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Teng P, Liu H, Xu D, Feng X, Liu M, Wang Q. Effect of optimizing cerebral oxygen saturation on postoperative delirium in older patients undergoing one-lung ventilation for thoracoscopic surgery. J Int Med Res 2024; 52:3000605241274604. [PMID: 39275973 PMCID: PMC11406607 DOI: 10.1177/03000605241274604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/20/2024] [Indexed: 09/16/2024] Open
Abstract
OBJECTIVES This randomized controlled trial investigated whether the regional cerebral oxygenation saturation (rScO2)-guided lung-protective ventilation strategy could improve brain oxygen and reduce the incidence of postoperative delirium (POD) in patients older than 65 years. METHODS This randomized controlled trial enrolled 120 patients undergoing thoracic surgery who received one-lung ventilation (OLV). Patients were randomly assigned to the lung-protective ventilation group (PV group) or rScO2-oriented lung-protective ventilation group (TPV group). rScO2 was recorded during the surgery, and the occurrence of POD was assessed. RESULTS The incidence of POD 3 days after surgery-the primary outcome-was significantly lower in the TPV group (23.3% versus 8.5%). Meanwhile, the levels of POD-related biological indicators (S100β, neuron-specific enolase, tumor necrosis factor-α) were lower in the TPV group. Considering the secondary outcomes, both groups exhibited a lower oxygenation index after OLV, whereas partial pressure of carbon dioxide and mean arterial pressure were significantly increased in the TPV group. In addition, minimum rScO2 during surgery and mean rScO2 were higher in the TPV group than in the PV group. CONCLUSION Continuous intraoperative monitoring of brain tissue oxygenation and active intervention measures guided by cerebral oxygen saturation are critical for improving brain metabolism and reducing the risk of POD.
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Affiliation(s)
- Peilan Teng
- Department of Anesthesiology, Ganyu Hospital Affiliated to Kangda College of Nanjing Medical University, Lianyungang, China
- Department of Anesthesiology, the Affiliated Clinical College of Yangzhou Medical College, Jiangsu, China
| | - Henghua Liu
- Department of Anesthesiology, Ganyu Hospital Affiliated to Kangda College of Nanjing Medical University, Lianyungang, China
| | - Derong Xu
- Department of Anesthesiology, Ganyu Hospital Affiliated to Kangda College of Nanjing Medical University, Lianyungang, China
| | - Xuexin Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Miao Liu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingxiu Wang
- Department of Anesthesiology, Shanghai East Clinical Medical College, Nanjing Medical University, Nanjing, China
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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2
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Mochetti MM, Silva EGP, Correa AAF, Cabette MR, Perissinotti IN, E Silva LOJ, Pessoa ADS, de Oliveira RC, da Silva LFF, de Souza HP, de Alencar JCG. Neuron-specific enolase at admission as a predictor for stroke volume, severity and outcome in ischemic stroke patients: a prognostic biomarker review. Sci Rep 2024; 14:2688. [PMID: 38302568 PMCID: PMC10834412 DOI: 10.1038/s41598-024-53080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
An ideal blood biomarker for stroke should provide reliable results, enable fast diagnosis, and be readily accessible for practical use. Neuron-specific enolase (NSE), an enzyme released after neuronal damage, has been studied as a marker for brain injury, including cerebral infarction. However, different methodologies and limited sample sizes have restricted the applicability of any potential findings. This work aims to determine whether NSE levels at Emergency Department (ED) admission correlate with stroke severity, infarcted brain volume, functional outcome, and/or death rates. A systematic literature review was performed using PubMed, Embase, and Scopus databases. Each reviewer independently assessed all published studies identified as potentially relevant. All relevant original observational studies (cohort, case-control, and cross-sectional studies) were included. Eleven studies (1398 patients) met the inclusion criteria. Among these, six studies reported a significant correlation between NSE levels and stroke severity, while only one found no association. Four studies indicated a positive relationship between infarcted brain volume assessed by imaging and NSE levels, in contrast to the findings of only one study. Four studies identified an association related to functional outcome and death rates, while three others did not reach statistical significance in their findings. These data highlight that NSE levels at ED admissions proved to be a promising tool for predicting the outcome of ischemic stroke patients in most studies. However, they presented high discrepancies and low robustness. Therefore, further research is necessary to establish and define the role of NSE in clinical practice.
