Reversal of Decreases in Cerebral Saturation in High-Risk Cardiac Surgery (original) (raw)
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Anesthesiology, 2016
Background Cerebral oxygen desaturation during cardiac surgery has been associated with adverse perioperative outcomes. Before a large multicenter randomized controlled trial (RCT) on the impact of preventing desaturations on perioperative outcomes, the authors undertook a randomized prospective, parallel-arm, multicenter feasibility RCT to determine whether an intervention algorithm could prevent desaturations. Methods Eight Canadian sites randomized 201 patients between April 2012 and October 2013. The primary outcome was the success rate of reversing cerebral desaturations below 10% relative to baseline in the intervention group. Anesthesiologists were blinded to the cerebral saturation values in the control group. Intensive care unit personnel were blinded to cerebral saturation values for both groups. Secondary outcomes included the area under the curve of cerebral desaturation load, enrolment rates, and a 30-day follow-up for adverse events. Results Cerebral desaturations occu...
Detection and treatment of cerebral hypoxia key to avoiding intraoperative brain injuries
Journal of clinical monitoring and computing, 2000
Despite impressive improvements in the overall safety of anesthetized patients in the past two decades, brain injury remains a major and growing problem. This is demonstrated by the on-going American Society of Anesthesiologists closed-claims analysis. Brain injury (including brain damage, stroke and awareness) represents the single largest fraction (17%) of malpractice claims . Consistent with this ¢nding are the recent large multicenter U.S. cardiac [2] and international noncardiac surgery [3] studies. The U.S. study found a 6% incidence of major brain injury following myocardial revascularization, whereas the international study, performed on patients at least 60 years of age, noted an alarming 26% incidence of marked cognitive decline postoperatively. Although such postoperative deterioration has often been discounted as a transient epiphenomenon, Newman et al. recently showed that it was highly predictive of neurocognitive deterioration ¢ve years later. Newman et al. have also shown that the deterioration is closely associated with a diminished quality of life and is age-related. Their work emphasizes that from a patient safety orientation, post-surgical brain injury is a growing socioeconomic as well as a potential medico-legal problem in our graying society.
İzmir Dr. Behçet Uz Çocuk Hast. Dergisi , 2021
Objective: In this study, we aimed to investigate the incidence of cerebral desaturation and the possible relationship between intraoperative cerebral desaturation and postoperative complications. Methods: A prospective, observational study was performed 115 patients under 18 years of age who required open heart surgery in a university hospital. Cerebral desaturation was defined as a 25% decrease in cerebral saturation (low alarm limit) when compared with the basal value. Duration (second) was referred to the amount of time the patient stays below low alarm limit. Depth (%) was referred to gap between the patient's cerebral regional oxygen saturation (rSO 2) level and the rSO 2 low alarm limit. The cerebral desaturation score was calculated using the %*seconds. The patients were divided into two groups: group 1 (desaturation score >3000 %sec) and group 2 (desaturation score ≤ 3000 %sec). The groups were compared in terms of demographic data, intraoperative and postoperative variables, postoperative complications , and duration of intensive care and hospital stays. Results: In the study, 59 patients (51.3%) were male and 28 patients (24.3%) had cyanotic heart disease. A total of 55 patients (47.8%) experienced over 3000 %sec desaturation. Postoperative complications were found to be increased in group 1 (71% vs 3.3%; χ²=57.119, p<0.001). In the multiple logistic regression analysis, desaturation score>3000 %sec (p<0.001), low body surface area (p=0.001) and prolonged cardi-opulmonary bypass (p=0.006) were found to be associated