Alpha-stat, beach chair, cerebral autoregulation… But who is at risk?

Murkin, John M.; Giraldo, Mauricio

doi:10.1007/s12630-016-0605-2

Cited by 2 publications

(1 citation statement)

References 41 publications

(76 reference statements)

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“…Interventions designed to minimise peri-operative reductions in rScO 2 may improve overall outcomes, particularly if rScO 2 is considered a reflection of adequacy of global perfusion, using the brain as an index organ [3]. This is of particular importance in emphasising the principle that if the brain is 'not OK', then be aware and beware [4].…”

Section: Introductionmentioning

confidence: 99%

Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial

et al. 2017

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Postoperative delirium is associated with increased morbidity and mortality. We hypothesised that restoration of regional cerebral oxygen desaturation would reduce the incidence of postoperative delirium in elderly patients after cardiac surgery. After institutional ethics review board approval and informed consent, a double-blinded, prospective, randomised, controlled trial was conducted in patients ≥ 60 years of age undergoing cardiac surgery with cardiopulmonary bypass. In the intervention group, an algorithm was commenced if regional cerebral oxygen saturation decreased below 75% of baseline value for 1 min or longer. In the control group, the cerebral oximetry monitor screen was electronically blinded. Assessment of delirium was performed with confusion assessment method for intensive care unit or confusion assessment method after discharge from intensive care unit at 12-h intervals for seven postoperative days. Postoperative delirium was present in 30 out of 123 (24.4%) and 31 out of 126 (24.6%) patients in the intervention and control groups, respectively, odds ratio 0.98 (95%CI 0.55-1.76), p = 0.97. Postoperative delirium was present in 20 (71%) out of 28 and in 41 (18%) out of 221 patients with baseline regional cerebral oxygen saturation ≤ 50, or > 50%, respectively, p = 0.0001. Higher baseline regional cerebral oxygen saturation and body mass index were protective against postoperative delirium. Restoration of regional cerebral oxygen desaturation did not result in lower postoperative delirium after cardiac surgery. Pre-operative regional cerebral oxygen saturation ≤ 50% was associated with increased postoperative delirium rates in elderly patients following cardiac surgery.

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Section: Introductionmentioning

confidence: 99%

Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial

et al. 2017

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Cerebral perfusion monitoring in acute care surgery: current and perspective use

Tsai

Chung

Lee

et al. 2016

Expert Review of Medical Devices

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The review will cover the technology of near infrared spectroscopy, cerebral oximetry and the utilization of cerebral oximetry in each clinical setting. Expert commentary: Cerebral oximetry provides a noninvasive measure of cerebral oxygenation, which when persistently declining, can serve as a warning sign of hemodynamic or metabolic compromise intraoperatively or a predictor of postoperative cognitive dysfunction. Although useful, the cerebral oximetry readings must be interpreted in the context of other clinical information. When cerebral desaturation is confirmed, an algorithm should be followed in an attempt to increase oxygen delivery to the brain and/or decrease cerebral metabolic rate of oxygen.

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Alpha-stat, beach chair, cerebral autoregulation… But who is at risk?

Cited by 2 publications

References 41 publications

Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial

Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial

Cerebral perfusion monitoring in acute care surgery: current and perspective use

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