TY - JOUR
T1 - Anticipating Postoperative Delirium during Burst Suppression Using Electroencephalography
AU - Ma, Owen
AU - Crepeau, Amy Z.
AU - Dutta, Arindam
AU - Bliss, Daniel W.
N1 - Publisher Copyright:
© 1964-2012 IEEE.
PY - 2020/9
Y1 - 2020/9
N2 - Objective: This study develops an electro-encephalography-based method for predicting postoperative delirium early during cardiac surgeries involving deep hypothermia circulatory arrest (DHCA), potentially providing an opportunity to intervene and minimize poor surgical outcome. DHCA is a surgical technique used during cardiac surgeries to facilitate repairs. Deep hypothermia is induced and supplemented by perfusion techniques to protect the brain during circulatory arrest, but concern for cerebral injury still remains. Methods: This research studies whether or not monitoring burst suppression, an electrophysiological phenomenon observed during patient cooling and warming, helps in predicting postoperative delirium, a correlate of poor prognosis. A metric called the burst suppression duty cycle (BSDC), akin to burst suppression ratio, is formulated to characterize this electrophysiological activity. Results: Assuming no complications occur prior to circulatory arrest, delirium diagnoses are correlated with the time elapsed until suppression activity ceases since resuming cardiopulmonary bypass. By comparing against a benchmark the times when BSDC reaches 100%, 15 of 16 cases can be correctly predicted. Similar accuracy can be achieved when querying BSDC progress earlier during warming. Conclusion: Our results show that our BSDC metric is a promising candidate for early detection of postoperative delirium, and motivates further analysis of the causal relationship between postoperative delirium and the procedure transitioning out of circulatory arrest. Significance: The developed methodology anticipates incidences of postoperative delirium during rewarming, which potentially provides an opportunity to intervene and avert it.
AB - Objective: This study develops an electro-encephalography-based method for predicting postoperative delirium early during cardiac surgeries involving deep hypothermia circulatory arrest (DHCA), potentially providing an opportunity to intervene and minimize poor surgical outcome. DHCA is a surgical technique used during cardiac surgeries to facilitate repairs. Deep hypothermia is induced and supplemented by perfusion techniques to protect the brain during circulatory arrest, but concern for cerebral injury still remains. Methods: This research studies whether or not monitoring burst suppression, an electrophysiological phenomenon observed during patient cooling and warming, helps in predicting postoperative delirium, a correlate of poor prognosis. A metric called the burst suppression duty cycle (BSDC), akin to burst suppression ratio, is formulated to characterize this electrophysiological activity. Results: Assuming no complications occur prior to circulatory arrest, delirium diagnoses are correlated with the time elapsed until suppression activity ceases since resuming cardiopulmonary bypass. By comparing against a benchmark the times when BSDC reaches 100%, 15 of 16 cases can be correctly predicted. Similar accuracy can be achieved when querying BSDC progress earlier during warming. Conclusion: Our results show that our BSDC metric is a promising candidate for early detection of postoperative delirium, and motivates further analysis of the causal relationship between postoperative delirium and the procedure transitioning out of circulatory arrest. Significance: The developed methodology anticipates incidences of postoperative delirium during rewarming, which potentially provides an opportunity to intervene and avert it.
KW - Burst suppression
KW - cardiac surgery
KW - deep hypothermia circulatory arrest (DHCA)
KW - electroencephalography
KW - postoperative delirium
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U2 - 10.1109/TBME.2020.2967693
DO - 10.1109/TBME.2020.2967693
M3 - Article
C2 - 32031924
AN - SCOPUS:85089768739
SN - 0018-9294
VL - 67
SP - 2659
EP - 2668
JO - IEEE Transactions on Biomedical Engineering
JF - IEEE Transactions on Biomedical Engineering
IS - 9
M1 - 8984212
ER -