Tissue oxygen saturation changes and postoperative complications in cardiac surgery: a prospective observational study (original) (raw)
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Acta anaesthesiologica Scandinavica, 2014
Microcirculatory disturbances following cardiac surgery with cardiopulmonary bypass (CPB) are thought to be at the origin of organ dysfunction, although few studies have correlated microvascular alterations with outcome. We aimed to assess the microcirculation with near infrared spectroscopy (NIRS) and correlate NIRS parameters with intensive care length of stay and organ dysfunction. Forty patients at increased risk of postoperative systemic inflammatory response syndrome after an elective cardiac surgery with CPB were included in this prospective observational study. Microcirculation of the thenar eminence was analysed by NIRS technology, through the tissue oxygen saturation (StO2 ) and the recovery slope after an ischaemic challenge. Organ dysfunction was assessed with the Sequential Organ Failure Assessment (SOFA) score. Microcirculation parameters were recorded at baseline, at different time points during the surgery and the first 48 postoperative hours. StO2 at baseline was 82...
Critical care (London, England), 2016
Impaired microcirculatory perfusion and tissue oxygenation during critical illness are associated with adverse outcome. The aim of this study was to detect alterations in tissue oxygenation or microvascular reactivity and their ability to predict outcome in critically ill patients using thenar near-infrared spectroscopy (NIRS) with a vascular occlusion test (VOT). Prospective observational study in critically ill adults admitted to a 12-bed intensive care unit (ICU) of a University Hospital. NIRS with a VOT (using a 40 % tissue oxygen saturation (StO2) target) was applied daily until discharge from the ICU or death. A group of healthy volunteers were evaluated in a single session. During occlusion, StO2 downslope was measured separately for the first (downslope 1) and last part (downslope 2) of the desaturation curve. The difference between downslope 2 and 1 was calculated (delta-downslope). The upslope and area of the hyperaemic phase (receive operating characteristic (ROC) area un...
Journal of Cardiothoracic and Vascular Anesthesia, 2007
Objective: Cerebral near-infrared spectroscopy (NIRS) was evaluated for use in monitoring global oxygenation in adult patients after cardiac surgery. Design: Prospective, randomized clinical monitoring study. Setting: Intensive care unit for cardiac surgery; university hospital. Participants: The study included 35 patients scheduled for cardiac surgery with insertion of a pulmonary artery catheter; patients with known cerebral-vascular perfusion disturbances were excluded. Interventions: Noninvasive cerebral NIRS oxygen saturation (rSO 2) and conventional intensive care monitoring parameters were assessed. Measurements and Main Results: Simple regression analysis was used to assess the correlation of rSO 2 to hemody-namic parameters. There was fair-to-moderate intersubject correlation to hemoglobin concentration (r ؍ 0.45, p < 0.0001) and mixed venous oxygen saturation (SmvO 2) (r ؍ 0.33, p < 0.0001). Sensitivity and specificity of rSO 2 to detect substantial (>1 standard deviation) changes in mixed venous oxygen saturation were 94% and 81%, respectively. Conclusions: Cerebral NIRS in adult patients might not be the tool to replace mixed venous oxygen monitoring. Further work has to be done to assess its potential to reflect intraindividual trends.
Critical Care …, 2011
N ear-infrared spectroscopy (NIRS) has been used as a tool to monitor tissue oxygen saturation (StO 2 ) in critically ill patients (1). In addition, changes in StO 2 during a vascular occlusion test (VOT) have been used as a marker of microvascular reactivity, in particular the StO 2 recovery after the VOT (2-5). During a VOT (upper arm arterial occlusion with a pneumatic cuff), depletion of local available oxygen is monitored by NIRS as a decrease in StO 2 ; after the cuff release, the arterial inflow is monitored as the rate of StO 2 increase during the reperfusion phase. The former can be used to calculate the muscle oxygen consumption and metabolic rate, whereas the latter can be used to quantify the intensity of the reactive hyperemia during the reperfusion period.
Journal of Clinical Monitoring and Computing, 2012
Main problem: Ischemia time is a prognostic factor in renal transplantation for postoperative graft function and survival. Kidney transplants from living donors have a higher survival rate than deceased donor kidneys probably due to shorter ischemia time. We hypothesized that measurement of intraoperative kidney oxygenation (µHbO) and microvascular perfusion predicts postoperative graft function. Methods: We measured microvascular hemoglobin oxygen saturation by reflectance spectrophotometry and microcirculatory kidney perfusion by laser Doppler flowmetry 5 and 30 min after kidney reperfusion on the organ surface in 53 renal transplant patients including 19 grafts from living donors. These values were related to systemic hemodynamics, cold ischemia time, early postoperative graft function, and hospital length of stay. Results: µHbO 2 improved 30 min after reperfusion compared to 5 min (from 67 to 71%, p<0.05). µHbO 2 correlated with mean arterial blood pressure and central venous pH (p<0.01). Most importantly, µHbO 2 was significantly higher in kidneys from living compared to deceased donors (74 vs. 63%) and in kidneys without vs. with biopsy-proven postoperative rejection (71 vs. 45%, p<0.001). Finally, µHbO 2 correlated positively with cold ischemia time and postoperative creatinine clearance and negatively with postoperative plasma creatinine, need for hemodialysis and hospital length of stay. Conclusions: Our results suggest higher oxygen extraction and thus oxygen demand of the grafts shortly after reperfusion. The intraoperative measurement of tissue oxygenation in kidney transplants is predictive of early postoperative graft function. Future studies should evaluate the potential effect of intraoperative therapeutic manoeuvres to improve organ tissue oxygenation in renal transplantation.
