{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:56:12Z","timestamp":1781862972599,"version":"3.54.5"},"reference-count":33,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Postoperative delirium (POD) is a common neurocognitive complication after cardiac surgery in elderly patients and is associated with adverse clinical outcomes. Impaired cerebral autoregulation and reduced cerebrovascular reserve may contribute to POD development. Automated transcranial Doppler sonography (TCD) enables non-invasive assessment of intracranial hemodynamics and may provide additional information for perioperative risk assessment. In this prospective single-center observational study, 108 patients aged &gt;70 years scheduled for elective cardiac surgery with cardiopulmonary bypass were enrolled. Patients who had pre-existing neurological disease, had a pathological carotid Doppler ultrasound, underwent emergency surgery, or were unable to undergo delirium screening were excluded. Preoperative bilateral TCD of the middle cerebral arteries was performed using an automated WAKIe R3 system. POD was assessed on postoperative days 1\u20133 using the CAM-ICU. The primary endpoint was the occurrence of POD. Twenty-one patients were excluded, leaving 87 patients for analysis. POD occurred in 14 patients (16%). All patients who developed POD had pathological preoperative TCD findings, whereas no POD occurred among patients with normal TCD examinations. Overall, 82 patients (94%) demonstrated pathological intracranial hemodynamic findings despite normal carotid Doppler ultrasound. In multivariable Firth logistic regression adjusted for age and sex, pathological TCD findings remained associated with POD; however, interpretation was limited by the small number of outcome events and quasi-complete separation. In elderly patients undergoing cardiac surgery with cardiopulmonary bypass, pathological preoperative TCD findings were frequently observed and may be associated with an increased risk of postoperative delirium. The marked discrepancy between normal carotid ultrasound and abnormal intracranial hemodynamics suggests that TCD may provide complementary information regarding cerebrovascular function. Given the limited sample size and event rate, these findings should be considered exploratory and require confirmation in larger multicenter studies.<\/jats:p>","DOI":"10.3390\/life16061026","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:18:43Z","timestamp":1781860723000},"page":"1026","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Transcranial Doppler Findings and Postoperative Delirium After Cardiac Surgery in Elderly Patients: A Prospective Observational Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Astrid","family":"Bergmann","sequence":"first","affiliation":[{"name":"Heart- and Diabetes-Center Bad Oeynhausen, Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany"},{"name":"Heart- and Diabetes-Center Bad Oeynhausen, Medical Center East Westphalia-Lippe, University Bielefeld, 32545 Bad Oeynhausen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yurii","family":"Ruzhyn","sequence":"additional","affiliation":[{"name":"Heart- and Diabetes-Center Bad Oeynhausen, Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany"},{"name":"Heart- and Diabetes-Center Bad Oeynhausen, Medical Center East Westphalia-Lippe, University Bielefeld, 32545 Bad Oeynhausen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Wiesemann","sequence":"additional","affiliation":[{"name":"Heart- and Diabetes-Center Bad Oeynhausen, Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany"},{"name":"Heart- and Diabetes-Center Bad Oeynhausen, Medical Center East Westphalia-Lippe, University Bielefeld, 32545 Bad Oeynhausen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolai","family":"Hulde","sequence":"additional","affiliation":[{"name":"Heart- and Diabetes-Center Bad Oeynhausen, Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany"},{"name":"Heart- and Diabetes-Center Bad Oeynhausen, Medical Center East Westphalia-Lippe, University Bielefeld, 32545 Bad Oeynhausen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janis","family":"Fliegenschmidt","sequence":"additional","affiliation":[{"name":"Knappschaft Kliniken, Ruhr-University Bochum, 44892 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Krannich","sequence":"additional","affiliation":[{"name":"BioStats GmbH, 14641 Nauen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7281-2137","authenticated-orcid":false,"given":"Vera","family":"von Dossow","sequence":"additional","affiliation":[{"name":"Heart- and Diabetes-Center Bad