Cerebral Monitoring and Post-operative Delirium and Outcomes
NCT ID: NCT04643834
Last Updated: 2024-03-19
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
COMPLETED
Total Enrollment
153 participants
Study Classification
OBSERVATIONAL
Study Start Date
2019-11-21
Study Completion Date
2023-11-30
Brief Summary
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Brain monitoring using near-infrared spectroscopy (NIRS) started in 2002 in the operating room of the Montreal heart Institute (MHI). This was followed by the use of somatic NIRS in 2010, transcranial Doppler in 2015 and processed electroencephalogram (pEEG) using Sedline (Masimo, Irvine CA) in 2017. The introduction of those modalities led to significant change in intraoperative management. The goal of these devices is to improve our ability to detect and predict post-operative complications as well as offering insights on how to prevent them. The current project explores in further detail the impact of the introduction of pEEG in the operating room and in the intensive care unit (ICU) on post-operative delirium.
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Detailed Description
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Overview of the problem: Post-operative delirium in cardiac surgery Brain monitoring using NIRS started in 2002 in the operating rooms of the MHI. Since that period, the investigators described our experience on 1613 reported patients from published case reports (n=30), cohort studies (n=1270), randomized controlled trials (n=313), and review articles.
In the presence of brain desaturation, the investigators have previously described an algorithmic approach based on a series of interventions (such as head positioning, increasing blood pressure and inspired oxygen etc.) which are triggered by the etiology, one at a time or simultaneously, ideally as early as possible i.e. when the cerebral NIRS value start to decrease by more than 10%. The success rate for correction of brain desaturation was more than 95%.
The use of both cerebral NIRS and pEEG led to new insights which were not apparent when these technologies were used in isolation. For instance, brain desaturation resulting from increased pEEG activity will be observed upon awakening. On the other hand, brain desaturation associated with reduced pEEG activity may indicates brain hypoperfusion. A new algorithm to manage cerebral NIRS and pEEG was introduced and published in May 2019.
This algorithm has not been validated and could represent a major advance in the care of cardiac surgical patients. One of the potential roles of this type of monitoring would be its ability to predict emergence delirium, postoperative delirium and other end-organ complications. Eventually, the early identification could lead to prevention of post-operative complications such as delirium.
Brain oximetry and delirium Between 16% and 30% of elderly hospitalised patients with cardiovascular disease will develop delirium. Delirium and cognitive dysfunction are highly frequent among hospitalized patients across all healthcare settings, but especially in surgical and critical care populations where rates are reported to be as high as 70%. Mortality is increased in patients with delirium after cardiac surgery.
Delirium is defined by the DSM-5 as an acute brain dysfunction associated with attention deficit and altered consciousness. Three types of delirium have been described : hypoactive associated with lethargia, hyperactive with agitation and a combination of both that can alternate. There are several predisposing factors such as pre-operative cognitive dysfunction. A recent systematic review has identified the following factors associated with delirium occurrence. Those factors include advanced age, prior psychiatric condition, mild cognitive impairment, and cerebrovascular disease. Post-operative delirium is associated with prolonged duration of hospitalisation, post-operative complications and increased mortality.
There have been several reports linking reduced cerebral NIRS measurements, delirium and post-operative cognitive dysfunction among surgical populations. The mechanism through which reduced brain saturation and delirium co-exist could include cerebral malperfusion and venous congestion from right heart dysfunction. Those factors have been recently explored and their association with delirium and post-operative cognitive dysfunction has been reported in the ICU as well as in the operating room. As right heart dysfunction can be associated with prolonged period of venous hypertension, this can lead to interstitial edema which can further impairs end organ perfusion such as the brain. In the context of cardiopulmonary bypass (CPB), this phenomenon might be aggravated by alteration in endothelial glycocalyx resulting in increased permeability of the capillary endothelium. The resulting interstitial edema is thought to be a mediator of adverse outcomes in critically ill fluid overloaded patients. In addition to altered NIRS values observed with delirium after cardiac surgery, abnormal brain electrical activity has been described.