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Affiliation(s)
- Matheus Menão Mochetti
- Curso de Medicina, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil.
| | | | | | | | - Iago Navas Perissinotti
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Adriano de Souza Pessoa
- Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil
| | - Rodrigo Cardoso de Oliveira
- Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil
| | | | - Heraldo Possolo de Souza
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Júlio César Garcia de Alencar
- Curso de Medicina, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Mantovani L, Mikus E, Tenti E, Sangiorgi D, Zannoni S, Cavallucci A, Ferroni L, Cimaglia P, Tolio V, Tremoli E, Savini C. Post-Operative Delirium and Cognitive Dysfunction in Aged Patients Undergoing Cardiac Surgery: A Randomized Comparison between Two Blood Oxygenators. Bioengineering (Basel) 2023; 10:1429. [PMID: 38136021 PMCID: PMC10740454 DOI: 10.3390/bioengineering10121429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
In elderly patients undergoing cardiac surgery, extracorporeal circulation affects the incidence of post-operative delirium and cognitive impairment with an impact on quality of life and mortality. In this study, a new oxygenator system (RemoweLL 2) was tested against a conventional system to assess its efficacy in reducing the onset of postoperative delirium and cognitive dysfunction and the levels of serum inflammatory markers. A total of 154 patients (>65 y.o.) undergoing cardiopulmonary bypass (CPB) were enrolled and randomly assigned to oxygenator RemoweLL 2 (n = 81) or to gold standard device Inspire (n = 73) between September 2019 and March 2022. The aims of the study were to assess the incidence of delirium and the cognitive decline by neuropsychiatric tests and the MoCa test intra-hospital and at 6 months after CPB. Inflammation biomarkers in both groups were also evaluated. Before the CPB, the experimental groups were comparable for all variables. After CPB, the incidence of severe post-operative delirium showed a better trend (p = 0.093) in patients assigned to RemoweLL 2 (16.0%) versus Inspire (26.0%). Differences in enolase levels (p = 0.049), white blood cells (p = 0.006), and neutrophils (p = 0.003) in favor of RemoweLL 2 were also found. The use of novel and better construction technologies in CPB oxygenator devices results in measurable better neurocognitive and neurological outcomes in the elderly population undergoing CPB.
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Affiliation(s)
- Lorenzo Mantovani
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (L.M.); (E.T.); (D.S.); (S.Z.); (A.C.); (L.F.); (V.T.); (E.T.); (C.S.)
| | - Elisa Mikus
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (L.M.); (E.T.); (D.S.); (S.Z.); (A.C.); (L.F.); (V.T.); (E.T.); (C.S.)
| | - Elena Tenti
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (L.M.); (E.T.); (D.S.); (S.Z.); (A.C.); (L.F.); (V.T.); (E.T.); (C.S.)
| | - Diego Sangiorgi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (L.M.); (E.T.); (D.S.); (S.Z.); (A.C.); (L.F.); (V.T.); (E.T.); (C.S.)
| | - Samantha Zannoni
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (L.M.); (E.T.); (D.S.); (S.Z.); (A.C.); (L.F.); (V.T.); (E.T.); (C.S.)
| | - Andrea Cavallucci
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (L.M.); (E.T.); (D.S.); (S.Z.); (A.C.); (L.F.); (V.T.); (E.T.); (C.S.)
| | - Letizia Ferroni
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (L.M.); (E.T.); (D.S.); (S.Z.); (A.C.); (L.F.); (V.T.); (E.T.); (C.S.)
| | - Paolo Cimaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy;
| | - Valentina Tolio
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (L.M.); (E.T.); (D.S.); (S.Z.); (A.C.); (L.F.); (V.T.); (E.T.); (C.S.)
| | - Elena Tremoli
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (L.M.); (E.T.); (D.S.); (S.Z.); (A.C.); (L.F.); (V.T.); (E.T.); (C.S.)
| | - Carlo Savini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (L.M.); (E.T.); (D.S.); (S.Z.); (A.C.); (L.F.); (V.T.); (E.T.); (C.S.)
