Cerebral Oximetry Monitoring to Maintain Normal Cerebral Oxygen Saturation during High-risk Cardiac Surgery (original) (raw)
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Interactive Cardiovascular and Thoracic Surgery, 2009
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of cerebral regional oxygen saturation (rSO ) monitoring during cardiac surgery can lead to improved clinical outcomes. Altogether 488 papers 2 were found using the reported search, of which eight presented the best evidence to answer the clinical question. The author, year, journal, country of study, study type, patient group studied, relevant outcomes, results and study weaknesses were tabulated. Four prospective and another four retrospective studies involving adult and paediatric patients undergoing various cardiac surgical procedures were selected. These have demonstrated that prolonged intra-operative cerebral desaturations are associated with adverse neurological outcomes and prolonged hospital stay. Further, interventions carried out by thoughtful use of the cerebral oximeter are associated with significant reduction in neurologic injury, major organ morbidity and mortality (MOMM) and duration of hospital stay. Some studies have indicated decreased ventilation and intensive care unit (ICU) stay times as well. Clinical benefit and the lack of use-associated risk of injury at a modest expense support the use of this device routinely in patients undergoing cardiac surgery.
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 ...
Journal of Cardiothoracic and Vascular Anesthesia, 2012
Objective: This "real-world" study was designed to assess the patterns of regional cerebral oxygen saturation (rSO 2) change during adult cardiac surgery. A secondary objective was to determine any relation between perioperative rSO 2 (baseline and during surgery) and patient characteristics or intraoperative variables. Design: Prospective, observational, multicenter, nonrandomized clinical study. Setting: Cardiac operating rooms at 3 academic medical centers. Participants: Ninety consecutive adult patients presenting for cardiac surgery with or without cardiopulmonary bypass. Interventions: Patients received standard care at each institution plus bilateral forehead recordings of cerebral oxygen saturation with the 7600 Regional Oximeter System (Nonin Medical, Plymouth, MN). Measurements and Main Results: The average baseline (before induction) rSO 2 was 63.9 ؎ 8.8% (range 41%-95%); preoperative hematocrit correlated with baseline rSO 2 (0.48% increase for each 1% increase in hematocrit, p ؍ 0.008). The average nadir (lowest recorded rSO 2 for any given patient) was 54.9 ؎ 6.6% and was correlated with on-pump surgery, baseline rSO 2 , and height. Baseline rSO 2 was found to be an independent predictor of length of stay (hazard ratio 1.044, confidence interval 1.02-1.07, for each percentage of baseline rSO 2). Conclusions: In cardiac surgical patients, lower baseline rSO 2 value, on-pump surgery, and height were significant predictors of nadir rSO 2 , whereas only baseline rSO 2 was a predictor of postoperative length of stay. These findings support previous research on the predictive value of baseline rSO 2 on length of stay and emphasize the need for further research regarding the clinical relevance of baseline rSO 2 and intraoperative changes.
Cerebral oxygen saturation monitoring in on-pump cardiac surgery - A 1 year experience
2009
To determine the usefulness of cerebral oxygen saturation monitoring in a heterogeneous population of patients undergoing on-pump cardiac surgery and the relationship between minimal perioperative cerebral oxygen saturation (rSO2) levels and clinically relevant outcome parameters. Setting: Cardiac anesthesia unit of a University Hospital Design: Retrospective analysis Participants: n=274 patients monitored bi-hemispherically with an INVOS 5100 cerebral oxymeter and n=526 matched patients without cerebral oxygenation monitoring. The decision to monitor a patient was based on individual co-morbidities associated with an increased risk of stroke (cerebral and/or peripheral artery disease, history of stroke) at the discretion of the attending anesthetist. Interventions: None prespecified. Measurements and main results: In a first analysis, all patients that had been monitored by cerebral oximetry in 2006 were determined by analysis of the anesthesia charts and the institutional cardiac surgery database and compared with a control group matched for Euroscore, age, and type of surgery. This analysis revealed that monitored patients had more preoperative risk factors, had a longer duration of surgery, cardiopulmonary bypass and aortic crossclamp, and needed longer high dependency unit care (all p<0.05) than the control patients. However, major postoperative complications were not different between both groups. In a second analytical step, monitored patients showing intraoperative minimal rSO2 levels of less than 50% or rSO2 levels greater than 50% were compared. This analysis revealed a higher incidence of postoperative organ dysfunction and hospital length of stay in patients with low rSO2 levels. However, groups were not comparable with respect to the preoperative risk profile. To adjust for these differences, in a third analytical step, patients were stratified according to the median Euroscore. This analysis revealed, that patients with an Euroscore ≤ 8 and intraoperative rSO2 levels <50% had more postoperative organ complications and longer high dependency unit and hospital stay in comparison to patients not showing intraoperative cerebral hypoperfusion. Such effects were not detectable in patients with a Euroscore > 8. Conclusions: These data suggests that patients with a higher risk profile for cerebral vascular accidents and renal dysfunction undergoing on-pump cardiac surgery may benefit from cerebral oxygenation monitoring and that rSO2 levels < 50% are associated with an unfavourable clinical course. However, the association between low cerebral oxygen saturation and worse outcome seems to be limited to patients with a low to moderate risk profile (Euroscore ≤ 8).
