Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Sep;52(9):3000605241274604.
doi: 10.1177/03000605241274604.

Effect of optimizing cerebral oxygen saturation on postoperative delirium in older patients undergoing one-lung ventilation for thoracoscopic surgery

Peilan Teng  1   2 , Henghua Liu  1 , Derong Xu  1 , Xuexin Feng  3 , Miao Liu  3 , Qingxiu Wang  4   5
Affiliations
Randomized Controlled Trial

Effect of optimizing cerebral oxygen saturation on postoperative delirium in older patients undergoing one-lung ventilation for thoracoscopic surgery

Peilan Teng et al. J Int Med Res. 2024 Sep.

Abstract

Objectives: This randomized controlled trial investigated whether the regional cerebral oxygenation saturation (rScO2)-guided lung-protective ventilation strategy could improve brain oxygen and reduce the incidence of postoperative delirium (POD) in patients older than 65 years.

Methods: This randomized controlled trial enrolled 120 patients undergoing thoracic surgery who received one-lung ventilation (OLV). Patients were randomly assigned to the lung-protective ventilation group (PV group) or rScO2-oriented lung-protective ventilation group (TPV group). rScO2 was recorded during the surgery, and the occurrence of POD was assessed.

Results: The incidence of POD 3 days after surgery-the primary outcome-was significantly lower in the TPV group (23.3% versus 8.5%). Meanwhile, the levels of POD-related biological indicators (S100β, neuron-specific enolase, tumor necrosis factor-α) were lower in the TPV group. Considering the secondary outcomes, both groups exhibited a lower oxygenation index after OLV, whereas partial pressure of carbon dioxide and mean arterial pressure were significantly increased in the TPV group. In addition, minimum rScO2 during surgery and mean rScO2 were higher in the TPV group than in the PV group.

Conclusion: Continuous intraoperative monitoring of brain tissue oxygenation and active intervention measures guided by cerebral oxygen saturation are critical for improving brain metabolism and reducing the risk of POD.

Keywords: Lung-protective ventilation; cerebral oxygen saturation; geriatrics; hypoxia; lung cancer; one-lung ventilation; postoperative delirium; thoracoscopic surgery.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interestsThe authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow diagram of the study. PV group, lung-protective ventilation group; TPV group: rScO2-oriented lung-protective ventilation group.
See this image and copyright information in PMC

References

    1. Tsai CH, Lai YC, Chang SC, et al.. Video-assisted thoracoscopic surgical decortication in the elderly with thoracic empyema: Five years' experience. J Chin Med Assoc 2016; 79: 25–28. - PubMed
    1. Jung DM, Ahn HJ, Jung SH, et al.. Apneic oxygen insufflation decreases the incidence of hypoxemia during one-lung ventilation in open and thoracoscopic pulmonary lobectomy: A randomized controlled trial. J Thorac Cardiovasc Surg 2017; 154: 360–366. - PubMed
    1. Li XM, Li F, Liu ZK, et al.. Investigation of one-lung ventilation postoperative cognitive dysfunction and regional cerebral oxygen saturation relations. J Zhejiang Univ Sci B 2015; 16: 1042–1048. - PMC - PubMed
    1. Hemmerling TM, Bluteau MC, Kazan R, et al.. Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry. Br J Anaesth 2008; 101: 870–875. - PubMed
    1. Albanese AM, Ramazani N, Greene N, et al.. Review of Postoperative Delirium in Geriatric Patients After Hip Fracture Treatment. Geriatr Orthop Surg Rehabil 2022; 13: 2151459321105894721514593211058947. - PMC - PubMed

Publication types

LinkOut - more resources