with postoperative complications. Conclusion: In patients undergoing congenital heart surgery, cerebral desaturation score >3000 %sec is associated with a negative effect on patient prognosis. ÖZ Amaç: Biz bu çalışma ile bir yıl içinde konjenital kalp cerrahisi geçiren pediatrik hastalarda serebral desa-türasyon oranlarını ve serebral desatürasyon ile komplikasyonlar arasındaki ilişkiyi araştırmayı amaçla-dık. Yöntem: Çalışma prospektif gözlemsel olarak bir üniversite hastanesinde gerçekleştirildi. Çalışmaya konje-nital kalp cerrahisi geçirecek 18 yaş altındaki 115 hasta dahil edildi. Serebral desatürasyon bazal değere göre %25'lik doku oksijen satürasyonunda azalma (alt alarm limiti) olarak tanımlandı. Süre (sn), hastanın düşük alarm limitinin altında kaldığı saniye olarak, derinlik (%) hastanın serebral doku satürasyonu (rSO 2) ile düşük alarm limiti altındaki rSO 2 farkı arasındaki yüzdeyi ifade etmekteydi. Serebral desatürasyon skoru (eğri altında kalan alan) %*sn kullanılarak hesaplandı. Hastalar iki gruba ayrıldı: grup 1 (desatürasyon skoru >3000 %sn) ve grup 2 (desatürasyon skoru ≤% 3000 %sn). Gruplar demografik veriler, intraoperatif ve postoperatif değişkenler, postoperatif komplikasyonlar, yoğun bakım ve hastanede kalış süreleri açısın-dan karşılaştırıldı. Bulgular: Çalışmada 59 hastayı (%51.3) erkekler oluşturmakta iken, 28 hastanın (%24.3) siyanotik kalp has-talığı mevcuttu. Ellibeş hastada (%47.8) desatürasyon skoru 3000 %sn üzerinde idi. Postoperatif komplikas-yonlar Grup 1'de anlamlı olarak fazla idi (% 71 vs % 3.3; χ²=57.119, p<0.001). Logistik regresyon analizinde desaturasyon skorunun >3000 %sn (p<0.001) olmasının, düşük vücüt yüzey alanının (p=0.001) ve uzamış kardiyopulmoner baypas süresinin (p=0.006) postoperatif komplikasyonlarla ilişkili olduğu saptandı. Sonuç: Konjenital kalp cerrahisi geçiren hastalarda serebral desatürasyon skorunun 3000 %sn üzerinde olması hasta prognozunda negatif sonuçlara neden olmaktadır. Anahtar kelimeler: Kardiyak cerrahi işlemler, doğumsal kalp kusurları, serebral hipoksi, komplikasyonlar, spektroskopi, yakın kızıl ötesi ID
Applied cardiopulmonary pathophysiology: ACP
Objective: To determine the relationship between a decrease in cerebral oxygen saturation (rSO2) – determined by near-infrared spectroscopy – below 80% of preoperative baseline and the incidence of stroke in patients undergoing deep hypothermic circulatory arrest (DHCA) for cardiac and/or thoracic aortic surgery.Setting: Cardiac anesthesia unit of a University Hospital Design: Retrospective analysis of the anesthesia charts and the institutional cardiac surgery database for the year 2006.Patients: 51 patients undergoing DHCA monitored bi-hemispherically with an INVOS 5100 cerebral oxymeter.Interventions: NoneMeasurements and main results: Patients were grouped according to an rSO2 less or greater than 80% of baseline for the left or right hemisphere in a desaturation (n = 11) and a no-desaturation group (n = 40). No between group differences in demographic variables and preoperative baseline rSO2 were observed. Duration of cardiopulmonary bypass, aortic cross-clamp, DHCA and effecti...
Anesthesia and analgesia, 2016
The purpose of this multicenter pilot study was to: (1) determine the frequency of regional cerebral oxygen saturation (rScO2) desaturations during cardiac surgery involving cardiopulmonary bypass (CPB); (2) evaluate the accuracy of clinician-identified rScO2 desaturations compared with those recorded continuously during surgery by the near-infrared spectroscopy (NIRS) monitor; and (3) assess the effectiveness of an intervention algorithm for reversing rScO2 desaturations. Two hundred thirty-five patients undergoing coronary artery bypass graft and/or valvular surgery were enrolled at 8 US centers in this prospective observational study. NIRS (Invos™ 5100C; Covidien) was used to monitor rScO2 during surgery. The frequency and magnitude of rScO2 decrements >20% from preanesthesia baseline were documented, and the efficacy of a standard treatment algorithm for correcting rScO2 was determined. The data from the NIRS monitor were downloaded at the conclusion of surgery and sent to th...
