Department of Cardiac Surgery, University Clinical Center Bonn, Bonn, North Rhine-Westphalia, Germany.
Department of Anaesthesiology and Intensive Care Medicine, University Clinical Center Bonn, Bonn, North Rhine-Westphalia, Germany.
Thorac Cardiovasc Surg. 2022 Oct;70(7):549-557. doi: 10.1055/s-0040-1715891. Epub 2020 Sep 4.
Heart surgery with extracorporeal circulation (ECC) often leads to postoperative delirium (POD). This is associated with increased morbidity resulting in longer hospital stay and associated costs. The purpose of our study was to analyze the effect of intraoperative mannitol application on POD in patients undergoing elective aortic valve replacement (AVR).
s In our retrospective single-center study, 259 patients underwent elective AVR, using Bretschneider cardioplegic solution for cardiac arrest, between 2014 and 2017. Patients were divided in mannitol ( = 188) and nonmannitol ( = 71) groups. POD was assessed using the confusion assessment method for the intensive care unit (ICU). Statistical significance was assumed at < 0.05.
Baseline patient characteristics did not differ between the groups. Incidence of POD was significantly higher in the nonmannitol group (33.8 vs. 13.8%; = 0.001). These patients required longer ventilation time (24.1 vs. 17.1 hours; = 0.021), higher reintubation rate (11.3 vs. 2.7%; = 0.009), ICU readmission (12.7 vs. 4.8%; = 0.026), prolonged ICU (112 vs. 70 hours; = 0.040), and hospital stay (17.8 vs. 12.6 days; < 0.001), leading to higher expenses (19,349 € vs. 16,606 €, < 0.001). A 30-day mortality was not affected, but nonmannitol group showed higher Simplified Acute Physiology Score II score (32.2 vs. 28.7; < 0.001). Mannitol substitution was independently associated with lower incidence of POD (odds ratio: 0.40; 95% confidence interval: 0.18-0.89; = 0.02).
Treatment with mannitol during ECC was associated with decreased incidence of POD. This was accompanied by shorter ventilation time, ICU and hospital stay, and lower treatment expenses.
体外循环（ECC）下心外科手术常导致术后谵妄（POD）。这与发病率增加有关，导致住院时间延长和相关费用增加。我们的研究目的是分析术中应用甘露醇对择期主动脉瓣置换术（AVR）患者 POD 的影响。
在我们的回顾性单中心研究中，2014 年至 2017 年间，259 例患者接受了 Bretschneider 心脏停搏液心脏停搏的择期 AVR。患者分为甘露醇组（n=188）和非甘露醇组（n=71）。采用重症监护病房（ICU）的意识模糊评估法评估 POD。假设统计显著性为 < 0.05。
两组患者的基线特征无差异。非甘露醇组 POD 发生率明显高于甘露醇组（33.8% vs. 13.8%； = 0.001）。这些患者需要更长的通气时间（24.1 与 17.1 小时； = 0.021）、更高的再插管率（11.3% 与 2.7%； = 0.009）、ICU 再入院率（12.7% 与 4.8%； = 0.026）、延长 ICU 时间（112 与 70 小时； = 0.040）和住院时间（17.8 与 12.6 天； < 0.001），导致费用增加（19349 欧元与 16606 欧元； < 0.001）。30 天死亡率不受影响，但非甘露醇组患者的简化急性生理学评分 II 评分更高（32.2 与 28.7； < 0.001）。甘露醇替代治疗与 POD 发生率降低独立相关（比值比：0.40；95%置信区间：0.18-0.89； = 0.02）。
ECC 期间应用甘露醇可降低 POD 的发生率。这与通气时间、ICU 和住院时间缩短以及治疗费用降低有关。
