Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patients
Introduction Delirium is a potentially preventable disorder characterised by acute disturbances in attention and cognition with fluctuating severity. Postoperative delirium is associated with prolonged intensive care unit and hospital stay, cognitive decline and mortality. The development of biomark...
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BMJ Publishing Group
2020-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/12/e044295.full |
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| author | Troy S Wildes Yo-El S Ju Thomas Nguyen S Kendall Smith Alyssa K Labonte MohammadMehdi Kafashan Orlandrea Hyche Christian S Guay Elizabeth Wilson Courtney W Chan Anhthi Luong L Brian Hickman Bradley A Fritz Daniel Emmert Thomas J Graetz Spencer J Melby Brendan P Lucey Michael S Avidan Ben J A Palanca |
| author_facet | Troy S Wildes Yo-El S Ju Thomas Nguyen S Kendall Smith Alyssa K Labonte MohammadMehdi Kafashan Orlandrea Hyche Christian S Guay Elizabeth Wilson Courtney W Chan Anhthi Luong L Brian Hickman Bradley A Fritz Daniel Emmert Thomas J Graetz Spencer J Melby Brendan P Lucey Michael S Avidan Ben J A Palanca |
| author_sort | Troy S Wildes |
| collection | DOAJ |
| description | Introduction Delirium is a potentially preventable disorder characterised by acute disturbances in attention and cognition with fluctuating severity. Postoperative delirium is associated with prolonged intensive care unit and hospital stay, cognitive decline and mortality. The development of biomarkers for tracking delirium could potentially aid in the early detection, mitigation and assessment of response to interventions. Because sleep disruption has been posited as a contributor to the development of this syndrome, expression of abnormal electroencephalography (EEG) patterns during sleep and wakefulness may be informative. Here we hypothesise that abnormal EEG patterns of sleep and wakefulness may serve as predictive and diagnostic markers for postoperative delirium. Such abnormal EEG patterns would mechanistically link disrupted thalamocortical connectivity to this important clinical syndrome.Methods and analysis P-DROWS-E (Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography) is a 220-patient prospective observational study. Patient eligibility criteria include those who are English-speaking, age 60 years or older and undergoing elective cardiac surgery requiring cardiopulmonary bypass. EEG acquisition will occur 1–2 nights preoperatively, intraoperatively, and up to 7 days postoperatively. Concurrent with EEG recordings, two times per day postoperative Confusion Assessment Method (CAM) evaluations will quantify the presence and severity of delirium. EEG slow wave activity, sleep spindle density and peak frequency of the posterior dominant rhythm will be quantified. Linear mixed-effects models will be used to evaluate the relationships between delirium severity/duration and EEG measures as a function of time.Ethics and dissemination P-DROWS-E is approved by the ethics board at Washington University in St. Louis. Recruitment began in October 2018. Dissemination plans include presentations at scientific conferences, scientific publications and mass media.Trial registration number NCT03291626. |
| format | Article |
| id | doaj-art-88de6c47d0c64e058046caf367f3c6be |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-88de6c47d0c64e058046caf367f3c6be2024-11-22T19:20:12ZengBMJ Publishing GroupBMJ Open2044-60552020-12-01101210.1136/bmjopen-2020-044295Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patientsTroy S Wildes0Yo-El S Ju1Thomas Nguyen2S Kendall Smith3Alyssa K Labonte4MohammadMehdi Kafashan5Orlandrea Hyche6Christian S Guay7Elizabeth Wilson8Courtney W Chan9Anhthi Luong10L Brian Hickman11Bradley A Fritz12Daniel Emmert13Thomas J Graetz14Spencer J Melby15Brendan P Lucey16Michael S Avidan17Ben J A Palanca18Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USADepartment of Neurology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USAGuy’s and St Thomas’ NHS Foundation Trust, London, UKDepartment of Anesthesiology, Washington University School of Medicine in St. Louis, St Louis, Missouri, USADepartment of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USADepartment of Anesthesiology, Washington University School of Medicine in St. Louis, St Louis, Missouri, USADepartment of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USAAnesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USADepartment of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USADepartment of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USADepartment of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USADepartment of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USADepartment of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USADepartment of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USADepartment of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USADepartment of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USADepartment of Neurology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USADepartment of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USADepartment of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USAIntroduction Delirium is a potentially preventable disorder characterised by acute disturbances in attention and cognition with fluctuating severity. Postoperative delirium is associated with prolonged intensive care unit and hospital stay, cognitive decline and mortality. The development of biomarkers for tracking delirium could potentially aid in the early detection, mitigation and assessment of response to interventions. Because sleep disruption has been posited as a contributor to the development of this syndrome, expression of abnormal electroencephalography (EEG) patterns during sleep and wakefulness may be informative. Here we hypothesise that abnormal EEG patterns of sleep and wakefulness may serve as predictive and diagnostic markers for postoperative delirium. Such abnormal EEG patterns would mechanistically link disrupted thalamocortical connectivity to this important clinical syndrome.Methods and analysis P-DROWS-E (Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography) is a 220-patient prospective observational study. Patient eligibility criteria include those who are English-speaking, age 60 years or older and undergoing elective cardiac surgery requiring cardiopulmonary bypass. EEG acquisition will occur 1–2 nights preoperatively, intraoperatively, and up to 7 days postoperatively. Concurrent with EEG recordings, two times per day postoperative Confusion Assessment Method (CAM) evaluations will quantify the presence and severity of delirium. EEG slow wave activity, sleep spindle density and peak frequency of the posterior dominant rhythm will be quantified. Linear mixed-effects models will be used to evaluate the relationships between delirium severity/duration and EEG measures as a function of time.Ethics and dissemination P-DROWS-E is approved by the ethics board at Washington University in St. Louis. Recruitment began in October 2018. Dissemination plans include presentations at scientific conferences, scientific publications and mass media.Trial registration number NCT03291626.https://bmjopen.bmj.com/content/10/12/e044295.full |
| spellingShingle | Troy S Wildes Yo-El S Ju Thomas Nguyen S Kendall Smith Alyssa K Labonte MohammadMehdi Kafashan Orlandrea Hyche Christian S Guay Elizabeth Wilson Courtney W Chan Anhthi Luong L Brian Hickman Bradley A Fritz Daniel Emmert Thomas J Graetz Spencer J Melby Brendan P Lucey Michael S Avidan Ben J A Palanca Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patients BMJ Open |
| title | Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patients |
| title_full | Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patients |
| title_fullStr | Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patients |
| title_full_unstemmed | Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patients |
| title_short | Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patients |
| title_sort | protocol for the prognosticating delirium recovery outcomes using wakefulness and sleep electroencephalography p drows e study a prospective observational study of delirium in elderly cardiac surgical patients |
| url | https://bmjopen.bmj.com/content/10/12/e044295.full |
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