Non-invasive Intracranial Pressure Dynamics During Cardiac Bypass Surgery: Prospective Study

Postoperative cognitive dysfunction (POCD) and delirium (incidence up to 52 %) are the common complications after cardiac surgery with cardiopulmonary bypass (CPB). It occurs during the first postoperative week (in approximately 33-83% of cases; in 20-60% of cases), and it may persist for several months after surgery. Our hypothesis is that managing of individual patient's CPP(t) to be close to optCPP during surgery is a way to avoid brain's hyperemic and ischemic episodes and to decrease a rate of post-operative cognitive dysfunction and delirium. This prospective observational study is being conducted at Kaunas Clinics, the Hospital of Lithuanian University of Health Sciences (LUHS). The study is registered in ClinicalTrials.gov Identifier: NCT04943458. The ongoing study at the moment includes 15 patients undergoing elective coronary artery bypass grafting (CABG) surgery with CPB. Based on our study, some patients experienced episodes of ICP values above critical threshold of 20 mmHg during cardiac surgery procedures. Such episodes can cause secondary brain insults and as a consequence a post-operative cognitive dysfunction. A measurement of ICP during cardiac bypass surgery provides sufficient diagnostic information since ICP(t) has fluctuations over the time. Precise and individual patient specific optCPP could be achieved by non-invasive monitoring of ICP(t).