Comparison of arterial blood pressure and cardiac index-based hemodynamic management on cognitive function in elderly patients undergoing spinal surgery: a randomized clinical trial
Bibliographic record
Abstract
BACKGROUND: Postoperative delayed neurocognitive recovery (DNR) is frequent in elderly patients. Prevention of DNR is essential to achieve a better postoperative outcome. METHODS: The aim of the present study was to compare mean arterial pressure (MAP) and Cardiac Index (CI) based hemodynamic management on early cognitive function in elderly patients undergoing spinal surgery. Sixty patients aged ≥60 years were enrolled. Patients were randomized to one of two groups. In Group MAP, hemodynamic management of patients was performed according to the MAP value. In Group CI, hemodynamic management of patients was performed according to the CI value. In all patients, standard anesthesia method was used and regional cerebral oxygen saturation (rScO<inf>2</inf>) was measured. Cognitive functions of patients were assessed by Montreal cognitive assessment (MoCA) test before surgery and seven days after surgery. Change in MoCA test (ΔMoCA) was calculated. RESULTS: Postoperative MoCA score was significantly greater in Group CI (25.2±2.4) than Group MAP (23.9±2.5) (P=0.046). The ΔMoCAs were 1 (IQR, 0-3) and 3 (IQR, 2-3.5) in Group CI and MAP respectively (P<0.001). Lowest and average rScO<inf>2</inf> values were significantly greater, and the decreased load of rScO2 below the threshold of 10% (AUCΔ10%) and 20% (AUCΔ20%) below its baseline were significantly lower in Group CI (P<0.05). CONCLUSIONS: CI-based hemodynamic management provided better postoperative cognitive function and higher intraoperative rScO2 when compared with MAP-based hemodynamic management.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Randomized trial | low |
| gpt | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Randomized trial | high |
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".