- Department of Experimental Diagnostic and Surgical Medicine (DIMEC), University of Bologna, 40126 Bologna, Italy
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Nübel J, Buhre C, Hoffmeister M, Oess S, Labrenz O, Jost K, Hauptmann M, Schön J, Fritz G, Butter C, Haase-Fielitz A. Association between Neuron-Specific Enolase, Memory Function, and Postoperative Delirium after Transfemoral Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:441. [PMID: 37998499 PMCID: PMC10672434 DOI: 10.3390/jcdd10110441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Although transfemoral aortic valve replacement (TAVR) is a safe treatment for elderly patients with severe aortic valve stenosis, postoperative microembolism has been described. In this secondary endpoint analysis of the POST-TAVR trial, we aimed to investigate whether changes in neuron-specific enolase (NSE)-a biomarker of neuronal damage-are associated with changes in memory function or postoperative delirium (POD). MATERIALS AND METHODS This was a prospective single-center study enrolling patients undergoing elective TAVR. Serum NSE was measured before and 24 h after TAVR. POD was diagnosed using CAM-ICU testing. Memory function was assessed before TAVR and before hospital discharge using the "Consortium to Establish a Registry for Alzheimer's Disease" (CERAD) word list and the digit span task (DST) implemented in "∆elta-App". RESULTS Subjects' median age was 82 years (25th to 75th percentile: 77.5-85.0), 42.6% of subjects were women. CERAD scores significantly increased from pre- to post-TAVR, with p < 0.001. POD occurred in 4.4% (6/135) of subjects at median 2 days after TAVR. After TAVR, NSE increased from a median of 1.85 ng/mL (1.30-2.53) to 2.37 ng/mL (1.69-3.07), p < 0.001. The median increase in NSE was 40.4% (13.1-138.0) in patients with POD versus 17.3% (3.3-43.4) in those without POD (p = 0.17). CONCLUSIONS Memory function improved after TAVR, likely due to learning effects, with no association to change in NSE. Patients with POD appear to have significantly higher postoperative levels of NSE compared to patients without POD after TAVR. This finding suggests that neuronal damage, as indicated by NSE elevation, may not significantly impair assessed memory function after TAVR.
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Affiliation(s)
- Jonathan Nübel
- Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany
| | - Charlotte Buhre
- Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany
| | - Meike Hoffmeister
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany
- Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg an der Havel, Germany
| | - Stefanie Oess
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany
- Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg an der Havel, Germany
| | - Oliver Labrenz
- Department of Psychology, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Kerstin Jost
- Department of Psychology, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Michael Hauptmann
- Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Julika Schön
- Anesthesia and Intensive Care, University Hospital Ruppin Brandenburg (UKRB), Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Georg Fritz
- Department of Anesthesiology, Intensive Care and Pain Therapy, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany
| | - Christian Butter
- Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
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5
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Huang Q, Zhou R, Hao X, Zhang W, Chen G, Zhu T. Circulating biomarkers in perioperative management of cancer patients. PRECISION CLINICAL MEDICINE 2023; 6:pbad018. [PMID: 37954451 PMCID: PMC10634636 DOI: 10.1093/pcmedi/pbad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/27/2023] [Indexed: 11/14/2023] Open
Abstract
Owing to the advances in surgical technology, most solid tumours can be controlled by surgical excision. The priority should be tumour control, while some routine perioperative management might influence cancer progression in an unnoticed way. Moreover, it is increasingly recognized that effective perioperative management should include techniques to improve postoperative outcomes. These influences are elucidated by the different functions of circulating biomarkers in cancer patients. Here, circulating biomarkers with two types of clinical functions were reviewed: (i) circulating biomarkers for cancer progression monitoring, for instance, those related to cancer cell malignancy, tumour microenvironment formation, and early metastasis, and (ii) circulating biomarkers with relevance to postoperative outcomes, including systemic inflammation, immunosuppression, cognitive dysfunction, and pain management. This review aimed to provide new perspectives for the perioperative management of patients with cancer and highlight the potential clinical translation value of circulating biomarkers in improving outcomes.
