{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T09:03:11Z","timestamp":1780563791648,"version":"3.54.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"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. Neurol."],"abstract":"\n Objective<\/jats:title>\n The use of multimodal neurologic monitoring (MNM) has rarely been reported in monitoring patients after cardiovascular surgery with cardiopulmonary bypass. This prospective observational cohort aims to the effectiveness of MNM in predicting neurologic dysfunction during the postoperative period for the patients undergoing cardiovascular surgery with cardiopulmonary bypass.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 156 patients who remained unawake 6\u202fh after ICU admission (Glasgow Coma Scale [GCS] score &lt; 8) were enrolled. These patients were monitored using a quantitative electroencephalogram (qEEG) and transcranial Doppler ultrasound. Neurologic dysfunction was classified according to the American College of Cardiology classification for neurologic injury following cardiac surgery, which includes Type I (focal injury, such as stroke diagnosed by CT\/MRI, or coma assessed by GCS) and Type II (global injury, such as delirium assessed by confusion assessment method for the ICU [CAM-ICU], or cognitive dysfunction evaluated by MoCA). The patients were grouped into non-neurologic (\n n<\/jats:italic>\n \u202f=\u202f85) and neurologic dysfunction groups (\n n<\/jats:italic>\n \u202f=\u202f71).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The duration of extracorporeal circulation and extubation were significantly longer in the neurologic dysfunction group than the non-neurologic dysfunction group (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05). The abnormal amplitude-integrated electroencephalogram (aEEG), relative alpha variability (RAV) grade (III-IV), and pulsatility index (PI) of patients in the neurologic dysfunction group were higher and the band energy percentage (\n \u03b1<\/jats:italic>\n %) and end diastolic velocities (EDVs) were lower than the non-neurologic dysfunction group (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05). Age, gender, days of tracheal intubation, aEEG, and RAV classification were significantly different between the subgroups that underwent different surgical procedures (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05). The RAV\u202f+\u202fA%\u202f+\u202fEDV\u202f+\u202fPI combination AUC for predicting neurologic dysfunction was 0.735 (95% CI: 0.658\u20130.812) with a specificity of 0.843 and a sensitivity of 0.507, which was better than other combined indicators (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n MNM can monitor the 24-h changes in postoperative brain function among these targeted patients. The AUC of RAV\u202f+\u202f\n \u03b1<\/jats:italic>\n %\u202f+\u202fEDV\u202f+\u202fPI combination for predicting neurologic dysfunction was better than other combined or single indicators. Given its relatively low sensitivity, the RAV\u202f+\u202f\n \u03b1<\/jats:italic>\n %\u202f+\u202fEDV\u202f+\u202fPI combination is suggested to serve best as a tool for identifying high-risk patients warranting intensified monitoring and preemptive neuroprotective strategies, rather than a standalone diagnostic test.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneur.2026.1834632","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T08:10:42Z","timestamp":1780560642000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive value of multimodal neurological monitoring in the postoperative neurological dysfunction after cardiovascular surgery with cardiopulmonary bypass"],"prefix":"10.3389","volume":"17","author":[{"given":"Miao","family":"Zou","sequence":"first","affiliation":[{"name":"Department of Critical Care Unit, The First Clinical Medical College of Three Gorges University","place":["Yichang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Unit, The First Clinical Medical College of Three Gorges University","place":["Yichang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinli","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Unit, The First Clinical Medical College of Three Gorges University","place":["Yichang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengqiu","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Critical Care Unit, The First Clinical Medical College of Three Gorges University","place":["Yichang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Unit, The First Clinical Medical College of Three Gorges University","place":["Yichang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Unit, The First Clinical Medical College of Three Gorges University","place":["Yichang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e652","DOI":"10.1161\/CIR.0b013e31823c074e","article-title":"2011 ACCF\/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation\/American Heart Association task force on practice guidelines","volume":"124","author":"Hillis","year":"2011","journal-title":"Circulation"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/B978-0-444-63599-0.00031-4","article-title":"Neurologic complications of cardiac and vascular surgery","volume":"141","author":"Sheth","year":"2017","journal-title":"Handb Clin Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/1354750X.2025.2522891","article-title":"Peripheral