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
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
Affiliations
Troy S Wildes
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
Yo-El S Ju
Department of Neurology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
Thomas Nguyen
Guy’s and St Thomas’ NHS Foundation Trust, London, UK
S Kendall Smith
Department of Anesthesiology, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
Alyssa K Labonte
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
MohammadMehdi Kafashan
Department of Anesthesiology, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
Orlandrea Hyche
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
Christian S Guay
Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
Elizabeth Wilson
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
Courtney W Chan
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
Anhthi Luong
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
L Brian Hickman
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
Bradley A Fritz
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
Daniel Emmert
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
Thomas J Graetz
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
Spencer J Melby
Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
Brendan P Lucey
Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
Michael S Avidan
Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
Ben J A Palanca
Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
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.
