Pediatric anesthesiologist and intensivist Sean Barnes discusses his research, which explores plasma biomarkers reflective of pathways implicated in delirium pathogenesis. This research aims to provide pediatric cardiac anesthesiologists and intensivists with the means to predict which patients are likely to develop delirium, and to possibly identify modifiable risk factors that will affect the approach of caring for children with congenital heart defects who are undergoing cardiopulmonary bypass surgery.
My name is Doctor Sean Barnes and I'm an assistant professor of anesthesiology and critical care medicine. I work both as a pediatric cardiac anesthesiologist and pediatric cardiac intensivist. My research explores plasma biomarkers, reflective of pathways implicated in delirium pathogenesis, ie neuronal and astra cytic injury, altered neurotransmitter signaling and inflammation. Over 40,000 infants and Children in the United States undergo cardiac surgery per year. Children undergoing cardiac surgery and specifically cardiopulmonary bypass surgery are particularly susceptible to development of post-operative IC U delirium with reported incidents of 50 to 60% versus 10 to 30% in the general pediatric intensive care population delirium. Research in hospitalized Children has lagged significantly behind mounting evidence and hospitalized adults. However, since the introduction of validated pediatric specific delirium screening tools, several research groups have shown through rigorous prior research that the prevalence of delirium in critically ill Children is similar to estimates in adults. IC delirium is not the same phenomenon as seen with emergence, delirium, emergence delirium occurs in Children who have undergone general anesthesia and is well described with typical features including a disoriented child who is likely inattentive and at times possibly combative. These behaviors are limited to a short period of time after receiving anesthesia, development of IC U delirium in Children is independently associated with increased duration of mechanical ventilation, IC U length of stay and a dramatic increase in hospital costs. One single center study demonstrated a fourfold increase in mortality associated with pediatric delirium. Adult studies have demonstrated that delirium is associated with worse long term global cognition and executive function. This neurofunction decline is independent of sedative or analgesic medication use, age pre-existing cognitive impairment, the burden of coexisting conditions and ongoing organ failures during IC U care. As a result, many IC U survivors have experienced delirium have a poor health related quality of life. Delirium is a complex patio physiologic process characterized by acute onset and fluctuating course of reduced awareness, inattentiveness and changes in cognition. The pathophysiology underlying this process is not fully understood. However, potential ideologies include brain cell injury, altered neurotransmitter signaling and inflammation. Adult studies have shown an association between plasma biomarkers and delirium both after surgery and during critical illness. Biomarkers of brain injury are an area ripe for investigation to elucidate, the pathophysiology of delirium in Children undergoing high risk surgery for congenital heart disease. My research aims to provide pediatric cardiac anesthesiologists and intensivist the means to predict which patients are likely to develop delirium and possibly identify modifiable risk factors that will impact how we approach caring for Children with congenital heart disease, undergoing cardiopulmonary bypass surgery
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