Brain electroencephalographic monitoring and delirium Electrical activity of the brain can be monitored through electroencephalography (EEG) and recently bedside monitor of pEEG such as the BIS (Medtronic, USA) or Sedline (Masimo Irvine CA) allow bedside measurement of frontal electrical activity. Delirium is associated with EEG changes, typically global slowing of EEG activity. Significant differences in EEG have been observed in elderly with or without delirium. The alpha, theta and delta wave power and the theta ratio in relation to the other EEG waves are different in patients with or without delirium. Furthermore, significant reduction in EEG activity leading to "burst-suppression" has been related to delirium appearance, prolonged hospital length of stay and mortality. Controversial results have been reported from studies and meta-analysis looking at intervention to correct those factors and improve outcome. However, these observations have never combined information obtained from frontal EEG with brain oximetry. A recent prospective study from Belgium reported an association with post-operative delirium and the information obtained from the combined use of brain NIRS and pEEG.
Previous work of delirium and brain oximetry and electroencephalographic monitoring In 2011, the investigators reported our first experience in the use of NIRS in 61 patients undergoing off-pump bypass cardiac surgery as a predictor post-operative cognitive dysfunction. In 2016, an observational study was conducted with 30 consecutive adults with delirium after cardiac surgery. The mean oximetry value decreased from (mean ± SD) 66.4 ± 6.7 to 50.8 ± 6.8 on the first day after delirium onset and increased in patients whose delirium resorbed over the 3 days. The relationship between oximetry, delirium diagnosis, and severity was analyzed with a marginal model and linear mixed models. Cerebral oximetry was related to delirium diagnosis (p≤.0001) and severity (p≤.0001). In that study, somatic oximetry values were normal in patients with delirium.
The second study, in 2017, was a case-control retrospective study which included 346 patients, of which 39 (11%), 104 (30%), and 142 (41%) patients presented delirium at 24, 48, and 72 hours post-ICU arrival, respectively. The cumulative fluid balance was associated with delirium occurrence (OR 1.20, 95% CI: 1.066-1.355, p=.003). History of neurological disorder, having both hearing and visual impairment, type of procedure, perioperative cerebral oximetry, mean pulmonary artery pressure pre-CPB, and mean arterial pressure post-CPB also contributed to delirium in the model.
In the third study, both a retrospective and prospective cohort were reported including a total of 382 patients. Adult patients who underwent portal venous pulsed-wave Doppler by the attending physician during usual care in the ICU were included in the retrospective cohort (n=237). For the prospective cohort (n=145), patients had a cognitive and echocardiographic evaluation the day before surgery and daily for three days after surgery. Delirium was independently assessed by the nursing staff in the prospective cohort. An association was found between delirium and portal vein pulsatility, a marker of right heart failure, in the retrospective cohort (OR:2.69 CI:1.47-4.90 p=0.001). In the prospective cohort, significant associations were confirmed 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:5.19 \[CI:2.27; 11.88\] p\<0.001) But also the association with delirium detected by the nursing staff was confirmed (HR:2.63 CI:1.13-6.11 p=0.025). Higher NT-pro-BNP 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. In this third study, baseline daily pEEG were obtained daily in combination with NIRS values. However, no association was observed between delirium and preliminary waveform analysis.
In summary, those studies support an association between episodes of cerebral desaturations measured by brain oximetry and the occurrence of delirium. Venous cerebral congestion as a consequence of right ventricular dysfunction leading to portal hypertension and possibly cytokine release through a cardio-intestinal syndrome appears to be a potential mechanism. As supported by other authors, reduced cerebral NIRS values could be secondary to elevated venous pressure, fluid overload and the latter contribute to a type of congestive delirium. It could also be reflective of increased cerebral metabolism, such as can be observed when patient emerge from general anesthesia after cardiac surgery. However, in those studies, only a single cerebral NIRS and pEEG value were obtained. The combination of both modalities with the use of bilateral cerebral NIRS was not studied prospectively in both the operating room and in the ICU. Currently, it is not known whether the information obtained by these monitors is different in patients presenting an episode of delirium compared to those who do not show any episode of postoperative delirium.
In the presence of brain desaturation, the investigators have previously described an algorithmic approach based on a series of interventions (such as head positioning, increasing blood pressure and inspired oxygen etc.) which are triggered by the etiology, one at a time or simultaneously, ideally as early as possible i.e. when the cerebral NIRS value start to decrease by more than 10%. The success rate for correction of brain desaturation was more than 95%.
