{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:23:01Z","timestamp":1775607781247,"version":"3.50.1"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T00:00:00Z","timestamp":1657670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Post-operative delirium is common in elderly patients and associated with increased morbidity and mortality. We evaluated in this pilot study whether a perioperative goal-directed hemodynamic optimization algorithm improves cerebral oxygenation and can reduce the incidence of delirium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Patients older than 70 years with high risk for post-operative delirium undergoing elective non-cardiac surgery were randomized to an intervention or control group. Patients in the intervention group received a perioperative hemodynamic optimization protocol based on uncalibrated pulse-contour analysis. Patients in the control group were managed according to usual standard of care. Incidence of delirium until day seven was assessed with confusion assessment method (CAM) and chart review. Cerebral oxygenation was measured with near-infrared spectroscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Delirium was present in 13 of 85 (15%) patients in the intervention group and 18 of 87 (21%) in the control group [risk difference \u22125.4%; 95% confidence interval, \u221216.8 to 6.1%; <jats:italic>P<\/jats:italic> = 0.47]. Intervention did not influence length of stay in hospital or in-hospital mortality. Amounts of fluids and vasopressors applied, mean arterial pressure, cardiac index, and near-infrared spectroscopy values were comparable between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The hemodynamic algorithm applied in high-risk non-cardiac surgery patients did not change hemodynamic interventions, did not improve patient hemodynamics, and failed to increase cerebral oxygenation. An effect on the incidence of post-operative delirium could not be observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p>[<jats:ext-link>Clinicaltrials.gov<\/jats:ext-link>], identifier [NCT01827501].<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.893459","type":"journal-article","created":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T07:47:52Z","timestamp":1657698472000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Perioperative Hemodynamic Optimization in Patients at Risk for Delirium \u2013 A Randomized-Controlled Trial"],"prefix":"10.3389","volume":"9","author":[{"given":"Kristina E.","family":"Fuest","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariane","family":"Servatius","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Ulm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan J.","family":"Schaller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"Jungwirth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manfred","family":"Blobner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,13]]},"reference":[{"key":"B1","author":"Hazzard","year":"2003","journal-title":"Principles of Geriatric Medicine and Gerontology."},{"key":"B2","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1053\/j.jvca.2013.12.003","article-title":"Type of anesthesia and postoperative delirium after vascular surgery.","volume":"28","author":"Ellard","year":"2014","journal-title":"J Cardiothorac Vasc Anesth."},{"key":"B3","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1046\/j.1532-5415.2001.49108.x","article-title":"Reducing delirium after hip fracture: a randomized trial.","volume":"49","author":"Marcantonio","year":"2001","journal-title":"J Am Geriatr Soc."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.2147\/CIA.S201323","article-title":"Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis.","volume":"14","author":"Janssen","year":"2019","journal-title":"Clin Interv Aging."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1007\/s00134-017-4867-0","article-title":"The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis.","volume":"43","author":"Muscedere","year":"2017","journal-title":"Intensive care medicine."},{"key":"B6","doi-asserted-by":"publisher","first-page":"S241","DOI":"10.1111\/j.1532-5415.2011.03671.x","article-title":"The importance of delirium: economic and societal costs.","author":"Leslie","year":"2011","journal-title":"J Am Geriatr Soc."},{"key":"B7","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1056\/NEJM199903043400901","article-title":"A multicomponent intervention to prevent delirium in hospitalized older patients.","volume":"340","author":"Inouye","year":"1999","journal-title":"N Engl J Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/EJA.0000000000000594","article-title":"European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium.","volume":"34","author":"Aldecoa","year":"2017","journal-title":"Eur J Anaesth."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1152\/physrev.00022.2020","article-title":"Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation.","volume":"101","author":"Claassen","year":"2021","journal-title":"Physiol Rev."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3390\/medicina56050240","article-title":"Sepsis Associated Delirium.","volume":"56","author":"Atterton","year":"2020","journal-title":"Medicina (Kaunas)."},{"key":"B11","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1213\/ANE.0000000000004517","article-title":"Association Between Perioperative Hypotension and Delirium in Postoperative Critically Ill Patients: A Retrospective Cohort Analysis.","volume":"130","author":"Maheshwari","year":"2020","journal-title":"Anesth Anal."},{"key":"B12","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1513\/AnnalsATS.201507-454OC","article-title":"Reduced Cerebral Perfusion Pressure during Lung Transplant Surgery Is Associated with Risk, Duration, and Severity of Postoperative Delirium.","volume":"13","author":"Smith","year":"2016","journal-title":"Ann Am Thorac Society."},{"key":"B13","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1093\/bja\/aer252","article-title":"Effect of age on intraoperative cerebrovascular autoregulation and near-infrared spectroscopy-derived cerebral oxygenation.","volume":"107","author":"Burkhart","year":"2011","journal-title":"Br J Anaesth."},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2018.00012","article-title":"Perioperative Goal-Directed Therapy Using Invasive Uncalibrated Pulse Contour Analysis.","volume":"5","author":"Saugel","year":"2018","journal-title":"Front Med (Lausanne)."},{"key":"B15","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.bja.2020.09.049","article-title":"Cardiac output estimation using pulse wave analysis-physiology, algorithms, and technologies: a narrative review.","volume":"126","author":"Saugel","year":"2021","journal-title":"Br J Anaesth."},{"key":"B16","doi-asserted-by":"publisher","first-page":"474","DOI":"10.7326\/0003-4819-119-6-199309150-00005","article-title":"A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics.","volume":"119","author":"Inouye","year":"1993","journal-title":"Ann Intern Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1001\/jama.275.11.852","article-title":"Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability.","volume":"275","author":"Inouye","year":"1996","journal-title":"JAMA."