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Affiliation(s)
- Qiyuan Huang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ruihao Zhou
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xuechao Hao
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Weiyi Zhang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guo Chen
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tao Zhu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
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Lozano-Vicario L, García-Hermoso A, Cedeno-Veloz BA, Fernández-Irigoyen J, Santamaría E, Romero-Ortuno R, Zambom-Ferraresi F, Sáez de Asteasu ML, Muñoz-Vázquez ÁJ, Izquierdo M, Martínez-Velilla N. Biomarkers of delirium risk in older adults: a systematic review and meta-analysis. Front Aging Neurosci 2023; 15:1174644. [PMID: 37251808 PMCID: PMC10213257 DOI: 10.3389/fnagi.2023.1174644] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Delirium is a neuropsychiatric syndrome associated with increased morbidity and mortality in older patients. The aim of this study was to review predictive biomarkers of delirium in older patients to gain insights into the pathophysiology of this syndrome and provide guidance for future studies. Two authors independently and systematically searched MEDLINE, Embase, Cochrane Library, Web of Science and Scopus databases up to August 2021. A total of 32 studies were included. Only 6 studies were eligible for the meta-analysis, pooled results showed a significant increase in some serum biomarkers (C-reactive protein [CRP], tumour necrosis factor alpha [TNF-α] and interleukin-6 [IL-6]) among patients with delirium (odds ratio = 1.88, 95% CI 1.01 to 1.637; I2 = 76.75%). Although current evidence does not favour the use of any particular biomarker, serum CRP, TNF-α, and IL-6 were the most consistent biomarkers of delirium in older patients.
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Affiliation(s)
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | | | - Joaquín Fernández-Irigoyen
- Proteomics Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | - Enrique Santamaría
- Proteomics Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
| | | | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel L. Sáez de Asteasu
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | | | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Martínez-Velilla
- Geriatric Unit, Hospital Universitario de Navarra (HUN), Pamplona, Spain
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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7
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Vasunilashorn SM, Lunardi N, Newman JC, Crosby G, Acker L, Abel T, Bhatnagar S, Cunningham C, de Cabo R, Dugan L, Hippensteel JA, Ishizawa Y, Lahiri S, Marcantonio ER, Xie Z, Inouye SK, Terrando N, Eckenhoff RG. Preclinical and translational models for delirium: Recommendations for future research from the NIDUS delirium network. Alzheimers Dement 2023; 19:2150-2174. [PMID: 36799408 PMCID: PMC10576242 DOI: 10.1002/alz.12941] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 02/18/2023]
Abstract
Delirium is a common, morbid, and costly syndrome that is closely linked to Alzheimer's disease (AD) and AD-related dementias (ADRD) as a risk factor and outcome. Human studies of delirium have advanced our knowledge of delirium incidence and prevalence, risk factors, biomarkers, outcomes, prevention, and management. However, understanding of delirium neurobiology remains limited. Preclinical and translational models for delirium, while challenging to develop, could advance our knowledge of delirium neurobiology and inform the development of new prevention and treatment approaches. We discuss the use of preclinical and translational animal models in delirium, focusing on (1) a review of current animal models, (2) challenges and strategies for replicating elements of human delirium in animals, and (3) the utility of biofluid, neurophysiology, and neuroimaging translational markers in animals. We conclude with recommendations for the development and validation of preclinical and translational models for delirium, with the goal of advancing awareness in this important field.