The use of both cerebral NIRS and pEEG led to new insights which were not apparent when these technologies were used in isolation. For instance, brain desaturation resulting from increased pEEG activity will be observed upon awakening. On the other hand, brain desaturation associated with reduced pEEG activity may indicates brain hypoperfusion. A new algorithm to manage cerebral NIRS and pEEG was introduced and published in May 2019.
This algorithm has not been validated and could represent a major advance in the care of cardiac surgical patients. One of the potential roles of this type of monitoring would be its ability to predict emergence delirium, postoperative delirium and other end-organ complications. Eventually, the early identification could lead to prevention of post-operative complications such as delirium.
Brain oximetry and delirium Between 16% and 30% of elderly hospitalised patients with cardiovascular disease will develop delirium. Delirium and cognitive dysfunction are highly frequent among hospitalized patients across all healthcare settings, but especially in surgical and critical care populations where rates are reported to be as high as 70%. Mortality is increased in patients with delirium after cardiac surgery.
Delirium is defined by the DSM-5 as an acute brain dysfunction associated with attention deficit and altered consciousness. Three types of delirium have been described : hypoactive associated with lethargia, hyperactive with agitation and a combination of both that can alternate. There are several predisposing factors such as pre-operative cognitive dysfunction. A recent systematic review has identified the following factors associated with delirium occurrence. Those factors include advanced age, prior psychiatric condition, mild cognitive impairment, and cerebrovascular disease. Post-operative delirium is associated with prolonged duration of hospitalisation, post-operative complications and increased mortality.
There have been several reports linking reduced cerebral NIRS measurements, delirium and post-operative cognitive dysfunction among surgical populations. The mechanism through which reduced brain saturation and delirium co-exist could include cerebral malperfusion and venous congestion from right heart dysfunction. Those factors have been recently explored and their association with delirium and post-operative cognitive dysfunction has been reported in the ICU as well as in the operating room. As right heart dysfunction can be associated with prolonged period of venous hypertension, this can lead to interstitial edema which can further impairs end organ perfusion such as the brain. In the context of cardiopulmonary bypass (CPB), this phenomenon might be aggravated by alteration in endothelial glycocalyx resulting in increased permeability of the capillary endothelium. The resulting interstitial edema is thought to be a mediator of adverse outcomes in critically ill fluid overloaded patients. In addition to altered NIRS values observed with delirium after cardiac surgery, abnormal brain electrical activity has been described.
Brain electroencephalographic monitoring and delirium Electrical activity of the brain can be monitored through electroencephalography (EEG) and recently bedside monitor of pEEG such as the BIS (Medtronic, USA) or Sedline (Masimo Irvine CA) allow bedside measurement of frontal electrical activity. Delirium is associated with EEG changes, typically global slowing of EEG activity. Significant differences in EEG have been observed in elderly with or without delirium. The alpha, theta and delta wave power and the theta ratio in relation to the other EEG waves are different in patients with or without delirium. Furthermore, significant reduction in EEG activity leading to "burst-suppression" has been related to delirium appearance, prolonged hospital length of stay and mortality. Controversial results have been reported from studies and meta-analysis looking at intervention to correct those factors and improve outcome. However, these observations have never combined information obtained from frontal EEG with brain oximetry. A recent prospective study from Belgium reported an association with post-operative delirium and the information obtained from the combined use of brain NIRS and pEEG.
Previous work of delirium and brain oximetry and electroencephalographic monitoring In 2011, the investigators reported our first experience in the use of NIRS in 61 patients undergoing off-pump bypass cardiac surgery as a predictor post-operative cognitive dysfunction. In 2016, an observational study was conducted with 30 consecutive adults with delirium after cardiac surgery. The mean oximetry value decreased from (mean ± SD) 66.4 ± 6.7 to 50.8 ± 6.8 on the first day after delirium onset and increased in patients whose delirium resorbed over the 3 days. The relationship between oximetry, delirium diagnosis, and severity was analyzed with a marginal model and linear mixed models. Cerebral oximetry was related to delirium diagnosis (p≤.0001) and severity (p≤.0001). In that study, somatic oximetry values were normal in patients with delirium.