Oeynhausen, Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany"},{"name":"Heart- and Diabetes-Center Bad Oeynhausen, Medical Center East Westphalia-Lippe, University Bielefeld, 32545 Bad Oeynhausen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.genhosppsych.2020.08.010","article-title":"Delirium in Elderly Patients: Prospective Prevalence across Hospital Services","volume":"67","author":"Fuchs","year":"2020","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1056\/NEJMcp1605501","article-title":"Delirium in Hospitalized Older Adults","volume":"377","author":"Marcantonio","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"90","DOI":"10.5312\/wjo.v11.i2.90","article-title":"Postoperative Delirium after Major Orthopedic Surgery","volume":"11","author":"Urban","year":"2020","journal-title":"World J. Orthop."},{"key":"ref_4","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_5","doi-asserted-by":"crossref","first-page":"328","DOI":"10.4103\/0971-9784.179634","article-title":"Current Approach to Diagnosis and Treatment of Delirium after Cardiac Surgery","volume":"19","author":"Evans","year":"2016","journal-title":"Ann. Card. 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":"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_8","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/CCM.0000000000000727","article-title":"Prevalence, Risk Factors, and Outcomes of Delirium in Mechanically Ventilated Adults*","volume":"43","author":"Mehta","year":"2015","journal-title":"Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s13613-022-01080-y","article-title":"Association between Frailty, Delirium, and Mortality in Older Critically Ill Patients: A Binational Registry Study","volume":"12","author":"Sahle","year":"2022","journal-title":"Ann. Intensive Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"111030","DOI":"10.1016\/j.jclinane.2022.111030","article-title":"Postoperative Delirium: An Independent Risk Factor for Poorer Quality of Life with Long-Term Cognitive and Functional Decline after Cardiac Surgery","volume":"85","author":"Tamayo","year":"2023","journal-title":"J. Clin. Anesth."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1001\/jamasurg.2015.2606","article-title":"Effect of Delirium and Other Major Complications After Elective Surgery in Older Adults","volume":"150","author":"Gleason","year":"2015","journal-title":"JAMA Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.zefq.2022.02.001","article-title":"Hospitalisation Costs and Health Related Quality of Life in Delirious Patients: A Scoping Review","volume":"169","author":"Schuit","year":"2022","journal-title":"Z. Evidenz Fortbild. Qual. Gesundheitswesen"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"829","DOI":"10.2106\/JBJS.N.00724","article-title":"Health Economic Implications of Perioperative Delirium in Older Patients After Surgery for a Fragility Hip Fracture","volume":"97","author":"Zywiel","year":"2015","journal-title":"J. Bone Jt. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bergmann, A., Fliegenschmidt, J., Ruggeri, S., Hulde, N., Middeke, C., Bunge, C., Preising, M., Hermes, C., and von Dossow, V. (2025). Comparison of DeltaScan\u00ae and CAM-ICU for the Assessment of Postoperative Delirium in Patients Undergoing Cardiac Surgery and Cardiac Interventions: A Prospective Observational Pilot Study. Life, 15.","DOI":"10.3390\/life15101640"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1055\/s-0041-1740984","article-title":"Preoperative Risk Factors and Early Outcomes of Delirium in Valvular Open-Heart Surgery","volume":"70","author":"Hulde","year":"2022","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1001\/jamasurg.2019.1163","article-title":"Effect of Targeting Mean Arterial Pressure During Cardiopulmonary Bypass by Monitoring Cerebral Autoregulation on Postsurgical Delirium Among Older Patients: A Nested Randomized Clinical Trial","volume":"154","author":"Brown","year":"2019","journal-title":"JAMA Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1053\/j.semtcvs.2020.09.032","article-title":"Personalized Blood Pressure Management During Cardiac Surgery with Cerebral Autoregulation Monitoring: A Randomized Trial","volume":"33","author":"Hogue","year":"2021","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1007\/s12630-021-02171-3","article-title":"Morbidity and Mortality in Patients Managed with High Compared with Low Blood Pressure Targets during On-Pump Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"69","author":"McEwen","year":"2022","journal-title":"Can. J. Anaesth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1177\/108925320400800206","article-title":"Intraoperative