Preoperative Cerebral Oxygen Saturation and Clinical Outcomes in Cardiac Surgery
Anesthesiology, 2011
The current study was designed to determine the relation between preoperative cerebral oxygen saturation (ScO 2 ), variables of cardiopulmonary function, mortality, and morbidity in a heterogeneous cohort of cardiac surgery patients. Methods: In this study, 1,178 consecutive patients scheduled for on-pump surgery were prospectively studied. Preoperative ScO 2 , demographics, N-terminal pro-B-type natriuretic peptide, high-sensitive troponin T, clinical outcomes, and 30-day and 1-yr mortality were recorded. Results: Median additive EuroSCORE was 5 (range: 0 -19). Thirty-day and 1-yr mortality and major morbidity (at least two major complications and/or a high-dependency unit stay of at least 10 days) were 3.5%, 7.7%, and 13.3%, respectively. Median minimal preoperative oxygen supplemented ScO 2 (ScO 2min-ox ) was 64% (range: 15-92%). ScO 2min-ox was correlated (all: P value Ͻ0.0001) with N-terminal pro-Btype natriuretic peptide (: Ϫ0.35), high-sensitive troponin T (: Ϫ0.28), hematocrit (: 0.34), glomerular filtration rate (: 0.19), EuroSCORE (: 0.20), and left ventricular ejection fraction class (: 0.12). Thirty-day nonsurvivors had a lower ScO 2min-ox than survivors (median 58% [95% CI, 50.7-62%] vs. 64% [95% CI, 64 -65%]; P Ͻ 0.0001). Receiver-operating curve analysis of ScO 2min-ox and 30-day mortality revealed an area-under-the-curve of 0.71 (95% CI, 0.68 -0.73%; P Ͻ 0.0001) in the total cohort and an areaunder-the-curve of 0.77 (95% CI, 0.69 -0.86%; P Ͻ 0.0001) in patients with a EuroSCORE more than 10. Logistic regression based on different EuroSCORE categories (0 -2; 3-5, 6 -10, Ͼ10), ScO 2min-ox , and duration of cardiopulmonary bypass showed that a ScO 2min-ox equal or less than 50% is an independent risk factor for 30-day and 1-yr mortality. Conclusions: Preoperative ScO 2 levels are reflective of the severity of cardiopulmonary dysfunction, associated with shortand long-term mortality and morbidity, and may add to preoperative risk stratification in patients undergoing cardiac surgery.
Reversal of Decreases in Cerebral Saturation in High-Risk Cardiac Surgery
Journal of Cardiothoracic and Vascular Anesthesia, 2013
Objectives: To measure the incidence of cerebral desaturations during high-risk cardiac surgery and to evaluate strategies to reverse cerebral desaturations. Design: Prospective observational study followed by a randomized controlled study with 1 intervention group and 1 control group. Setting: Tertiary care center specialized in cardiac surgery. Participants: All patients were scheduled for high-risk cardiac surgery, 279 consecutive patients in the prospective study and 48 patients in the randomized study. Interventions: An algorithmic approach of strategies to reverse cerebral desaturations. In the control group, no attempts were made to reverse cerebral desaturations. Measurements and Main Results: Cerebral saturation was measured using near-infrared reflectance spectroscopy. A decrease of 20% from baseline for 15 seconds defined cerebral desaturations. The success or failure of the interventions was noted. Demographic data were collected. Models for predicting the probability and the reversal of cerebral desaturations were based on multiple logistic regressions. In the randomized study, 12 hours of measurements were continued in the intensive care unit without interventions. Differences in desaturation load (% desaturation  time) were compared between groups. Half of the high-risk patients had cerebral desaturations that could be reversed 88% of the time. Interventions resulted in smaller desaturation loads in the operating room and in the intensive care unit. Conclusions: Cerebral desaturations in high-risk cardiac surgery are frequent but can be reversed most of the time resulting in a smaller desaturation load. A large randomized study will be needed to measure the impact of reversing cerebral desaturations on patient's outcome.
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...
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).
Pakistan Journal of Medical Sciences Online
Objective: To study the relationship between cerebral oxygen saturation changes and postoperative neurologic complications. Methodology: Seventy two adult patients with ASA class II, III who were scheduled for elective cardiac surgery, were randomized into three groups: Group I: with CPB (on -pump) Group II: without CPB (off- pump) Group III: valve surgery. Neuropsychological outcome was assessed by the Mini-Mental State Examination (MMSE). Cerebral oxygen saturation was also measured. Results: There was no statistical difference in desaturation of more than 20% among three groups (P=0.113) but it was significant between group I and II (P=0.042). Changes of rSO2 in different hours of surgery was significant in group I and group II (P=0.0001 in both ) but it was not significant in group III ( P=0.075) . Conclusion: Although cerebral oximetry is a noninvasive and useful method of monitoring during cardiac surgery, it has low accuracy to determine postoperative neurologic complications.