DG Journal Club
Clin Transplant. 2022 Aug 27
INTRODUCTION Delirium occurs frequently after lung transplantation and is associated with poor clinical outcomes. Significantly prolonged jugular venous congestion (JVC) occurs during off-pump lung transplantation and is thought to impair cerebral perfusion. Our study aimed to test the hypothesis that increased intraoperative JVC is associated with an increased risk of postoperative delirium among lung transplantation recipients.
METHODS This is a retrospective observational cohort study. Adult patients who received off-pump lung transplantation at the Vanderbilt University Medical Center between 2006 and 2016 are included. The magnitude of JVC was calculated by the area under curve (AUC) of the CVP above the threshold of 12 mmHg. Postoperative delirium was assessed by Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) criteria during their ICU stay. Multivariate regression analysis was used to determine the association of intraoperative JVC with postoperative delirium, adjusting for baseline demographics, surgical and intraoperative characteristics.
RESULTS Thirty-two (23.5%) out of 136 patients developed delirium in the ICU. There was no statistical difference in terms of intraoperative JVC between patients with delirium and those without (4,058±6,650 vs. 3,495±10,151 mmHg*min, P = 0.772). Furthermore, during multivariate regression analysis, JVC was not associated with an increased risk of delirium (Odds Ratio: 1.03 per 100mmHg*min increase in venous congestion; 95% confidence interval: 0.31, 3.39; P = 0.96).
CONCLUSIONS Delirium occurred frequently after off-pump lung transplantation. Although physiologically plausible, the present study did not find an association between increased JVC during off-pump lung transplantation and an increased risk of postoperative delirium.