Cerebral Oximetry and Autoregulation during Cardiopulmonary Bypass: A Review

Vranken, Nousjka P.A.; Weerwind, Patrick W.; Sutedja, Nadia A.; Ševerdija, Ervin E.; Barenbrug, Paul

doi:10.1051/ject/201749182

Cited by 25 publications

(7 citation statements)

References 103 publications

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“…Especially during cardiac surgery, it is known that mean arterial pressure is correlated with cerebral oxygenation as soon as the pressure is lower or higher than the lower or upper limit of cerebral autoregulation 39 . As we kept the MAP within normal limits it is not surprising that MAP was not a significant contributor to cerebral oxygenation in this study.…”

Section: Discussionmentioning

confidence: 99%

Carbon dioxide and cardiac output as major contributors to cerebral oxygenation during apnoeic oxygenation

Kaiser,

Bauer,

Riva

et al. 2024

Sci Rep

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Apnoeic oxygenation has experienced a resurgence in interest in critical care and perioperative medicine. However, its effect on cerebral oxygenation and factors influencing it, have not yet been investigated in detail. By using near-infrared spectroscopy, we intended to provide further evidence for the safety of apnoeic oxygenation and to increase our understanding of the association between cerebral perfusion, haemodynamic, respiratory and demographic factors. In this secondary analysis of a prospective randomized controlled noninferiority trial, we recruited 125 patients, who underwent surgery under general anaesthesia with neuromuscular blockade. Arterial blood samples were taken every 2 min for a total of 15 min under apnoeic oxygenation with 100% oxygen. Near-infrared spectroscopy and cardiac output were continuously measured. Statistical analysis was performed using uni- and multivariable statistics. Ninety-one complete data sets were analysed. In six patients the SpO2 fell below 92% (predefined study termination criterion). The significant average increase of cerebral oxygenation was 0.5%/min and 2.1 mmHg/min for the arterial pressure of carbon dioxide (paCO2). The median cardiac output increased significantly from 5.0 l/min (IQR 4.5–6.0) to 6.5 l/min (IQR 5.7–7.5). The most significant effect on cerebral oxygenation was exhibited by the variable paCO2 and non-specific patient factors, followed by cardiac output and paO2. Apnoeic oxygenation proves to have a high safety profile while significantly increasing cerebral oxygenation, paCO2 and cardiac output. In reverse, NIRS might act as a reliable clinical surrogate of paCO2 and cardiac output during stable arterial oxygenation.

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Section: Discussionmentioning

confidence: 99%

Carbon dioxide and cardiac output as major contributors to cerebral oxygenation during apnoeic oxygenation

Kaiser,

Bauer,

Riva

et al. 2024

Sci Rep

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show abstract

“…Clearly defined standard values would be very helpful for a simplified interpretation of the measurement data, and could contribute to improved acceptance of NIRS as monitoring method. [50,51] On the other hand, rSO 2 values are a result of, and need to be interpreted in the complex context of, physiological parameters that contribute to cerebral oxygen delivery and demand. [50,52,53] At present, NIRS devices from different manufacturers can deliver measured values that differ from one another.…”

Section: Discussionmentioning

confidence: 99%

“…[50,51] On the other hand, rSO 2 values are a result of, and need to be interpreted in the complex context of, physiological parameters that contribute to cerebral oxygen delivery and demand. [50,52,53] At present, NIRS devices from different manufacturers can deliver measured values that differ from one another. [46,53,54] It would be desirable if there was a standardization here.…”

Section: Discussionmentioning

confidence: 99%

Pre- and intraoperative cerebral near-infrared spectroscopy and postoperative delirium: Results of a prospective cross-sectional trial

et al. 2022

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Postoperative delirium (PODE) is a serious complication that can occur during the first few days after surgery. A number of causes can make delirium more likely; one factor to consider is hypoxia during anesthesia. In this study, the pre-and intraoperative cerebral regional oxygen saturation (rSO 2 ) as measured by near-infrared spectroscopy (NIRS) was to be examined with regard to an association with the occurrence of PODE in patients undergoing major abdominal procedures. Data from 80 patients (33 women, 47 men) was examined. The mean age was 66.31 ± 10.55 years (between 42 and 84 years). Thirteen patients developed PODE. The preoperative rSO 2 values (P = .10) and the rSO 2 values during the steady state of anesthesia (P = .06) tended to be lower in the delirium group than in the non-delirium group. There was a significant correlation between the preoperative rSO 2 and the preoperative hemoglobin values (P < .001). The variance of rSO 2 during the steady state of anesthesia was significantly greater in the delirium group compared to the non-delirium group (P = .03). In two patients from the delirium group, rSO 2 dropped below 50%; they also had a minimum mean arterial pressure below 50 mm Hg, which could have disturbed cerebral autoregulation. The duration of rSO 2 decreases (>10%, >15%, >20%) and increases (>10%) compared to the preoperative values was not significantly different between patients with and without PODE. The results suggest that NIRS could be a useful monitoring method for patients undergoing abdominal surgical procedures, on the one hand to recognize patients with low pre-or intraoperative rSO 2 values, and on the other hand to detect changes in rSO 2 values during anesthesia.

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“…Some brain pathologies such as stroke, regional brain death, and carotid arterial stenosis may decouple the relationships between regional and global oxygenation parameters as well as alter the anatomical ratios of veins and arteries 22 . There are reports that rSO 2 does not reflect changes in jugular bulb oximetry in the case of head injury 29–31 . Forehead NIRS interrogates the frontal lobes supplied by the superficial branches of the anterior and middle cerebral arteries.…”

Section: Discussionmentioning

confidence: 99%

Cerebral hemoglobin oxygenation in children with congenital heart disease

Terada

Nakamura

Nakao

et al. 2021

Pediatrics International

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Background It is important to identify the pathological characteristics of cerebral circulation and oxygen metabolism at the bedside in children with congenital heart disease (CHD) to prevent neurodevelopmental impairments. The brain regional oxygen saturation index (rSO2) can be easily obtained at the bedside with near‐infrared spectroscopy and has been widely used in the management of children with CHD in recent years. Methods To determine if the rSO2 before or after CHD surgery is a good predictor of cerebral oxygen metabolism, we investigated the impact of different clinical variables on the correlation between rSO2 and reference values under steady ratios of hemoglobin oxygen saturation in the internal jugular vein (SjvO2) or femoral artery (SaO2) (0.75:0.25, 0.66:0.34, and 0.50:0.50) in 186 children with CHD undergoing cardiac catheterization. Results In three patient groups—double ventricles before surgery, double ventricles after surgery, and single ventricle before surgery—there were significant relationships between rSO2 and the reference values of SO2 under all three steady ratios of SjvO2 and SaO2. No relationship with the reference values was found for the single ventricle after surgery group. Conclusions Regional oxygen saturation index is useful for assessing cerebral oxygenation in children with CHD, but knowledge of the underlying cardiac pathology in CHD, especially in the case of a single ventricle after surgery, is important for the correct interpretation of rSO2 measurements obtained using near‐infrared spectroscopy.

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Cerebral Oximetry and Autoregulation during Cardiopulmonary Bypass: A Review

Cited by 25 publications

References 103 publications

Carbon dioxide and cardiac output as major contributors to cerebral oxygenation during apnoeic oxygenation

Carbon dioxide and cardiac output as major contributors to cerebral oxygenation during apnoeic oxygenation

Pre- and intraoperative cerebral near-infrared spectroscopy and postoperative delirium: Results of a prospective cross-sectional trial

Cerebral hemoglobin oxygenation in children with congenital heart disease

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