Collegium antropologicum, 2012
58 patients who underwent on-pump coronary artery bypass graft surgery were evaluated for changes in regional cerebral oxygen saturation (rSO2) measured by near infrared spectroscopy (NIRS). If rSO2 during the operation fell to more than 20% under the baseline, standardized interventions were undertaken to maintain rSO2. Despite those interventions, in some cases we observed inability to maintain rSO2 above this threshold. Therefore we divided patients in two subgroups: 1. without prolonged rSO2 desaturation; 2. with prolonged rSO2 desaturation (area under the curve >150 min% for rSO2<20% of baseline and >50 min% for rSO2<50% of absolute value). The data were analyzed to determine whether there were major differences in outcome of these two groups. 18 out of 58 patients (31%) had prolonged rSO2 desaturation during operation. There was significantly higher number of diabetic patients in group with prolonged rSO2 desaturation (p=0.02). Intraoperative data revealed signific...
Critical Care, 2016
Background: The aim of this study was to elucidate the possible role of cerebral saturation monitoring in the post-cardiac arrest setting. Methods: Cerebral tissue saturation (SctO 2) was measured in 107 successfully resuscitated out-of-hospital cardiac arrest patients for 48 hours between 2011 and 2015. All patients were treated with targeted temperature management, 24 hours at 33°C and rewarming at 0.3°C per hour. A threshold analysis was performed as well as a linear mixed models analysis for continuous SctO 2 data to compare the relation between SctO 2 and favorable (cerebral performance category (CPC) 1-2) and unfavorable outcome (CPC 3-4-5) at 180 days post-cardiac arrest in OHCA patients. Results: Of the 107 patients, 50 (47 %) had a favorable neurological outcome at 180 days post-cardiac arrest. Mean SctO 2 over 48 hours was 68 % ± 4 in patients with a favorable outcome compared to 66 % ± 5 for patients with an unfavorable outcome (p = 0.035). No reliable SctO 2 threshold was able to predict favorable neurological outcome. A significant different course of SctO 2 was observed, represented by a logarithmic and linear course of SctO 2 in patients with favorable outcome and unfavorable outcome, respectively (p < 0.001). During the rewarming phase, significant higher SctO 2 values were observed in patients with a favorable neurological outcome (p = 0.046). Conclusions: This study represents the largest post-resuscitation cohort evaluated using NIRS technology, including a sizeable cohort of balloon-assisted patients. Although a significant difference was observed in the overall course of SctO 2 between OHCA patients with a favorable and unfavorable outcome, the margin was too small to likely represent functional outcome differentiation based on SctO 2 alone. As such, these results given such methodology as performed in this study suggest that NIRS is insufficient by itself to serve in outcome prognostication, but there may remain benefit when incorporated into a multi-neuromonitoring bedside assessment algorithm.
Anaesthesia and Intensive Care, 2017
This prospective pilot study evaluated whether low preoperative cerebral tissue oxygen saturation is associated with unfavourable outcomes after major elective non-cardiac surgery. Eighty-one patients over 60 years of age, American Society of Anesthesiologists physical status 3 or 4, were recruited. Resting cerebral tissue oxygen saturation was recorded on room air, and after oxygen supplementation, using cerebral oximetry. The primary outcome was 30-day major adverse event of combined mortality or severe morbidity, and the secondary outcome was 30-day new disability. Eleven patients (13.6%) suffered a major adverse event, and 28 patients (34.6%) experienced new disability. Room air cerebral tissue oxygen saturation was significantly different between patients who had a major adverse event, 67% (95% confidence interval [CI] 65–70) versus unaffected, 71% (95% CI 70–72; P=0.04). No statistical difference was found between patients for new disability (range 70%– 74%; P=0.73). Room air ...
Annals of Thoracic Surgery, 2009
Background. Previous studies have reported an 11% to 75% incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSO 2 ) saturation. The purpose of this study is to examine whether decreased rSO 2 predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG).