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Anticipating Postoperative Delirium During Cardiac Surgeries Involving Deep Hypothermia Circulatory Arrest

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Aortic aneurysms and dissections are life threatening conditions addressed by replacing damaged sections of the aorta. Blood circulation must be halted to facilitate repairs. Ischemia places the body, especially the brain, at risk of damage. Deep hypothermia circulatory arrest (DHCA)

Aortic aneurysms and dissections are life threatening conditions addressed by replacing damaged sections of the aorta. Blood circulation must be halted to facilitate repairs. Ischemia places the body, especially the brain, at risk of damage. Deep hypothermia circulatory arrest (DHCA) is employed to protect patients and provide time for surgeons to complete repairs on the basis that reducing body temperature suppresses the metabolic rate. Supplementary surgical techniques can be employed to reinforce the brain's protection and increase the duration circulation can be suspended. Even then, protection is not completely guaranteed though. A medical condition that can arise early in recovery is postoperative delirium, which is correlated with poor long term outcome. This study develops a methodology to intraoperatively monitor neurophysiology through electroencephalography (EEG) and anticipate postoperative delirium. The earliest opportunity to detect occurrences of complications through EEG is immediately following DHCA during warming. The first observable electrophysiological activity after being completely suppressed is a phenomenon known as burst suppression, which is related to the brain's metabolic state and recovery of nominal neurological function. A metric termed burst suppression duty cycle (BSDC) is developed to characterize the changing electrophysiological dynamics. Predictions of postoperative delirium incidences are made by identifying deviations in the way these dynamics evolve. Sixteen cases are examined in this study. Accurate predictions can be made, where on average 89.74% of cases are correctly classified when burst suppression concludes and 78.10% when burst suppression begins. The best case receiver operating characteristic curve has an area under its convex hull of 0.8988, whereas the worst case area under the hull is 0.7889. These results demonstrate the feasibility of monitoring BSDC to anticipate postoperative delirium during burst suppression. They also motivate a further analysis on identifying footprints of causal mechanisms of neural injury within BSDC. Being able to raise warning signs of postoperative delirium early provides an opportunity to intervene and potentially avert neurological complications. Doing so would improve the success rate and quality of life after surgery.

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2020