Burst-suppression and Postoperative Delirium: Comment

The recent report by Pedemonte et al.¹  of their substudy of the Minimizing ICU Neurologic Dysfunction with Dexmedetomidine-induced Sleep (MINDDS) study²  emphasized the relationship between electroencephalogram (EEG) burst-suppression during cardiopulmonary bypass and delirium in elderly patients undergoing cardiac surgery. It raises several important points regarding the potential for cerebral monitoring to identify patients who may be at risk for significant postoperative neurologic complications, including delirium and postoperative cognitive dysfunction. However, interpreting these complex relationships requires certain safeguards to minimize the risk of potential false discovery, and thus maximize the confidence in a study’s conclusions. These safeguards include, but are not limited to, clear adherence to the prespecified substudy aims and a priori hypotheses, the development of a data statistical analytic plan before accessing the data, and consideration to the potential moderating effects in the substudy...