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Affiliation(s)
- Sarinnapha M. Vasunilashorn
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nadia Lunardi
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA
| | - John C. Newman
- Department of Medicine, University of California, San Francisco, California, USA
- Buck Institute for Research on Aging, Novato, California, USA
| | - Gregory Crosby
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Leah Acker
- Department of Anesthesiology, Duke University, Durham, Massachusetts, USA
| | - Ted Abel
- Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Seema Bhatnagar
- Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Colm Cunningham
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - Rafael de Cabo
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Laura Dugan
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, USA
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Joseph A. Hippensteel
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yumiko Ishizawa
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shouri Lahiri
- Department of Neurology, Neurosurgery, and Biomedical Sciences, Cedar-Sinai Medical Center, Los Angeles, California, USA
| | - Edward R. Marcantonio
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Zhongcong Xie
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sharon K. Inouye
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Niccolò Terrando
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Cell Biology, Duke University, Durham, North Carolina, USA
- Department of Immunology, Duke University, Durham, North Carolina, USA
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, USA
| | - Roderic G. Eckenhoff
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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8
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de Alencar JCG, Garcez FB, Pinto AAS, Silva LOJE, Soler LDM, Fernandez SSM, Van Vaisberg V, Gomez Gomez LM, Ribeiro SML, Avelino-Silva TJ, Souza HP. Brain injury biomarkers do not predict delirium in acutely ill older patients: a prospective cohort study. Sci Rep 2023; 13:4964. [PMID: 36973363 PMCID: PMC10041516 DOI: 10.1038/s41598-023-32070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Delirium is a common, serious, and often preventable neuropsychiatric emergency mostly characterized by a disturbance in attention and awareness. Systemic insult and inflammation causing blood-brain-barrier (BBB) damage and glial and neuronal activation leading to more inflammation and cell death is the most accepted theory behind delirium's pathophysiology. This study aims to evaluate the relationship between brain injury biomarkers on admission and delirium in acutely ill older patients. We performed a prospective cohort study which analyzed plasma S100B levels at admission in elderly patients. Our primary outcome was delirium diagnosis. Secondary outcomes were association between S100B, NSE and Tau protein and delirium diagnosis and patients' outcomes (admissions to intensive care, length of hospital stay, and in-hospital mortality). We analyzed 194 patients, and 46 (24%) developed delirium, 25 on admission and 21 during hospital stay. Median of S100B at admission in patients who developed delirium was 0.16 and median was 0.16 in patients who didn't develop delirium (p: 0.69). Levels S100B on admission did not predict delirium in acutely ill elderly patients.Trial registration: The study was approved by the local institutional review board (CAPPESq, no. 77169716.2.0000.0068, October 11, 2017) and registered in Brazilian Clinical Trials Registry (ReBEC, no. RBR-233bct).
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Affiliation(s)
- Júlio César Garcia de Alencar
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
- Curso de Medicina, Faculdade de Odontologia de Bauru, Universidade de São Paulo, 9, Dr. Octávio Pinheiro Brisolla, Bauru, SP, 17012-901, Brazil.
| | - Flávia Barreto Garcez
- Hospital Universitário, Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | | | | | - Lucas de Moraes Soler
- Disciplina de Nefrologia, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo, São Paulo, Brazil
| | | | - Victor Van Vaisberg
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luz Marina Gomez Gomez
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Heraldo Possolo Souza
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Wang JH, Liu T, Bai Y, Chen YQ, Cui YH, Gao XY, Guo JR. The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty. Front Pharmacol 2023; 14:947982. [PMID: 37025488 PMCID: PMC10072322 DOI: 10.3389/fphar.2023.947982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 02/15/2023] [Indexed: 04/08/2023] Open
Abstract
Objective: This study aimed to clarify the effect of parecoxib sodium on the occurrence of postoperative delirium and to investigate its possible mechanism. Methods: A total of 80 patients who underwent elective hip arthroplasty in our hospital between December 2020 and December 2021 were selected and randomly divided into two groups: a parecoxib sodium group (group P, n = 40) and a control group (group C, n = 40). Patients in group P were intravenously injected with 40 mg of parecoxib sodium 30 min before anesthesia and at the end of the surgery. Patients in group C were intravenously injected with the same volume of normal saline at the same time points. The primary endpoint was the incidence of POD, and the secondary endpoints were the levels of inflammatory factors (tumor necrosis factor- α [TNF-α], interleukin [IL]-1β, IL-6, and IL-10), nerve injury-related factors (brain-derived neurotrophic factor [BDNF], S-100β protein, neuron-specific enolase [NSE], and neurofilament light chain [NfL]), and antioxidant factors (heme oxygenase-1 [HO-1]), as well as the Visual Analogue Scale (VAS) and Confusion Assessment Method-Chinese Reversion (CAM-CR) scores. Results: The incidence of POD was 10% in group P and 27.5% in group C. Intergroup comparison revealed that the levels of TNF-α, IL-1β, S-100β, NfL, and NSE were lower, and BDNF was higher, in group P than in group C at each postoperative time point. The levels of IL-6 were lower, and the levels of IL-10 and HO-1 were higher, in group P than in group C at 1 h and 1 day postoperatively (p < 0.05). Three days after surgery, the differences in the levels of IL-6, IL-10, and HO-1 were not statistically significant between the two groups (p > 0.05). The VAS and CAM-CR scores were lower at each postoperative time point in group P than in group C (p < 0.05). Conclusion: Parecoxib sodium could reduce postoperative pain, decrease the plasma levels of inflammatory and nerve injury-related factors, upregulate HO-1 levels, and reduce the incidence of POD. The results of this study suggest that parecoxib sodium may reduce the occurrence of POD through the effects of anti-inflammation, analgesia, and antioxidants.
