Effect of Targeting Mean Arterial Pressure During Cardiopulmonary Bypass by Monitoring Cerebral Autoregulation on Postsurgical Delirium Among Older Patients

作者：Charles H. Brown, Karin J. Neufeld, Jing Tian, Julia M. Probert, Andrew Laflam, Laura K. Max, Daijiro Hori, Yohei Nomura, Kaushik Mandal, Ken M. Brady, Charles W. Jr Hogue, and the Cerebral Autoregulation Study Group, Ashish S. Shah, Kenton J. Zehr, Duke Edward Cameron, John V. Conte, Oscar Joseph Bienvenu, Rebecca F. Gottesman, Atsushi Yamaguchi, Michael A. Kraut · 发表于：JAMA Surgery · 年份：2019 · DOI：10.1001/jamasurg.2019.1163 · 被引用次数：187 · 研究领域：Intensive Care Unit Cognitive Disorders、Sepsis Diagnosis and Treatment、Family and Patient Care in Intensive Care Units

Importance: Delirium occurs in up to 52% of patients after cardiac surgery and may result from changes in cerebral perfusion. Using intraoperative cerebral autoregulation monitoring to individualize and optimize cerebral perfusion may be a useful strategy to reduce the incidence of delirium after cardiac surgery. Objective: To determine whether targeting mean arterial pressure during cardiopulmonary bypass (CPB) using cerebral autoregulation monitoring reduces the incidence of delirium compared with usual care. Design, Setting, and Participants: This randomized clinical trial nested within a larger trial enrolled patients older than 55 years who underwent nonemergency cardiac surgery at a single US academic medical center between October 11, 2012, and May 10, 2016, and had a high risk for neurologic complications. Patients, physicians, and outcome assessors were masked to the assigned intervention. A total of 2764 patients were screened, and 199 were eligible for analysis in this study. Intervention: In the intervention group, the patient's lower limit of cerebral autoregulation was identified during surgery before CPB. On CPB, the patient's mean arterial pressure was targeted to be greater than that patient's lower limit of autoregulation. In the control group, mean arterial pressure targets were determined according to institutional practice. Main Outcomes and Measures: The main outcome was any incidence of delirium on postoperative days 1 through 4, as adjudicated by a con...