{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T05:07:54Z","timestamp":1775192874667,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Postoperative delirium (POD) is a neurocognitive syndrome affecting patients undergoing surgery. It is a frequent complication of coronary artery bypass grafting (CABG) and is associated with higher morbidity, mortality and treatment costs. This study aimed to investigate the relationship between gaseous microemboli (GME) load during cardiopulmonary bypass (CPB) and subsequent POD in patients undergoing CABG. Methods: In total, 102 patients undergoing elective on-pump CABG were evaluated in this observational study. An ultrasonic microbubble counter, with probes placed on the arterial and venous lines, was used during CPB to evaluate the GME load for each patient. During the first postoperative week, the patients were examined for the presence of POD. Results: Patients diagnosed with POD had higher number of bubbles in the arterial CPB line (5382.8 (4127.8\u20136637.8) vs. 2389.4 (2033.9\u20132745.0), p &lt; 0.001), higher volume of bubbles in both the venous (24.2 \u00b5L (16.8\u201331.6) vs. 12.4 \u00b5L (9.7\u201315.1), p = 0.004) and arterial lines (1.82 \u00b5L (1.43\u20132.21) vs. 0.29 \u00b5L (0.22\u20130.36), p &lt; 0.001), lower quality factor (QF) values (p = 0.039), a lower venoarterial reduction in bubble number (83.0% (77.8\u201388.1) vs. 92.4% (90.9\u201393.8), p = 0.001) and a lower venoarterial reduction in bubble volume (88.8% (85.4\u201392.2) vs. 96.3% (95.2\u201397.3), p &lt; 0.001) compared to the patients without POD. Older age (p = 0.005), a lower reduction in bubble volume (p &lt; 0.001) and lower QF values (p = 0.004) were significant independent predictors of POD. Conclusions: Our findings indicate a strong association between GME and the occurrence of POD, which entails that all available actions should be implemented to prevent their generation and facilitate the elimination of GME from the CPB circuit.<\/jats:p>","DOI":"10.3390\/jcm14145123","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T13:33:27Z","timestamp":1752845607000},"page":"5123","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Gaseous Microemboli and Postoperative Delirium in Coronary Artery Bypass Grafting"],"prefix":"10.3390","volume":"14","author":[{"given":"Vladimir","family":"Tutu\u0161","sequence":"first","affiliation":[{"name":"Department of Anesthesia, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2839-1935","authenticated-orcid":false,"given":"Milica","family":"Paunovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Rajovi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nata\u0161a","family":"Mili\u0107","sequence":"additional","affiliation":[{"name":"Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9558-0850","authenticated-orcid":false,"given":"Milo\u0161","family":"Matkovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radmila","family":"Karan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0665-2961","authenticated-orcid":false,"given":"Svetozar","family":"Putnik","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8606-9559","authenticated-orcid":false,"given":"Nemanja","family":"Aleksi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2923-4145","authenticated-orcid":false,"given":"Danijela","family":"Trifunovi\u0107 Zamaklar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Jugovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8860-229X","authenticated-orcid":false,"given":"Ilija","family":"Bilbija","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selena","family":"Ne\u0161i\u0107","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5167-4388","authenticated-orcid":false,"given":"Dejan","family":"Markovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.jtcvs.2007.06.031","article-title":"Epidemiology of stroke after cardiac surgery in the current era","volume":"134","author":"Anyanwu","year":"2007","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2160","DOI":"10.1016\/j.athoracsur.2006.01.080","article-title":"Clinically silent cerebral ischemic events after cardiac surgery: Their incidence, regional vascular occurrence, and procedural dependence","volume":"81","author":"Floyd","year":"2006","journal-title":"Ann. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e010920","DOI":"10.1161\/JAHA.118.010920","article-title":"Silent Brain Infarcts Following Cardiac Procedures: A Systematic Review and Meta-Analysis","volume":"8","author":"Indja","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1067\/mtc.2001.114099","article-title":"Cerebral injury during cardiopulmonary bypass: Emboli impair memory","volume":"121","author":"Fearn","year":"2001","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.bja.2020.06.063","article-title":"Postoperative delirium: Perioperative assessment, risk reduction, and management","volume":"125","author":"Jin","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1016\/j.athoracsur.2015.12.074","article-title":"The Impact of Delirium After Cardiac Surgical Procedures on Postoperative Resource Use","volume":"101","author":"Brown","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","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. Anaesthesiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s13019-021-01496-w","article-title":"Risk factors of postoperative delirium after cardiac surgery: A meta-analysis","volume":"16","author":"Chen","year":"2021","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e254","DOI":"10.1016\/j.bja.2022.05.032","article-title":"Perioperative risk factors associated with increased incidence of postoperative delirium: Systematic review, meta-analysis, and Grading of Recommendations Assessment, Development, and Evaluation system report of clinical literature","volume":"130","author":"Mevorach","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0022-5223(03)01281-9","article-title":"Predictors of delirium after cardiac surgery delirium: Effect of beating-heart (off-pump) surgery","volume":"127","author":"Bucerius","year":"2004","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"373","DOI":"10.2190\/03FJ-9QJE-NNBN-B0WC","article-title":"Postcardiotomy delirium: An overview","volume":"6","author":"Vasquez","year":"1975","journal-title":"Int. J. Psychiatry Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1051\/ject\/201547010","article-title":"Perspective on Cerebral Microemboli in Cardiac Surgery: Significant Problem or Much Ado About Nothing?","volume":"47","author":"Mitchell","year":"2015","journal-title":"J. Extra Corpor. Technol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.5301\/ijao.5000010","article-title":"Generation, detection and prevention of gaseous microemboli during cardiopulmonary bypass procedure","volume":"34","author":"Lou","year":"2011","journal-title":"Int. J. Artif. Organs."