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Affiliation(s)
- Jin-Huo Wang
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Tong Liu
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yu Bai
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yong-Quan Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Ying-Hui Cui
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xin-Yue Gao
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
- *Correspondence: Xin-Yue Gao, Jian-Rong Guo,
| | - Jian-Rong Guo
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
- *Correspondence: Xin-Yue Gao, Jian-Rong Guo,
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Zhang W, Han S, Li J. Effects of individualized PEEP on postoperative delirium among older patients in prone position: study protocol for a prospective randomized controlled trial. BMC Neurol 2022; 22:459. [PMID: 36494654 PMCID: PMC9733048 DOI: 10.1186/s12883-022-02990-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Postoperative delirium (POD) is an acute mental disorder that often occurs in the elderly after surgery. It can delay functional recovery, extend hospital stay, and increase 1-year mortality and financial costs. Studies have shown that inflammation and cerebral desaturation are the potential pathogenesis of postoperative delirium. Prone-position surgery increases peak airway pressure and decreases lung compliance, exacerbating ventilator-induced inflammation response, as well as the decrease of the patient's cerebral oxygen saturation. Recent studies demonstrated that lung-protective ventilation strategy could reduce inflammatory response and improve cerebral oxygen saturation (rSO2) to prevent POD. In this trial, we aim to investigate the effect of the individualized PEEP on postoperative delirium in elderly patients during prone position. METHODS A prospective, randomized clinical trial will be performed in Hebei General Hospital. 106 patients undergoing elective surgery in prone position will be randomly divided into controlled group (group C) and individualized PEEP group (group I). Lung-protective ventilation with tidal volume of 6ml/kg predictive body weight (PBW) and positive end-expiratory pressure (PEEP) of 5 cm H2O will be applied to patients in group C. Patients in group I will receive the same tidal volume as described in group C plus individualized PEEP corresponding to the maximum dynamic compliance (Cdyn) in the titration method. Our primary endpoint is the prevalence of postoperative delirium based on the Confusion Assessment Method (CAM) until postoperative day 3. Secondary endpoints include the intraoperative rSO2, respiratory variables, arterial blood gases, lung ultrasound score (LUS), postoperative VAS score, and plasma concentrations of IL-6, IL-1β and neuron-specific enolase (NSE). DISCUSSION The results of the current protocol might provide evidence for individualized PEEP to prevent POD among older surgical patients in prone position. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2200056001). Registered 2022 January 30, http://www.chictr.org.cn/index.aspx .
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Affiliation(s)
- Wenchao Zhang
- grid.440208.a0000 0004 1757 9805Department of Anesthesiology, Hebei General Hospital, 050051 Shijiazhuang, Hebei Province China ,grid.412026.30000 0004 1776 2036Graduate Faculty, Hebei North University, 075000 Zhangjiakou, Hebei Province China
| | - Shuang Han
- grid.440208.a0000 0004 1757 9805Department of Anesthesiology, Hebei General Hospital, 050051 Shijiazhuang, Hebei Province China
| | - Jianli Li
- grid.440208.a0000 0004 1757 9805Department of Anesthesiology, Hebei General Hospital, 050051 Shijiazhuang, Hebei Province China
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