American Journal of Case Reports, 2019
Mistake in diagnosis Background: Patients undergoing cardiac surgery are at risk of adverse perioperative neurological complications. Cerebral oximetry monitoring is increasingly used in these patients to detect intraoperative cerebral hypoxia or ischemic events. Near-infrared spectroscopy (NIRS) uses the near-infrared region of the electromagnetic spectrum for oximetry imaging. A case is reported of the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest. Case Report: A 65-year-old man was admitted to the Emergency Department with dysarthria, left facial ptosis, left hemiplegia, and arterial hypotension of 75/50 mmHg. Computed tomography (CT) angiography showed a Stanford type A aortic dissection extending to the right common carotid artery. Shortly after arrival in the operating room, his hemodynamic condition rapidly deteriorated resulting in cardiac arrest. Despite the rapid onset of extracorporeal circulation, adequate systemic blood flow could not be restored. Cerebral NIRS values remained within the normal range (70-80%) from the start of emergency resuscitation, during a prolonged period of extremely low global blood perfusion values, and until all resuscitation ceased. Conclusions: Cerebral oximetry values reflect a balance between cerebral oxygen delivery and consumption. This case demonstrated the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest.
Critical Care, 2009
To assess potential metabolic and microcirculatory alterations in critically ill patients, near-infrared spectroscopy (NIRS) has been used, in combination with a vascular occlusion test (VOT), for the non-invasive measurement of tissue oxygen saturation (StO 2 ), oxygen consumption, and microvascular reperfusion and reactivity. The methodologies for assessing StO 2 during a VOT, however, are very inconsistent in the literature and, consequently, results vary from study to study, making data comparison difficult and potentially inadequate. Two major aspects concerning the inconsistent methodology are measurement site and probe spacing. To address these issues, we investigated the effects of probe spacing and measurement site using 15 mm and 25 mm probe spacings on the thenar and the forearm in healthy volunteers and quantified baseline, ischemic, reperfusion, and hyperemic VOT-derived StO 2 variables.
Journal of Clinical Monitoring and Computing
Near infrared spectroscopy (NIRS) has been used to evaluate regional cerebral tissue oxygen saturation (ScO 2) during the last decades. Perioperative management algorithms advocate to maintain ScO 2 , by maintaining or increasing cardiac output (CO), e.g. with fluid infusion. We hypothesized that ScO 2 would increase in responders to a standardized fluid challenge (FC) and that the relative changes in CO and ScO 2 would correlate. This study is a retrospective substudy of the FLuid Responsiveness Prediction Using Extra Systoles (FLEX) trial. In the FLEX trial, patients were administered two standardized FCs (5 mL/kg ideal body weight each) during cardiac surgery. NIRS monitoring was used during the intraoperative period and CO was monitored continuously. Patients were considered responders if stroke volume increased more than 10% following FC. Datasets from 29 non-responders and 27 responders to FC were available for analysis. Relative changes of ScO 2 did not change significantly in non-responders (mean difference − 0.3% ± 2.3%, p = 0.534) or in fluid responders (mean difference 1.6% ± 4.6%, p = 0.088). Relative changes in CO and ScO 2 correlated significantly, p = 0.027. Increasing CO by fluid did not change cerebral oxygenation. Despite this, relative changes in CO correlated to relative changes in ScO 2. However, the clinical impact of the present observations is unclear, and the results must be interpreted with caution. Trial registration: http://Clini calTr ial.gov identifier for main study (FLuid Responsiveness Prediction Using Extra Systoles-FLEX): NCT03002129.
British Journal of Anaesthesia, 2013
† Cerebral oxygen saturation might provide better non-invasive monitor of tissue perfusion than mixed venous oxygen saturation. † Simultaneous measurements of cerebral oxygen saturation using two near-infrared spectroscopy monitors (INVOS w and Foresight w) were compared in cardiac surgery. † Cerebral oxygen saturation appears to provide a more responsive monitor of tissue perfusion than mixed venous saturation. Background. We hypothesized that previously reported contradictory results regarding the equivalence of mixed venous (Smv O 2) and cerebral (rS c O 2) oxygen saturation might be related to time delay issues and to measurement technology. In order to explore these two factors, we designed a prospective clinical study comparing Smv O 2 with relative (INVOS w) and absolute (Foresight w) rS c O 2 measurements. Methods. Forty-two consenting patients undergoing elective off-pump coronary artery bypass grafting were included. Two INVOS and two Foresight sensors continuously registered rS c O 2. Smv O 2 was measured continuously via a pulmonary artery catheter. Data were assessed by within-and between-group comparisons and correlation analysis. Results. A similar time delay of 19 (4) and 18 (4) s was found for Smv O 2 compared with rS c O 2 measurements by Foresight and INVOS, respectively, during haemodynamic changes. After adjusting for this time delay, the correlation between Smv O 2 and rS c O 2 increased from r¼0.25 to 0.75 (P,0.001) for Foresight, and from r¼0.28 to 0.73 (P,0.001) for INVOS. Comparison of Foresight and INVOS revealed significant differences in absolute rS c O 2 values (range 58-89% for Foresight and 28-95% for INVOS). Changes in rS c O 2 in response to acute haemodynamic alterations were significantly more pronounced with INVOS compared with Foresight (P,0.001). Conclusions. Considering the important time delay with Smv O 2 , rS c O 2 seems to reflect more appropriately acute haemodynamic alterations. This might suggest its use as a valid alternative to invasive monitoring of tissue oxygen saturation. Relative and absolute rS c O 2 measurements demonstrated significant differences in measured rS c O 2 values and in the magnitude of rS c O 2 changes during haemodynamic alterations.