The second study, in 2017, was a case-control retrospective study which included 346 patients, of which 39 (11%), 104 (30%), and 142 (41%) patients presented delirium at 24, 48, and 72 hours post-ICU arrival, respectively. The cumulative fluid balance was associated with delirium occurrence (OR 1.20, 95% CI: 1.066-1.355, p=.003). History of neurological disorder, having both hearing and visual impairment, type of procedure, perioperative cerebral oximetry, mean pulmonary artery pressure pre-CPB, and mean arterial pressure post-CPB also contributed to delirium in the model.
In the third study, both a retrospective and prospective cohort were reported including a total of 382 patients. Adult patients who underwent portal venous pulsed-wave Doppler by the attending physician during usual care in the ICU were included in the retrospective cohort (n=237). For the prospective cohort (n=145), patients had a cognitive and echocardiographic evaluation the day before surgery and daily for three days after surgery. Delirium was independently assessed by the nursing staff in the prospective cohort. An association was found between delirium and portal vein pulsatility, a marker of right heart failure, in the retrospective cohort (OR:2.69 CI:1.47-4.90 p=0.001). In the prospective cohort, significant associations were confirmed 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:5.19 \[CI:2.27; 11.88\] p\<0.001) But also the association with delirium detected by the nursing staff was confirmed (HR:2.63 CI:1.13-6.11 p=0.025). Higher NT-pro-BNP 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. In this third study, baseline daily pEEG were obtained daily in combination with NIRS values. However, no association was observed between delirium and preliminary waveform analysis.
In summary, those studies support an association between episodes of cerebral desaturations measured by brain oximetry and the occurrence of delirium. Venous cerebral congestion as a consequence of right ventricular dysfunction leading to portal hypertension and possibly cytokine release through a cardio-intestinal syndrome appears to be a potential mechanism. As supported by other authors, reduced cerebral NIRS values could be secondary to elevated venous pressure, fluid overload and the latter contribute to a type of congestive delirium. It could also be reflective of increased cerebral metabolism, such as can be observed when patient emerge from general anesthesia after cardiac surgery. However, in those studies, only a single cerebral NIRS and pEEG value were obtained. The combination of both modalities with the use of bilateral cerebral NIRS was not studied prospectively in both the operating room and in the ICU. Currently, it is not known whether the information obtained by these monitors is different in patients presenting an episode of delirium compared to those who do not show any episode of postoperative delirium.
Conditions
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Delirium
Cerebral Desaturation
EEG With Abnormally Slow Frequencies
Study Design
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Observational Model Type
COHORT
Study Time Perspective
PROSPECTIVE
Eligibility Criteria
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Inclusion Criteria
* Male or female patients, age 18 and older, undergoing cardiac surgery with CPB or off pump CABG
Exclusion Criteria
* Patient with a critical pre-operative state defined as any of the following: vasopressor requirement, mechanical circulatory support, dialysis, mechanical ventilation, cardiac arrest necessitating resuscitation, aborted sudden death, preoperative cardiac massage, preoperative intra-aortic balloon pump.
* Patient with the diagnosis of delirium at any point before surgery during the current hospitalization
* Emergent surgery
* Surgery under deep hypothermic circulatory arrest
* Patient with the diagnosis of delirium at any point before surgery during the current hospitalization
* Emergent surgery
* Surgery under deep hypothermic circulatory arrest
Minimum Eligible Age
18 Years
Maximum Eligible Age
100 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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Masimo Corporation
INDUSTRY
Sponsor Role
collaborator
Montreal Heart Institute
OTHER
Sponsor Role
lead
Responsible Party
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Andre Denault
Principal Investigator
Responsibility Role
PRINCIPAL_INVESTIGATOR
Principal Investigators
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Andre Y Denault, MD, PhD
Role: PRINCIPAL_INVESTIGATOR
Montreal Heart Institute
Locations
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Montreal Heart Institute
Montreal, Quebec, Canada
Site Status
Countries
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Canada
References
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Benkreira A, Beaubien-Souligny W, Mailhot T, Bouabdallaoui N, Robillard P, Desjardins G, Lamarche Y, Cossette S, Denault A. Portal Hypertension Is Associated With Congestive Encephalopathy and Delirium After Cardiac Surgery. Can J Cardiol. 2019 Sep;35(9):1134-1141. doi: 10.1016/j.cjca.2019.04.006. Epub 2019 Apr 16.
