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doi: 10.1097/ALN.0000000000000329
Critical Care Medicine: Clinical Science

Decreased Functional Connectivity and Disturbed Directionality of Information Flow in the Electroencephalography of Intensive Care Unit Patients with Delirium after Cardiac Surgery

van Dellen, Edwin M.D., Ph.D.; van der Kooi, Arendina W. Ph.D.; Numan, Tianne M.Sc.; Koek, Huiberdina L. M.D., Ph.D.; Klijn, Francina A. M. M.D.; Buijsrogge, Marc P. M.D., Ph.D.; Stam, Cornelis J. M.D., Ph.D.; Slooter, Arjen J. C. M.D., Ph.D.

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Background: In this article, the authors explore functional connectivity and network topology in electroencephalography recordings of patients with delirium after cardiac surgery, aiming to improve the understanding of the pathophysiology and phenomenology of delirium. The authors hypothesize that disturbances in attention and consciousness in delirium may be related to alterations in functional neural interactions.
Methods: Electroencephalography recordings were obtained in postcardiac surgery patients with delirium (N = 25) and without delirium (N = 24). The authors analyzed unbiased functional connectivity of electroencephalography time series using the phase lag index, directed phase lag index, and functional brain network topology using graph analysis.
Results: The mean phase lag index was lower in the α band (8 to 13 Hz) in patients with delirium (median, 0.120; interquartile range, 0.113 to 0.138) than in patients without delirium (median, 0.140; interquartile range, 0.129 to 0.168; P < 0.01). Network topology in delirium patients was characterized by lower normalized weighted shortest path lengths in the α band (t = −2.65; P = 0.01). δ Band–directed phase lag index was lower in anterior regions and higher in central regions in delirium patients than in nondelirium patients (F = 4.53; P = 0.04, and F = 7.65; P < 0.01, respectively).
Conclusions: Loss of α band functional connectivity, decreased path length, and increased δ band connectivity directed to frontal regions characterize the electroencephalography during delirium after cardiac surgery. These findings may explain why information processing is disturbed in delirium.

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