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2918","DOI":"10.1378\/chest.128.4.2918","article-title":"Microbubbles: Pathophysiology and clinical implications","volume":"128","author":"Barak","year":"2005","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1097\/00003246-200107000-00012","article-title":"Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)","volume":"29","author":"Ely","year":"2001","journal-title":"Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2983","DOI":"10.1001\/jama.289.22.2983","article-title":"Monitoring sedation status over time in ICU patients: Reliability and validity of the Richmond Agitation-Sedation Scale (RASS)","volume":"289","author":"Ely","year":"2003","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"230","DOI":"10.5761\/atcs.oa.18-00019","article-title":"Retrospective Analysis of Air Handling by Contemporary Oxygenators in the Setting of Cardiac Surgery","volume":"24","author":"Benstoem","year":"2018","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.athoracsur.2013.08.074","article-title":"Elimination of gaseous microemboli from cardiopulmonary bypass using hypobaric oxygenation","volume":"97","author":"Gipson","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"129","DOI":"10.7863\/jum.1994.13.2.129","article-title":"Gas bubble emboli detected by transcranial Doppler sonography in patients with prosthetic heart valves: A preliminary report","volume":"13","author":"Dauzat","year":"1994","journal-title":"J. Ultrasound Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1161\/01.STR.29.9.1821","article-title":"Microemboli in cerebral circulation and alteration of cognitive abilities in patients with mechanical prosthetic heart valves","volume":"29","author":"Deklunder","year":"1998","journal-title":"Stroke"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/0041-624X(72)90359-9","article-title":"Ultrasonic detection of bubbles with doppler flow transducers","volume":"10","author":"Nishi","year":"1972","journal-title":"Ultrasonics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1016\/j.ultrasmedbio.2007.04.008","article-title":"Gaseous microemboli sizing in extracorporeal circuits using ultrasound backscatter","volume":"33","author":"Lynch","year":"2007","journal-title":"Ultrasound Med. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1177\/0267659117722595","article-title":"Optical verification and in-vitro characterization of two commercially available acoustic bubble counters for cardiopulmonary bypass systems","volume":"33","author":"Segers","year":"2018","journal-title":"Perfusion"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/1089253210370903","article-title":"The (un)importance of cerebral microemboli","volume":"14","author":"Kruis","year":"2010","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1213\/ANE.0b013e3181b5af06","article-title":"Why are cerebral microemboli not associated with cognitive decline?","volume":"109","author":"Kalkman","year":"2009","journal-title":"Anesth. Analg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1053\/j.jvca.2017.12.030","article-title":"Postoperative Delirium in Cardiac Surgery Patients","volume":"32","author":"Porkkala","year":"2018","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"110953","DOI":"10.1016\/j.mehy.2022.110953","article-title":"Plasma fibrinogen: An important piece of the COVID-19 ICU delirium puzzle?","volume":"168","author":"Saxena","year":"2022","journal-title":"Med. Hypotheses"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e01391","DOI":"10.1002\/brb3.1391","article-title":"High levels of plasma fibrinogen are related to post-stroke cognitive impairment","volume":"9","author":"Liu","year":"2019","journal-title":"Brain Behav."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e32991","DOI":"10.1097\/MD.0000000000032991","article-title":"Postoperative delirium, neuroinflammation, and influencing factors of postoperative delirium: A review","volume":"102","author":"Xiao","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1213\/ANE.0000000000006379","article-title":"Associations Between Systemic and Cerebral Inflammation in an Ovine Model of Cardiopulmonary Bypass","volume":"136","author":"Elsaafien","year":"2023","journal-title":"Anesth. Analg."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Demertzis, S., Puthettu, M., Nafi, M., Bagnato, P., Cassina, T., and Vandenberghe, S. (2022). Gaseous micro-embolism (GME) is associated with systemic inflammatory response syndrome (SIRS) after open heart surgery. A missing piece of a complex puzzle?. medRxiv.","DOI":"10.1101\/2022.01.20.22269116"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0003-4975(99)00475-0","article-title":"Cerebral microemboli during cardiopulmonary bypass: Increased emboli during perfusionist interventions","volume":"68","author":"Taylor","year":"1999","journal-title":"Ann. Thorac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4393","DOI":"10.7150\/thno.26869","article-title":"State-of-the-art of microbubble-assisted blood-brain barrier disruption","volume":"8","author":"Song","year":"2018","journal-title":"Theranostics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1161\/01.STR.25.7.1393","article-title":"The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning","volume":"25","author":"Pugsley","year":"1994","journal-title":"Stroke"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/5123\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:12:17Z","timestamp":1760033537000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/5123"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,18]]},"references-count":34,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14145123"],"URL":"https:\/\/doi.org\/10.3390\/jcm14145123","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,18]]}}}