Reference Type
BACKGROUND
Ameloot K, Genbrugge C, Meex I, Eertmans W, Jans F, De Deyne C, Dens J, Mullens W, Ferdinande B, Dupont M. Is venous congestion associated with reduced cerebral oxygenation and worse neurological outcome after cardiac arrest? Crit Care. 2016 May 15;20(1):146. doi: 10.1186/s13054-016-1297-2.
Reference Type
BACKGROUND
Svennevig K, Hoel T, Thiara A, Kolset S, Castelheim A, Mollnes T, Brosstad F, Fosse E, Svennevig J. Syndecan-1 plasma levels during coronary artery bypass surgery with and without cardiopulmonary bypass. Perfusion. 2008 May;23(3):165-71. doi: 10.1177/0267659108098215.
Reference Type
BACKGROUND
Bruegger D, Brettner F, Rossberg I, Nussbaum C, Kowalski C, Januszewska K, Becker BF, Chappell D. Acute degradation of the endothelial glycocalyx in infants undergoing cardiac surgical procedures. Ann Thorac Surg. 2015 Mar;99(3):926-31. doi: 10.1016/j.athoracsur.2014.10.013. Epub 2015 Jan 17.
Reference Type
BACKGROUND
Hori D, Max L, Laflam A, Brown C, Neufeld KJ, Adachi H, Sciortino C, Conte JV, Cameron DE, Hogue CW Jr, Mandal K. Blood Pressure Deviations From Optimal Mean Arterial Pressure During Cardiac Surgery Measured With a Novel Monitor of Cerebral Blood Flow and Risk for Perioperative Delirium: A Pilot Study. J Cardiothorac Vasc Anesth. 2016 Jun;30(3):606-12. doi: 10.1053/j.jvca.2016.01.012. Epub 2016 Jan 12.
Reference Type
BACKGROUND
Cerebral Oxygenation and Neurological Outcomes Following Critical Illness (CONFOCAL) Research Group; Canadian Critical Care Trials Group; Wood MD, Maslove DM, Muscedere JG, Day AG, Gordon Boyd J. Low brain tissue oxygenation contributes to the development of delirium in critically ill patients: A prospective observational study. J Crit Care. 2017 Oct;41:289-295. doi: 10.1016/j.jcrc.2017.06.009. Epub 2017 Jun 15.
Reference Type
BACKGROUND
Haggstrom L, Welschinger R, Caplan GA. Functional neuroimaging offers insights into delirium pathophysiology: A systematic review. Australas J Ageing. 2017 Sep;36(3):186-192. doi: 10.1111/ajag.12417. Epub 2017 May 18.
Reference Type
BACKGROUND
Lei L, Katznelson R, Fedorko L, Carroll J, Poonawala H, Machina M, Styra R, Rao V, Djaiani G. Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial. Anaesthesia. 2017 Dec;72(12):1456-1466. doi: 10.1111/anae.14056. Epub 2017 Sep 22.
Reference Type
BACKGROUND
Lopez MG, Pandharipande P, Morse J, Shotwell MS, Milne GL, Pretorius M, Shaw AD, Roberts LJ 2nd, Billings FT 4th. Intraoperative cerebral oxygenation, oxidative injury, and delirium following cardiac surgery. Free Radic Biol Med. 2017 Feb;103:192-198. doi: 10.1016/j.freeradbiomed.2016.12.039. Epub 2016 Dec 27.
Reference Type
BACKGROUND
Rogers CA, Stoica S, Ellis L, Stokes EA, Wordsworth S, Dabner L, Clayton G, Downes R, Nicholson E, Bennett S, Angelini GD, Reeves BC, Murphy GJ. Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery. Br J Anaesth. 2017 Sep 1;119(3):384-393. doi: 10.1093/bja/aex182.
Reference Type
BACKGROUND
Zorrilla-Vaca A, Healy R, Grant MC, Joshi B, Rivera-Lara L, Brown C, Mirski MA. Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials. Can J Anaesth. 2018 May;65(5):529-542. doi: 10.1007/s12630-018-1065-7. Epub 2018 Jan 18.
Reference Type
BACKGROUND
Momeni M, Meyer S, Docquier MA, Lemaire G, Kahn D, Khalifa C, Rosal Martins M, Van Dyck M, Jacquet LM, Peeters A, Watremez C. Predicting postoperative delirium and postoperative cognitive decline with combined intraoperative electroencephalogram monitoring and cerebral near-infrared spectroscopy in patients undergoing cardiac interventions. J Clin Monit Comput. 2019 Dec;33(6):999-1009. doi: 10.1007/s10877-019-00253-8. Epub 2019 Jan 11.
