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

Objective(s): To investigate whether cerebral oximetry index (COx)-guided blood pressure management during cardiopulmonary bypass (CPB) could reduce postoperative delirium (POD) in patients undergoing acute type A aortic dissection (ATAAD) repair.

Design: A prospective, randomized controlled trial.

Setting: Patients undergoing ATAAD repair with CPB.

Participants: 157 patients with ATAAD were randomly assigned to COx-guided management (n = 76) or conventional blood pressure management (n = 81) during CPB.

Interventions: COx-guided blood pressure management (intervention group) versus conventional blood pressure management (control group) during CPB.

Measurements and main results: The primary outcome was POD incidence within the first 7 postoperative days (significantly lower in the COx-guided group: 15% v 30%, p = 0.039). Secondary outcomes included lower delirium severity (Delirium Rating Scale-Revised-98 score: 5 v 10, p = 0.033), shorter POD duration (0 v 2 days, p = 0.045), reduced postoperative cerebral infarction (1.3% v 8.6%, p = 0.037), and reduced acute kidney injury (27.6% v 43.2%, p = 0.042) in the COx-guided group. Shorter time to extubation (16.9 v 18.4 hours, p = 0.027) and reduced intensive care unit stay (7.3 v 8.2 days, p = 0.042) were observed in the COx-guided group.

Conclusions: COx-guided blood pressure management during CPB was associated with reduced incidence and severity of POD following ATAAD surgery. This approach also showed potential benefits in reducing postoperative complications and improving early recovery outcomes. Further multicenter studies are needed to confirm these findings.