cytokine modulation by anesthetic agents: a systematic review of neuroprotective and anti-inflammatory effects in randomised clinical trials","author":"Saxena","year":"2025","journal-title":"Biomarkers"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1447007","DOI":"10.3389\/fcvm.2024.1447007","article-title":"Temperature management in acute type a aortic dissection treatment: deep vs. moderate hypothermic circulatory arrest. Is colder better?","volume":"11","author":"Abdulwahab","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s10877-018-0136-1","article-title":"Assessment of cerebral hemodynamic parameters using pulsatile versus non-pulsatile cerebral blood outflow models","volume":"33","author":"Uryga","year":"2019","journal-title":"J Clin Monit Comput"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e70086","DOI":"10.1002\/brb3.70086","article-title":"Quantitative electroencephalography monitoring in type a aortic dissection surgery: a clinical case review and prospective applications","volume":"14","author":"Wang","year":"2024","journal-title":"Brain Behav"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1097\/ALN.0000000000002194","article-title":"Neurocognitive function after cardiac surgery: from phenotypes to mechanisms","volume":"129","author":"Berger","year":"2018","journal-title":"Anesthesiology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1097\/WNP.0000000000000875","article-title":"Predictive value of multimodality intraoperative neurophysiological monitoring during cardiac surgery","volume":"40","author":"Thirumala","year":"2023","journal-title":"J Clin Neurophysiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.bj.2020.05.005","article-title":"Multimodal neurocritical monitoring","volume":"43","author":"Yang","year":"2020","journal-title":"Biom J"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1093\/ons\/opw036","article-title":"Intraoperative computed tomography angiography: a novel completion imaging modality for carotid endarterectomy","volume":"13","author":"Sen","year":"2017","journal-title":"Oper 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Cardiovasc Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.1053\/j.jvca.2020.11.035","article-title":"Brain protection in aortic arch surgery: an evolving field","volume":"35","author":"Qu","year":"2021","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2634","DOI":"10.1053\/j.jvca.2023.08.139","article-title":"Hypothermic circulatory arrest in adult aortic arch surgery: a review of hypothermic circulatory arrest and its anesthetic implications","volume":"37","author":"Ghia","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.jtcvs.2019.01.127","article-title":"Aortic arch surgery with hypothermic circulatory arrest and unilateral antegrade cerebral perfusion: perioperative outcomes","volume":"159","author":"Wang","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref17","volume-title":"StatPearls","author":"Senst","year":"2025"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/S0140-6736(20)30631-0","article-title":"Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): a randomised placebo-controlled trial","volume":"396","author":"Turan","year":"2020","journal-title":"Lancet"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1053\/j.jvca.2016.11.013","article-title":"Associated risk factors and complications in vascular surgery patients requiring unplanned postoperative reintubation","volume":"31","author":"Brovman","year":"2017","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e013260","DOI":"10.1161\/JAHA.119.013260","article-title":"Sex differences in long-term survival after major cardiac surgery: a population-based cohort study","volume":"8","author":"Johnston","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1152\/japplphysiol.01191.2011","article-title":"Pulsatile flow during cardiopulmonary bypass preserves postoperative microcirculatory perfusion irrespective of systemic hemodynamics","volume":"112","author":"Koning","year":"2012","journal-title":"J Appl Physiol (1985)"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.1038\/s41390-024-03484-x","article-title":"Neuromonitoring practices for neonates with congenital heart disease: a scoping review","volume":"97","author":"Pardo","year":"2025","journal-title":"Pediatr Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1053\/j.jvca.2011.05.015","article-title":"Multimodal brain monitoring reduces major neurologic complications in cardiac surgery","volume":"25","author":"Zanatta","year":"2011","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e002939","DOI":"10.1136\/openhrt-2024-002939","article-title":"Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort study","volume":"11","author":"Brown","year":"2024","journal-title":"Open Heart"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.aucc.2017.02.001","article-title":"Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery","volume":"31","author":"Larson","year":"2018","journal-title":"Aust Crit Care"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1097\/EJA.0000000000001895","article-title":"Intra-operative electroencephalogram frontal alpha-band spectral analysis and postoperative delirium in cardiac surgery: a prospective cohort 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