Reference Type
BACKGROUND
Taillefer MC, Denault AY. Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy. Can J Anaesth. 2005 Jan;52(1):79-87. doi: 10.1007/BF03018586.
Reference Type
BACKGROUND
Denault A, Deschamps A, Murkin JM. A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth. 2007 Dec;11(4):274-81. doi: 10.1177/1089253207311685.
Reference Type
BACKGROUND
Harel F, Denault A, Ngo Q, Dupuis J, Khairy P. Near-infrared spectroscopy to monitor peripheral blood flow perfusion. J Clin Monit Comput. 2008 Feb;22(1):37-43. doi: 10.1007/s10877-007-9105-9. Epub 2007 Nov 27.
Reference Type
BACKGROUND
Denault AY, Deschamps A, Couture P. Intraoperative hemodynamic instability during and after separation from cardiopulmonary bypass. Semin Cardiothorac Vasc Anesth. 2010 Sep;14(3):165-82. doi: 10.1177/1089253210376673. Epub 2010 Jul 23.
Reference Type
BACKGROUND
Denault AY, Haddad F, Jacobsohn E, Deschamps A. Perioperative right ventricular dysfunction. Curr Opin Anaesthesiol. 2013 Feb;26(1):71-81. doi: 10.1097/ACO.0b013e32835b8be2.
Reference Type
BACKGROUND
Denault AY, Couture P. Practical diastology. World J Anesthesiology. 2014;3(1):96-104
Reference Type
BACKGROUND
St-Pierre P, Deschamps A, Cartier R, Basmadjian AJ, Denault AY. Inhaled milrinone and epoprostenol in a patient with severe pulmonary hypertension, right ventricular failure, and reduced baseline brain saturation value from a left atrial myxoma. J Cardiothorac Vasc Anesth. 2014 Jun;28(3):723-9. doi: 10.1053/j.jvca.2012.10.017. Epub 2013 Apr 26. No abstract available.
Reference Type
BACKGROUND
Denault A, Lamarche Y, Rochon A, Cogan J, Liszkowski M, Lebon JS, Ayoub C, Taillefer J, Blain R, Viens C, Couture P, Deschamps A. Innovative approaches in the perioperative care of the cardiac surgical patient in the operating room and intensive care unit. Can J Cardiol. 2014 Dec;30(12 Suppl):S459-77. doi: 10.1016/j.cjca.2014.09.029. Epub 2014 Oct 5.
Reference Type
BACKGROUND
Laflamme M, Perrault LP, Carrier M, Elmi-Sarabi M, Fortier A, Denault AY. Preliminary experience with combined inhaled milrinone and prostacyclin in cardiac surgical patients with pulmonary hypertension. J Cardiothorac Vasc Anesth. 2015 Feb;29(1):38-45. doi: 10.1053/j.jvca.2014.06.012. Epub 2014 Oct 17.
Reference Type
BACKGROUND
Gebhard CE, Desjardins G, Gebhard C, Gavra P, Denault AY. Intratracheal Milrinone Bolus Administration During Acute Right Ventricular Dysfunction After Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2017 Apr;31(2):489-496. doi: 10.1053/j.jvca.2016.11.033. Epub 2016 Nov 22.
Reference Type
BACKGROUND
Hu T, Collin Y, Lapointe R, Carrier FM, Massicotte L, Fortier A, Lambert J, Vandenbroucke-Menu F, Denault AY. Preliminary Experience in Combined Somatic and Cerebral Oximetry Monitoring in Liver Transplantation. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):73-84. doi: 10.1053/j.jvca.2017.07.019. Epub 2017 Jul 20.
Reference Type
BACKGROUND
Lecluyse V, Couture EJ, Denault AY. A Proposed Approach to Cerebral and Somatic Desaturation in the Intensive Care Unit: Preliminary Experience and Review. J Cardiothorac Vasc Anesth. 2017 Oct;31(5):1805-1809. doi: 10.1053/j.jvca.2017.02.175. Epub 2017 Feb 20. No abstract available.
