AUTHOR=Fuest Kristina E. , Servatius Ariane , Ulm Bernhard , Schaller Stefan J. , Jungwirth Bettina , Blobner Manfred , Schmid Sebastian 

TITLE=Perioperative Hemodynamic Optimization in Patients at Risk for Delirium – A Randomized-Controlled Trial

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.893459

DOI=10.3389/fmed.2022.893459

ISSN=2296-858X

ABSTRACT=Background: Postoperative delirium is common in elderly patients and associated with increased morbidity and mortality. We evaluated in this pilot study whether a perioperative goal-directed hemodynamic optimization algorithm improves cerebral oxygenation and can reduce the incidence of delirium.
Methods: Patients older than 70 years with high risk for postoperative delirium undergoing elective non-cardiac surgery were randomized to an intervention or control group. Patients in the intervention group received a perioperative hemodynamic optimization protocol based on uncalibrated pulse-contour analysis. Patients in the control group were managed according to usual standard of care. Incidence of delirium until day seven was assessed with confusion assessment method and chart review. Cerebral oxygenation was measured with near-infrared spectroscopy.
Results: Delirium was present in 13 of 85 (15%) patients in the intervention group and 18 of 87 (21%) in the control group (risk difference [RD] -5.4%; 95% confidence interval [CI], -16.8 to 6.1%; P = 0.47). Intervention did not influence length of stay in hospital or in-hospital mortality. Amounts of fluids and vasopressors applied, mean arterial pressure, cardiac index, and near-infrared spectroscopy values were comparable between groups. 
Conclusions: The hemodynamic algorithm applied in high-risk non-cardiac surgery patients did not change hemodynamic interventions, did not improve patient hemodynamics, and failed to increase cerebral oxygenation. An effect on the incidence of postoperative delirium could not be observed.
Trial registration: Clinicaltrials.gov identifier: NCT01827501 Registered April 2013