Article description

Summary:

• This study aimed to investigate whether cerebral oximetry index (COx)-guided blood pressure management during cardiopulmonary bypass (CPB) could reduce postoperative delirium (POD) in patients undergoing acute type A aortic dissection (ATAAD) repair;
• A single-center, prospective, randomized controlled trial;A single-center, prospective, randomized controlled trial;
• A total of 157 adult patients undergoing emergency repair for ATAAD were enrolled;
• The COx-guided group (n = 76) received individualized MAP targets based on COx, while the control group (n = 81) received standard MAP targets of 60–80 mmHg;
• The primary outcome was the incidence of POD within the first 7 postoperative days, which occurred less frequently in the COx-guided group than in the control group (15% vs 30%; RR 0.50; 95% CI 0.28–0.89; p = 0.039).
• Secondary outcomes in the COx-guided group included lower delirium severity (DRS-R98: 5 vs 10, p=0.033) and shorter postoperative delirium duration (0 vs 2 days, p=0.045).
• The COx-guided group demonstrated lreduced postoperative cerebral infarction (1.3% vs 8.6%, p=0.037), reduced acute kidney injury (27.6% vs 43.2%, p=0.042), faster extubation (16.9 vs 18.4 hours, p=0.027), and a shorter ICU stay (7.3 vs 8.2 days, p=0.042).

Conclusions:

• COx-guided individualized blood pressure management showed promising associations with lower POD incidence and improved outcomes in selected ATAAD patients
• These findings remain hypothesis-generating and require validation in larger multicenter studies alongside the development of standardized, practical protocols to support safe and effective wider adoption.