Abstract
In this prospective observational pilot study patients with the diagnosis of end-stage lung disease and listed for lung transplantation underwent a cognitive function test battery before and after lung transplantation to investigate postoperative cognitive function in three domains (visual and verbal memory, executive functioning, concentration/speed of processing). Additionally we investigated intraoperative risk factors for postoperative cognitive dysfunction. In total, 24 patients were included in this pilot study. The incidence of postoperative cognitive dysfunction was 58.3%. In the cognitive dysfunction group, the domains executive functioning and concentration/attention were significantly impaired whereas memory was not affected. Patients with cognitive impairment had a significantly longer ICU stay. The strongest independent risk factor for the development of cognitive dysfunction was operation time. No influence of cerebral oxygen desaturations on cognitive dysfunction was found. This might have important implications for early psychological rehabilitation strategies in this high-risk patient collective.
Highlights
Lung transplantation is a well-established therapy for endstage lung diseases that improves quality of life and survival rates (Yusen et al, 2016)
Cognitive dysfunction after surgery has to be distinguished between postoperative delirium, which occurs within the first 7 days after surgery and cognitive decline, which is earliest diagnosed at postoperative day 8 (Evered et al, 2018)
In our study the overall incidence of postoperative delirium was 41.7% which is comparable to previous studies (34% reported in existing literature) (Smith et al, 2014)
Summary
Lung transplantation is a well-established therapy for endstage lung diseases that improves quality of life and survival rates (Yusen et al, 2016). Several studies revealed conflicting results regarding the impairment of cognitive function after lung transplantation (Cohen et al, 2014; Limbos et al, 2000; Smith et al, 2014). Perioperative neurocognitive disorders included any form of acute event, such as postoperative delirium within the first 72–96 h after surgery, and cognitive dysfunction mostly diagnosed after day seven post procedure, such as delayed neurocognitive recovery and postoperative neurocognitive dysfunction (POCD) (Evered et al, 2018). Delirium is a form of acute brain failure characterized by altered consciousness with a reduced ability to focus, sustain, or shift attention that develops quickly and tends to fluctuate over the course of the day (Inouye, 2006). POCD is defined by changes in neuropsychological tests administered before and after anesthesia and surgery including memory, executive functioning, and
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