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Chavez-Valdez R, Northington FJ, Sharp A, Burton VJ, Lammert DB, Jantzie LL, Robinson S, Stafstrom CE, Ferriero D, Gano D, Numis A, Gerner G, Scafidi J, Gilmore M, Allen MC, Hilberg M, Parkinson C. Correspondence on "Recognition and Management of Delirium in the Neonatal Intensive Care Unit: Case Series From a Single-Center Level IV Intensive Care Unit". J Child Neurol 2024:8830738241259054. [PMID: 38819375 DOI: 10.1177/08830738241259054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Affiliation(s)
| | - Frances J Northington
- Division of Neonatology, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Neuroscience Intensive Care Nursery (NICN) Program, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Dawn B Lammert
- Neuroscience Intensive Care Nursery (NICN) Program, Johns Hopkins University, Baltimore, MD, USA
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lauren L Jantzie
- Division of Neonatology, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Neuroscience Intensive Care Nursery (NICN) Program, Johns Hopkins University, Baltimore, MD, USA
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Shenandoah Robinson
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carl E Stafstrom
- Neuroscience Intensive Care Nursery (NICN) Program, Johns Hopkins University, Baltimore, MD, USA
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Adam Numis
- Department of Pediatrics and Neurology, University of California, San Francisco, CA, USA
| | - Gwendolyn Gerner
- Neuroscience Intensive Care Nursery (NICN) Program, Johns Hopkins University, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Joseph Scafidi
- Neuroscience Intensive Care Nursery (NICN) Program, Johns Hopkins University, Baltimore, MD, USA
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | | | - Marilee C Allen
- Division of Neonatology, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Neuroscience Intensive Care Nursery (NICN) Program, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle Hilberg
- Neuroscience Intensive Care Nursery (NICN) Program, Johns Hopkins University, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Charlamaine Parkinson
- Division of Neonatology, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Neuroscience Intensive Care Nursery (NICN) Program, Johns Hopkins University, Baltimore, MD, USA
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Song YX, Wang Q, Ma YL, Chen KS, Liu M, Zhou XF, Zhao H, Lou JS, Li H, Liu YH, Mi WD, Cao JB. Preoperative prognostic nutritional index predicts postoperative delirium in aged patients after surgery: A matched cohort study. Gen Hosp Psychiatry 2024; 86:58-66. [PMID: 38101151 DOI: 10.1016/j.genhosppsych.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Prognostic nutritional index (PNI) is an indicator to evaluate the nutritional immune status of patients. This study aimed to assess whether preoperative PNI could predict the occurrence of postoperative POD in aged patients undergoing non-neurosurgery and non-cardiac surgery. METHOD The aged patients undergoing non-neurosurgery and non-cardiac surgery between January 2014 and August 2019 were included in the retrospective cohort study. The correlation between POD and PNI was investigated by univariate and multivariable logistic regression analysis, propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and subgroup analysis. RESULTS In the cohort (n = 29,814), the cutoff value of PNI was 46.01 determined by the receiver operating characteristic (ROC) curve. In univariate and three multivariable regression analysis, the ORs of PNI ≤ 46.01 was 2.573(95% CI:2.261-2.929, P < 0.001),1.802 (95% CI:1.567-2.071, P < 0.001),1.463(95% CI:1.246-1.718, P < 0.001),1.370(95% CI:1.165-1.611, P < 0.001). In the PSM model and IPTW model, the ORs of PNI ≤ 46.01 were 1.424(95% CI:1.172-1.734, P < 0.001) and 1.356(95% CI:1.223-1.505, P < 0.001). CONCLUSION The PNI was found to have a predictive value for POD in patients undergoing non-neurosurgery and non-cardiac surgery. Improving preoperative nutritional status may be beneficial in preventing POD for aged patients.
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Affiliation(s)
- Yu-Xiang Song
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Qian Wang
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese People's Liberation Army, Beijing 100853, China
| | - Yu-Long Ma
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Kun-Sha Chen
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese People's Liberation Army, Beijing 100853, China
| | - Min Liu
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Xue-Feng Zhou
- Hangzhou Le9 Healthcare Technology Co., Ltd, Hangzhou 311215, China
| | - Hong Zhao
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China
| | - Jing-Sheng Lou
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Hao Li
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yan-Hong Liu
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Wei-Dong Mi
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China.
| | - Jiang-Bei Cao
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China.