},{"key":"B18","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1001\/jama.2012.6857","article-title":"Postoperative delirium: a 76-year-old woman with delirium following surgery.","volume":"308","author":"Marcantonio","year":"2012","journal-title":"JAMA."},{"key":"B19","doi-asserted-by":"publisher","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: the confusion assessment method. A new method for detection of delirium.","volume":"113","author":"Inouye","year":"1990","journal-title":"Ann Intern Med."},{"key":"B20","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/0895-4356(94)90122-8","article-title":"The Mini-Mental State Examination score and the clinical diagnosis of dementia.","volume":"47","author":"Kukull","year":"1994","journal-title":"J Clin Epidemiol."},{"key":"B21","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people.","volume":"173","author":"Rockwood","year":"2005","journal-title":"CMAJ."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1820","DOI":"10.1007\/s00134-017-4940-8","article-title":"The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (>\/= 80 years).","volume":"43","author":"Flaatten","year":"2017","journal-title":"Intens Care Med."},{"key":"B23","first-page":"349","article-title":"Pr\u00e4operative Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen.","volume":"58","year":"2017","journal-title":"Ana\u00e4sth Intens."},{"key":"B24","doi-asserted-by":"publisher","first-page":"R687","DOI":"10.1186\/cc3887","article-title":"Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445].","volume":"9","author":"Pearse","year":"2005","journal-title":"Crit Care."},{"key":"B25","doi-asserted-by":"crossref","first-page":"i3","DOI":"10.1093\/bja\/aep299","article-title":"Near-infrared spectroscopy as an index of brain and tissue oxygenation.","author":"Murkin","year":"2009","journal-title":"Br J Anaesth."},{"key":"B26","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1097\/CCM.0b013e3181cabb42","article-title":"Different assessment tools for intensive care unit delirium: which score to use?","volume":"38","author":"Luetz","year":"2010","journal-title":"Crit Care Med."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0242378","article-title":"The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients.","volume":"15","author":"Krewulak","year":"2020","journal-title":"PLoS One."},{"key":"B28","doi-asserted-by":"publisher","first-page":"526","DOI":"10.7326\/M13-1927","article-title":"The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts.","volume":"160","author":"Inouye","year":"2014","journal-title":"Ann Intern Med."},{"key":"B29","doi-asserted-by":"crossref","first-page":"347","DOI":"10.3233\/JAD-170288","article-title":"Delirium severity post-surgery and its relationship with long-term cognitive decline in a cohort of patients without dementia.","volume":"61","author":"Vasunilashorn","year":"2018","journal-title":"J Alzheimers Dis."},{"key":"B30","doi-asserted-by":"crossref","first-page":"549","DOI":"10.2307\/2530245","article-title":"A multiple testing procedure for clinical trials.","volume":"35","author":"O\u2019Brien","year":"1979","journal-title":"Biometrics."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1186\/s13741-021-00220-5","article-title":"Comparison of restrictive fluid therapy with goal-directed fluid therapy for postoperative delirium in patients undergoing spine surgery: a randomized controlled trial.","volume":"10","author":"Wang","year":"2021","journal-title":"Perioper Med (Lond)."},{"key":"B32","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.ijsu.2018.04.007","article-title":"Effect of goal-directed fluid therapy on early cognitive function in elderly patients with spinal stenosis: A Case-Control Study.","author":"Zhang","year":"2018","journal-title":"Int J Surg."},{"key":"B33","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1097\/ANA.0b013e3182712fba","article-title":"BIS-guided anesthesia decreases postoperative delirium and cognitive decline.","volume":"25","author":"Chan","year":"2013","journal-title":"J Neurosurg Anesthesiol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"i98","DOI":"10.1093\/bja\/aet055","article-title":"Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction.","author":"Radtke","year":"2013","journal-title":"Br J Anaesth."},{"key":"B35","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1001\/jama.2018.22005","article-title":"Effect of electroencephalography-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery: The ENGAGES randomized clinical trial.","volume":"321","author":"Wildes","year":"2019","journal-title":"JAMA."},{"key":"B36","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-016-1237-1","article-title":"Algorithm-guided goal-directed haemodynamic therapy does not improve renal function after major abdominal surgery compared to good standard clinical care: a prospective randomised trial.","volume":"20","author":"Schmid","year":"2016","journal-title":"Crit Care."},{"key":"B37","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1093\/bja\/aes468","article-title":"Randomized controlled trial of goal-directed haemodynamic treatment in patients with proximal femoral fracture.","volume":"110","author":"Bartha","year":"2013","journal-title":"Br J Anaesth."},{"key":"B38","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1097\/MCC.0000000000000422","article-title":"Personalized hemodynamic management.","volume":"23","author":"Saugel","year":"2017","journal-title":"Curr Opin Crit Care."},{"key":"B39","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1177\/0885066618807399","article-title":"Relationship between near-infrared spectroscopy-derived cerebral oxygenation and delirium in critically Ill patients: a systematic review.","volume":"34","author":"Bendahan","year":"2019","journal-title":"J Intens Care Med."},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8122208","article-title":"Near-infrared spectroscopy monitoring in cardiac and noncardiac surgery: pairwise and network meta-analyses.","volume":"8","author":"Ortega-Loubon","year":"2019","journal-title":"J Clin Med."},{"key":"B41","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s00423-013-1151-9","article-title":"Fast-track surgery decreases the incidence of postoperative delirium and other complications in elderly patients with colorectal carcinoma.","volume":"399","author":"Jia","year":"2014","journal-title":"Langenbecks Arch Surg."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.893459\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T04:24:02Z","timestamp":1658723042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.893459\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,13]]},"references-count":41,"alternative-id":["10.3389\/fmed.2022.893459"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.893459","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,13]]},"article-number":"893459"}}