• Patrick J Smith, James A Blumenthal, Benson M Hoffman, Sarah K Rivelli, Scott M Palmer, Robert D Davis, and Joseph P Mathew.
• 1 Department of Psychiatry and Behavioral Sciences.
• Ann Am Thorac Soc. 2016 Feb 1;13(2):180-7.

RationaleDelirium is common following lung transplant and is associated with poorer clinical outcomes. The extent to which intraoperative hemodynamic alterations may contribute to postoperative delirium among lung transplant recipients has not been examined.ObjectivesTo examine the impact of intraoperative hemodynamic changes on neurobehavioral outcomes among lung transplant recipients.MethodsIntraoperative hemodynamic function during lung transplant was assessed in a consecutive series of patients between March and November 2013. Intraoperative cerebral perfusion pressure was assessed every minute in all patients. Following lung transplant, patients were monitored for the presence and severity of delirium using the Confusion Assessment Method and the Delirium Rating Scale until hospital discharge.Measurements And Main ResultsSixty-three patients received lung transplants, of whom 23 (37%) subsequently developed delirium. Lower cerebral perfusion pressure was associated with increased risk of delirium (odds ratio [OR], 2.08 per 10-mm Hg decrease; 95% confidence interval [CI], 1.02-4.24; P = 0.043), longer duration of delirium (OR, 1.7 d longer per 10-mm Hg decrease; 95% CI, 1.1-2.7; P = 0.022), and greater delirium severity (b = -0.81; 95% CI, -1.47 to -0.15; P = 0.017).ConclusionsPoorer cerebral perfusion pressure during lung transplant is associated with greater risk for delirium following transplant, as well as greater duration and severity of delirium, independent of demographic and medical predictors.

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