Aymen Benkreira1, William Beaubien-Souligny2, Tanya Mailhot3, Nadia Bouabdallaoui4, Pierre Robillard5, Georges Desjardins1, Yoan Lamarche6, Sylvie Cossette3, André Denault1. 1. Department of Anesthesiology and Intensive Care, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. 2. Department of Anesthesiology and Intensive Care, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. Electronic address: william.beaubien@gmail.com. 3. Nursing Research Laboratory, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. 4. Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. 5. Department of Radiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. 6. Department of Cardiac Surgery and Intensive Care, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Abstract
BACKGROUND: Venous congestion might lead to congestive encephalopathy after cardiac surgery. However, objective signs of congestion have yet to be associated with delirium. Portal vein flow pulsatility is a congestion marker that may identify a subgroup of patients at risk. METHODS: We performed a retrospective study and a prospective study in patients undergoing cardiac surgery. Adult patients who underwent portal vein Doppler imaging by the attending physician during usual care in the intensive care unit were included in the retrospective cohort. For the prospective cohort, patients had a cognitive and echocardiographic evaluation the day before surgery and daily for 3 days after surgery. Delirium was independently assessed by the nursing staff in the prospective cohort. RESULTS: A total of 237 patients in the retrospective cohort and 145 patients in the prospective cohort were included, for whom 1074 portal Doppler evaluations were performed. An association was found between delirium and portal vein pulsatility in the retrospective cohort (odds ratio [OR], 2.69; confidence interval [CI], 1.47-4.90; P = 0.001). In the prospective cohort, significant associations were found between the presence of portal vein pulsatility and the development of cognitive dysfunction and asterixis assessed by the investigators (OR, 2.10; CI, 1.25-3.53; P = 0.005 and OR, 2.23; CI, 1.13; 4.41; P = 0.02, and delirium detected by the nursing staff (hazard ratio, 2.63; CI, 1.13-6.11; P = 0.025). Higher N-terminal pro-beta natriuretic peptide measurements (OR, 4.03; CI, 1.78-9.15; P = 0.001) and cerebral desaturations (OR, 2.54; CI, 1.12-5.76; P = 0.03) were associated with cognitive dysfunction. CONCLUSION: These data present an association among hepatic congestion, delirium, and encephalopathy in patients undergoing cardiac surgery. Further studies should explore whether those neurological complications may have a congestive origin in some patients.
BACKGROUND:Venous congestion might lead to congestive encephalopathy after cardiac surgery. However, objective signs of congestion have yet to be associated with delirium. Portal vein flow pulsatility is a congestion marker that may identify a subgroup of patients at risk. METHODS: We performed a retrospective study and a prospective study in patients undergoing cardiac surgery. Adult patients who underwent portal vein Doppler imaging by the attending physician during usual care in the intensive care unit were included in the retrospective cohort. For the prospective cohort, patients had a cognitive and echocardiographic evaluation the day before surgery and daily for 3 days after surgery. Delirium was independently assessed by the nursing staff in the prospective cohort. RESULTS: A total of 237 patients in the retrospective cohort and 145 patients in the prospective cohort were included, for whom 1074 portal Doppler evaluations were performed. An association was found between delirium and portal vein pulsatility in the retrospective cohort (odds ratio [OR], 2.69; confidence interval [CI], 1.47-4.90; P = 0.001). In the prospective cohort, significant associations were found between the presence of portal vein pulsatility and the development of cognitive dysfunction and asterixis assessed by the investigators (OR, 2.10; CI, 1.25-3.53; P = 0.005 and OR, 2.23; CI, 1.13; 4.41; P = 0.02, and delirium detected by the nursing staff (hazard ratio, 2.63; CI, 1.13-6.11; P = 0.025). Higher N-terminal pro-beta natriuretic peptide measurements (OR, 4.03; CI, 1.78-9.15; P = 0.001) and cerebral desaturations (OR, 2.54; CI, 1.12-5.76; P = 0.03) were associated with cognitive dysfunction. CONCLUSION: These data present an association among hepatic congestion, delirium, and encephalopathy in patients undergoing cardiac surgery. Further studies should explore whether those neurological complications may have a congestive origin in some patients.
Authors: Ashley Miller; Marcus Peck; Tom Clark; Hannah Conway; Segun Olusanya; Nick Fletcher; Nick Coleman; Prashant Parulekar; Jonathan Aron; Justin Kirk-Bayley; Jonathan Nicholas Wilkinson; Adrian Wong; Jennie Stephens; Antonio Rubino; Ben Attwood; Andrew Walden; Andrew Breen; Manprit Waraich; Catherine Nix; Simon Hayward Journal: J Intensive Care Soc Date: 2021-04-23
Authors: André Y Denault; Matthew P Aldred; Ali Hammoud; Yu Hao Zeng; William Beaubien-Souligny; Etienne J Couture; Stéphanie Jarry; Caroline E Gebhard; Stephane Langevin; Yoan Lamarche; Pierre Robillard Journal: Crit Care Explor Date: 2020-09-28
Authors: Ross T Prager; Michael T Pratte; Laura H Thompson; Kylie E McNeill; Christina Milani; David M Maslove; Shannon M Fernando; Kwadwo Kyeremanteng Journal: Crit Care Explor Date: 2021-12-09
Authors: Marta Torres-Arrese; Gonzalo García de Casasola-Sánchez; Manuel Méndez-Bailón; Esther Montero-Hernández; Marta Cobo-Marcos; Mercedes Rivas-Lasarte; Luis Caurcel-Díaz; Pablo Rodríguez-Fuertes; Tomas Villén-Villegas; Yale Tung-Chen Journal: Medicina (Kaunas) Date: 2022-01-14 Impact factor: 2.430