Cerebral Oximetry Index-Guided Blood Pressure Management During Cardiopulmonary Bypass Reduces Postoperative Delirium in Patients with Acute Type A Aortic Dissection.

Summary

In a single-center RCT of 157 ATAAD patients on CPB, COx-guided individualized blood pressure management halved postoperative delirium (15% vs 30%) and reduced delirium severity/duration, cerebral infarction, and acute kidney injury. Extubation times and ICU length of stay were also shorter with COx guidance.

Key Findings

• Postoperative delirium incidence was reduced from 30% (control) to 15% with COx-guided management (p=0.039).
• Delirium severity and duration were lower (DRS-R-98: 5 vs 10; POD duration 0 vs 2 days).
• Lower rates of postoperative cerebral infarction (1.3% vs 8.6%) and acute kidney injury (27.6% vs 43.2%); faster extubation (16.9 vs 18.4 h) and shorter ICU stay (7.3 vs 8.2 days).

Clinical Implications

Consider incorporating COx-guided individualized MAP targets during CPB to reduce postoperative delirium and complications in ATAAD repair. Implementation requires near-infrared cerebral oximetry with COx computation and protocolized responses.

Limitations

• Single-center study with modest sample size and potential lack of blinding.
• Short delirium assessment window (first 7 postoperative days) and no long-term cognitive follow-up.

Future Directions

Multicenter trials to validate COx-guided hemodynamic targets, assess long-term neurocognitive outcomes, and define implementation pathways across diverse cardiac procedures.