status Publié
Affiliations UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire
UCL - SSS/IONS/NEUR - Clinical Neuroscience
UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
UCL - SSS/IREC/MEDA - Pôle de médecine aiguë
UCL - SSS/IREC/SLUC - Pôle St.-Luc
UCL - (SLuc) Service de pathologies cardiovasculaires intensives
UCL - (SLuc) Service d'anesthésiologie
UCL - (SLuc) Service de soins intensifs
UCL - (SLuc) Service de neurologie
Keywords Anesthesiology and Pain Medicine ; Health Informatics ; Critical Care and Intensive Care Medicine ; Burst suppression ; Cerebral oximetry ; Depth-of-anesthesia monitor ; Postoperative cognitive decline ; Postoperative delirium
Links
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Bibliographic reference Momeni, Mona ; Meyer, Sabrina ; Docquier, Marie-Agnès ; Lemaire, Guillaume ; Kahn, David ; et. al. Predicting postoperative delirium and postoperative cognitive decline with combined intraoperative electroencephalogram monitoring and cerebral near-infrared spectroscopy in patients undergoing cardiac interventions. In: Journal of Clinical Monitoring and Computing, Vol. 33, no. 6, p. 999-1009 (2019)
Permanent URL http://hdl.handle.net/2078.1/210408