Reference Type
BACKGROUND
Couture EJ, Provencher S, Denault AY. Management of Severe Pulmonary Hypertensive Disease for Surgical and Nonsurgical Procedures. Int Anesthesiol Clin. 2018 Fall;56(4):e28-e55. doi: 10.1097/AIA.0000000000000202. No abstract available.
Reference Type
BACKGROUND
Denault AY, Brassard P, Jacquet-Lagreze M, Halwagi AE. Targeting optimal blood pressure monitoring: what's next? J Thorac Dis. 2018 Sep;10(Suppl 26):S3281-S3285. doi: 10.21037/jtd.2018.08.115. No abstract available.
Reference Type
BACKGROUND
Numan T, van den Boogaard M, Kamper AM, Rood PJT, Peelen LM, Slooter AJC; Dutch Delirium Detection Study Group. Delirium detection using relative delta power based on 1-minute single-channel EEG: a multicentre study. Br J Anaesth. 2019 Jan;122(1):60-68. doi: 10.1016/j.bja.2018.08.021. Epub 2018 Oct 2.
Reference Type
BACKGROUND
Paquet C, Deschamps A, Denault AY, Couture P, Carrier M, Babin D, Levesque S, Piquette D, Lambert J, Tardif JC. Baseline regional cerebral oxygen saturation correlates with left ventricular systolic and diastolic function. J Cardiothorac Vasc Anesth. 2008 Dec;22(6):840-6. doi: 10.1053/j.jvca.2008.02.013. Epub 2008 May 12.
Reference Type
BACKGROUND
Gelinas C, Choiniere M, Ranger M, Denault A, Deschamps A, Johnston C. Toward a new approach for the detection of pain in adult patients undergoing cardiac surgery: near-infrared spectroscopy--a pilot study. Heart Lung. 2010 Nov-Dec;39(6):485-93. doi: 10.1016/j.hrtlng.2009.10.018. Epub 2010 Apr 24.
Reference Type
BACKGROUND
de Tournay-Jette E, Dupuis G, Bherer L, Deschamps A, Cartier R, Denault A. The relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction in elderly patients after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2011 Feb;25(1):95-104. doi: 10.1053/j.jvca.2010.03.019. Epub 2010 Jul 22.
Reference Type
BACKGROUND
Deschamps A, Denault A, Rochon A, Cogan J, Page P, D'Antono B. Evaluation of autonomic reserves in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2013 Jun;27(3):485-93. doi: 10.1053/j.jvca.2012.07.016. Epub 2012 Oct 1.
Reference Type
BACKGROUND
Deschamps A, Lambert J, Couture P, Rochon A, Lebon JS, Ayoub C, Cogan J, Denault A. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. J Cardiothorac Vasc Anesth. 2013 Dec;27(6):1260-6. doi: 10.1053/j.jvca.2013.01.019. Epub 2013 Jun 18.
Reference Type
BACKGROUND
Mailhot T, Cossette S, Lambert J, Cournoyer A, Denault AY. Cerebral oximetry as a biomarker of postoperative delirium in cardiac surgery patients. J Crit Care. 2016 Aug;34:17-23. doi: 10.1016/j.jcrc.2016.02.024. Epub 2016 Mar 30.
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Other Identifiers
Review additional registry numbers or institutional identifiers associated with this trial.
2020-2667
Identifier Type: -
Identifier Source: org_study_id
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The Use of Cooling Helmet for Neuroprotection Management in Open Heart Surgery
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COMPLETED
NA
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COMPLETED
NA
Near Infrared Spectroscopy for Detection of Cerebral Desaturation After Positioning for Neurosurgical Procedures
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COMPLETED
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COMPLETED
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COMPLETED
NA
Association Between Local Cerebral Oxygenation Monitoring and Postoperative Delirium in Carotid Endarterectomy
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RECRUITING
Postoperative Delirium in Elderly Patients Undergoing Major Non-Cardiac Surgery in Singapore
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COMPLETED
Interest in Combining Intraoperative ElectroEncephaloGram (EEG) With Assessment of Frailty to Predict Postoperative Delirium in Patients Aged >75 Years Undergoing Major Non-cardiac Surgery
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RECRUITING
Cerebral Oxygen Desaturation and Post-Operative Delirium in Thoracic Surgical Patients
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UNKNOWN
Taking Brain Monitoring to the Next Level
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COMPLETED
NA