Transcranial Ultrasonic Monitoring for Cardiac and Vascular Surgery","volume":"8","author":"Doblar","year":"2004","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Byd\u00e9n, M., Segern\u00e4s, A., Thulesius, H., Vanky, F., Ahlgren, E., Skoog, J., and Zachrisson, H. (2021). Cerebrovascular Reserve Capacity as a Predictor of Postoperative Delirium: A Pilot Study. Front. Surg., 8.","DOI":"10.3389\/fsurg.2021.658849"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1093\/icvts\/ivs317","article-title":"Improved Perioperative Neurological Monitoring of Coronary Artery Bypass Graft Patients Reduces the Incidence of Postoperative Delirium: The Haga Brain Care Strategy","volume":"15","author":"Palmbergen","year":"2012","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s10877-019-00385-x","article-title":"Preoperative Transcranial Doppler and Cerebral Oximetry as Predictors of Delirium Following Valvular Heart Surgery: A Case\u2013Control Study","volume":"34","author":"Soh","year":"2020","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/MAT.0b013e318241abd3","article-title":"Real-Time Continuous Neuromonitoring Combines Transcranial Cerebral Doppler with near-Infrared Spectroscopy Cerebral Oxygen Saturation during Total Aortic Arch Replacement Procedure: A Pilot Study","volume":"58","author":"Wang","year":"2012","journal-title":"ASAIO J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/s40140-021-00483-0","article-title":"Role of Transcranial Doppler in Cardiac Surgery Patients","volume":"11","author":"Gupta","year":"2021","journal-title":"Curr. Anesthesiol. Rep."},{"key":"ref_25","unstructured":"(2026, June 01). Transkranielle Doppler-Sonographie TCD Transkranieller Doppler. Available online: https:\/\/www.neuromedical.de\/index.php\/de\/gefaessdiagnostiek\/tcd-doppler-diagnose-ueberwachung-waki."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1161\/01.STR.27.12.2197","article-title":"Assessment of Cerebral Autoregulation Using Carotid Artery Compression","volume":"27","author":"Smielewski","year":"1996","journal-title":"Stroke"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.1600-0404.1999.tb07342.x","article-title":"Cerebrovascular Reactivity in Carotid Artery Occlusion: Possible Implications for Surgical Management of Selected Groups of Patients","volume":"99","author":"Silvestrini","year":"1999","journal-title":"Acta Neurol. Scand."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1017\/S1478951516001176","article-title":"Delirium in the Intensive Care Setting: A Reevaluation of the Validity of the CAM\u2013ICU and ICDSC versus the DSM\u2013IV\u2013TR in Determining a Diagnosis of Delirium as Part of the Daily Clinical Routine","volume":"15","author":"Boettger","year":"2017","journal-title":"Palliat. Support. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying Confusion: The Confusion Assessment Method","volume":"113","author":"Inouye","year":"1990","journal-title":"Ann. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Wickham, H. (2016). Ggplot2, Springer International Publishing. Use R!.","DOI":"10.1007\/978-3-319-24277-4"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kasputyt\u0117, G., Kumpaitien\u0117, B., \u0160vag\u017edien\u0117, M., Andrejaitien\u0117, J., Gailiu\u0161as, M., \u0160irvinskas, E., Gelmanas, A., Hamarat, Y., Chaleckas, E., and Putnynait\u0117, V. (2024). The Association of Cerebral Autoregulation Dysfunction and Postoperative Memory Impairment in Cardiac Surgery Patients. Medicina, 60.","DOI":"10.3390\/medicina60081337"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1213\/ANE.0000000000004601","article-title":"Current Neurologic Assessment and Neuroprotective Strategies in Cardiac Anesthesia: A Survey to the Membership of the Society of Cardiovascular Anesthesiologists","volume":"131","author":"Krause","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1053\/j.jvca.2025.01.003","article-title":"Cerebral Oximetry Index\u2013Guided Blood Pressure Management During Cardiopulmonary Bypass Reduces Postoperative Delirium in Patients with Acute Type A Aortic Dissection","volume":"39","author":"Chen","year":"2025","journal-title":"J. Cardiothorac. Vasc. Anesth."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/6\/1026\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:43:19Z","timestamp":1781862199000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/6\/1026"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":33,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["life16061026"],"URL":"https:\/\/doi.org\/10.3390\/life16061026","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]}}}