• Cerebral Oxygenation and Neurological Outcomes Following Critical Illness (CONFOCAL) Research Group, Canadian Critical Care Trials Group, Michael D Wood, David M Maslove, John G Muscedere, Andrew G Day, and Gordon Boyd J J Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Dept. of Critical Care Medicine, Queen's University, Kingston, ON, Canada; Dept.
• Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada. Electronic address: 14mdw@queensu.ca.
• J Crit Care. 2017 Oct 1; 41: 289-295.

PurposeTo test the hypothesis that poor brain tissue oxygenation (BtO2) during the first 24h of critical illness correlates with the proportion of time spent delirious. We also sought to define the physiological determinants of BtO2.Materials And MethodsAdult patients admitted to the ICU within the previous 24h were considered eligible for enrollment if they required mechanical ventilation, and/or vasopressor support. BtO2 was measured using near-infrared spectroscopy, for 24h after enrollment. Hourly vital signs and clinically ordered arterial and central venous blood gases were collected throughout BtO2 monitoring. Patients were screened daily for delirium with the confusion assessment method for the intensive care unit (CAM-ICU).ResultsBtO2 and the proportion of time spent delirious did not result in a significant correlation (p=0.168). However, critically ill patients who spent the majority of their ICU stay delirious had significantly lower mean BtO2 compared to non-delirious patients, (p=0.017). BtO2 correlated positively with central venous pO2 (p=0.00003) and hemoglobin concentration (p=0.001). Logistic regression indicated that lower BtO2, higher narcotic doses and a history of alcohol abuse were independent risk factors for delirium.ConclusionsPoor cerebral oxygenation during the first 24 hours of critical illness contributes to the development of delirium.Trial RegistrationThis trial is registered on clinicaltrials.gov (Identifier: NCT02344043), retrospectively registered January 8, 2015.Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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