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Takeuchi M, Suzuki H, Matsumoto Y, Kikuchi Y, Takanami K, Wagatsuma T, Sugisawa J, Tsuchiya S, Nishimiya K, Hao K, Godo S, Shindo T, Shiroto T, Takahashi J, Kumagai K, Kohzuki M, Takase K, Saiki Y, Yasuda S, Shimokawa H. Prediction of the development of delirium after transcatheter aortic valve implantation using preoperative brain perfusion SPECT. PLoS One 2022; 17:e0276447. [PMID: 36327325 PMCID: PMC9632803 DOI: 10.1371/journal.pone.0276447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Delirium is an important prognostic factor in postoperative patients undergoing cardiovascular surgery and intervention, including transcatheter aortic valve implantation (TAVI). However, delirium after transcatheter aortic valve implantation (DAT) is difficult to predict and its pathophysiology is still unclear. We aimed to investigate whether preoperative cerebral blood flow (CBF) is associated with DAT and, if so, whether CBF measurement is useful for predicting DAT. Methods We evaluated CBF in 50 consecutive patients before TAVI (84.7±4.5 yrs., 36 females) using 99mTc ethyl cysteinate dimer single-photon emission computed tomography. Preoperative CBF of the DAT group (N = 12) was compared with that of the non-DAT group (N = 38) using whole brain voxel-wise analysis with SPM12 and region of interest-based analysis with the easy-Z score imaging system. Multivariable logistic regression analysis with the presence of DAT was used to create its prediction model. Results The whole brain analysis showed that preoperative CBF in the insula was lower in the DAT than in the non-DAT group (P<0.05, family-wise error correction). Decrease extent ratio in the insula of the DAT group (17.6±11.5%) was also greater relative to that of the non-DAT group (7.0±11.3%) in the region of interest-based analysis (P = 0.007). A model that included preoperative CBF in the insula and conventional indicators (frailty index, short physical performance battery and mini-mental state examination) showed the best predictive power for DAT (AUC 0.882). Conclusions These results suggest that preoperative CBF in the insula is associated with DAT and may be useful for its prediction.
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Affiliation(s)
- Masashi Takeuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Rehabilitation Medicine, Tohoku University Hospital, Sendai, Japan
| | - Hideaki Suzuki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Division of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshihiro Wagatsuma
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiichiro Kumagai
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Kohzuki
- Department of Rehabilitation Medicine, Tohoku University Hospital, Sendai, Japan
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- National Cerebral and Cardiovascular Center, Suita, Japan
- * E-mail:
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
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Abstract
An aging-related reduction in the brain's functional reserve may explain why delirium is more frequent in the elderly than in younger people insofar as the reserve becomes inadequate to cover the metabolic requirements that are critically increased by stressors. The aim of this paper is to review the normal aging-related changes that theoretically compromise complex mental activities, neuronal and synaptic densities, and the neurocomputational flexibility of the functional reserve. A pivotal factor is diminished connectivity, which is substantially due to the loss of synapses and should specifically affect association systems and cholinergic fibres in delirious patients. However, micro-angiopathy with impaired blood flow autoregulation, increased blood/brain barrier permeability, changes in cerebrospinal fluid dynamics, weakened mitochondrial performance, and a pro-inflammatory involution of the immune system may also jointly affect neurons and their synaptic assets, and even cause the progression of delirium to dementia regardless of the presence of co-existing plaques, tangles, or other pathological markers. On the other hand, the developmental growth in functional reserve during childhood and adolescence makes the brain increasingly resistant to delirium, and residual reserve can allow the elderly to recover. These data support the view that functional reserve is the variable that confronts stressors and governs the risk and intensity of and recovery from delirium. Although people of any age are at risk of delirium, the elderly are at greater risk because aging and age-dependent structural changes inevitably affect the brain's functional reserve.
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