Association between pediatric postoperative delirium and regional cerebral oxygen saturation: a prospective observational study

Abstract

Background: Postoperative delirium (POD) represents a prevalent and noteworthy complication in the context of pediatric surgical interventions. In recent times, a hypothesis has emerged positing that cerebral ischemia and regional cerebral oxygen desaturation might serve as potential catalysts in the pathogenesis of POD. The primary aim of this study was to methodically examine the potential relationship between POD and regional cerebral oxygen saturation (rSO₂) and to assess the predictive and evaluative utility of rSO₂ in the context of POD.

Methods: This prospective observational study was conducted at the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China, spanning the period from November 2020 to March 2021. The research cohort comprised children undergoing surgical procedures within this clinical setting. To measure rSO₂ dynamics, cerebral near-infrared spectroscopy (NIRS) was used to monitor rSO₂ levels both before and after surgery. In addition, POD was assessed in the paediatric patients according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. The analysis of the association between the rSO₂ index and the incidence of POD was carried out through the application of either the independent samples t-test or the nonparametric rank-sum test. To ascertain the threshold value of the adjusted rSO₂ index for predictive and evaluative purposes regarding POD in the pediatric population, the Receiver Operating Characteristics (ROC) curve was employed.

Results: A total of 211 cases were included in this study, of which 61 (28.9%) developed POD. Participants suffering delirium had lower preoperative rSO₂mean, lower preoperative rSO_2min, and lower postoperative rSO_2min, higher ∆rSO_2mean, higher amount of ∆rSO_2mean, lower ∆rSO_2min (P < 0.05). Preoperative rSO_2mean (AUC = 0.716, 95%CI 0.642-0.790), ∆rSO_2mean (AUC = 0.694, 95%CI 0.614-0.774), amount of ∆rSO_2mean (AUC = 0.649, 95%CI 0.564-0.734), preoperative rSO_2min (AUC = 0.702, 96%CI 0.628-0.777), postoperative rSO_2min (AUC = 0.717, 95%CI 0.647-0.787), and ∆rSO_2min (AUC = 0.714, 95%CI 0.638-0.790) performed well in sensitivity and specificity, and the best threshold were 62.05%, 1.27%, 2.41%, 55.68%, 57.36%, 1.29%.

Conclusions: There is a close relationship between pediatric POD and rSO₂. rSO₂ could be used as an effective predictor of pediatric POD. It might be helpful to measure rSO₂ with NIRS for early recognizing POD and making it possible for early intervention.

Keywords: Delirium; Pediatrics; Postoperative period; Regional cerebral oxygen saturation.