Factors associated with a low initial cerebral oxygen saturation value in patients undergoing cardiac surgery

Kobayashi, Kensuke; Kitamura, Tadashi; Kohira, Satoshi; Torii, Shinzo; Horai, Tetsuya; Hirata, Mitsuho; Mishima, Toshiaki; Sughimoto, Koichi; Ohkubo, Hirotoki; Irisawa, Yusuke; Matsushiro, Takuya; Hayashi, Hidenori; Miyata, Yurie; Tsuchida, Yuta; Ohtomo, Naoki; Miyaji, Kagami

doi:10.1007/s10047-016-0941-6

Cited by 31 publications

(19 citation statements)

References 31 publications

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“…The ability of NIRS to identify patients at risk is not an unexpected finding, considering the fact that patient age is one of the variables used for EuroSCORE calculation, and at the same time rScO 2 baseline values decrease with increasing age. 15 However, it emphasises the importance of Table 4 Regional cerebral oxygen saturation (rScO 2 ) values for cardiac surgery patients with and without postoperative cognitive dysfunction (POCD) at discharge and at 3 monthsdlLow target MAP group. Median with (inter-quartile range) and tested with ManneWhitney U-test.…”

Section: Postoperative Cognitive Dysfunction At Dischargementioning

confidence: 99%

The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial

Holmgaard

Vedel

Rasmussen

et al. 2019

British Journal of Anaesthesia

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Background: Postoperative cognitive dysfunction (POCD) occurs commonly after cardiac surgery. Near-infrared spectroscopy (NIRS) has been used to monitor regional cerebral oxygen saturation (rScO 2) in order to minimise the occurrence of POCD by applying dedicated interventions when rScO 2 decreases. However, the association between rScO 2 intraoperatively and POCD has not been clarified. Methods: This is a secondary analysis of a randomised trial with physician-blinded NIRS monitoring and cognitive testing at discharge from hospital and at 3 months after surgery. The association between intraoperative rScO 2 values and POCD at discharge from hospital and at 3 months after surgery was investigated. The prespecified candidate predictive variable of interest was cumulative time during surgery with rScO 2 !10% below its preoperative value. Results: One hundred and fifty-three patients had complete NIRS data and neurocognitive assessments at discharge, and 44 of these patients (29%) had POCD. At 3 months, 148 patients had complete data, and 12 (8%) of these patients had POCD. The median time with rScO 2 >10% below preoperative values did not differ for patients with and without POCD at discharge (difference¼0.0 min; Hodges-Lehmann 95% confidence interval, À3.11e1.47, P¼0.88). Other rScO 2 time thresholds that were assessed were also not significantly different between those with and without POCD at discharge. This applied both to absolute rScO 2 values and relative changes from preoperative values. Similar results were found in relation to POCD at 3 months. Conclusions: No significant association was found between intraoperative rScO 2 values and POCD. These findings bring into question the rationale for attempting to avoid decreases in rScO 2 if the goal is to prevent POCD. Clinical trial registration: NCT 02185885.

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Section: Postoperative Cognitive Dysfunction At Dischargementioning

confidence: 99%

The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial

Holmgaard

Vedel

Rasmussen

et al. 2019

British Journal of Anaesthesia

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“…Previous studies reported that ScO 2 significantly correlated with Hgb, NTproBNP, eGFR, LVEF, age, and variables associated with body size [16, 17, 20, 21, 24]. To our knowledge, the current study was the first one that demonstrated a significant correlation between BNP and ScO 2 , although Heringlake et al reported that between NTproBNP and ScO 2 [24].…”

Section: Discussionmentioning

confidence: 49%

“…In line with these studies, Heringlake et al showed that ScO 2 significantly correlated with age, Hgb, N-terminal pro-brain natriuretic peptide (NTproBNP), estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LVEF) [24]. ScO 2 values thus could be associated with risk factors, such as cardiac dysfunction [10, 19, 20, 21, 24], renal dysfunction [21–24], age [24], and anemia [16, 17, 21, 24]. Consequently, Heringlake et al showed that the baseline ScO 2 could be predictive of morbidity and mortality after cardiac surgery [24].…”

Section: Introductionmentioning

confidence: 99%

Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery

Mukaida¹,

Hayashida²,

Matsushita³

et al. 2017

PLoS ONE

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PurposeA previous study reported that low baseline cerebral oxygen saturation (ScO2) (≤50%) measured with near-infrared spectroscopy was predictive of poor clinical outcomes after cardiac surgery. However, such findings have not been reconfirmed by others. We conducted the current study to evaluate whether the previous findings would be reproducible, and to explore mechanisms underlying the ScO2-based outcome prediction.MethodsWe retrospectively investigated 573 consecutive patients, aged 20 to 91 (mean ± standard deviation, 67.1 ± 12.8) years, who underwent major cardiovascular surgery. Preanesthetic baseline ScO2, lowest intraoperative ScO2, various clinical variables, and hospital mortality were examined.ResultsBivariate regression analyses revealed that baseline ScO2 correlated significantly with plasma brain natriuretic peptide concentration (BNP), hemoglobin concentration (Hgb), estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LVEF) (p < 0.0001 for each). Baseline ScO2 correlated with BNP in an exponential manner, and BNP was the most significant factor influencing ScO2. Logistic regression analyses revealed that baseline and lowest intraoperative ScO2 values, but not relative ScO2 decrements, were significantly associated with hospital mortality (p < 0.05), independent of the EuroSCORE (p < 0.01). Receiver operating curve analysis of ScO2 values and hospital mortality revealed an area under the curve (AUC) of 0.715 (p < 0.01) and a cutoff value of ≤50.5% for the baseline and ScO2, and an AUC of 0.718 (p < 0.05) and a cutoff value of ≤35% for the lowest intraoperative ScO2. Low baseline ScO2 (≤50%) was associated with increases in intubation time, intensive care unit stay, hospital stay, and hospital mortality.ConclusionBaseline ScO2 was reflective of severity of systemic comorbidities and was predictive of clinical outcomes after major cardiovascular surgery. ScO2 correlated most significantly with BNP in an exponential manner, suggesting that BNP plays a major role in the ScO2-based outcome prediction.

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“…It is very difficult to define a clinically relevant threshold of ScO 2 levels and the definition of cerebral desaturation assessed with NIRS is vague [31]. Patient characteristics, or intraoperative data including haematocrit, can possibly influence the ScO 2 readings [32,33]. We observed a comparable haemodilution during surgery for fluid responders and non-responders-obviously due to the administered fluid in each FC.…”

Section: Discussionmentioning

confidence: 73%

The response of a standardized fluid challenge during cardiac surgery on cerebral oxygen saturation measured with near-infrared spectroscopy

Holmgaard

Vistisen

Ravn

et al. 2019

J Clin Monit Comput

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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.

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Factors associated with a low initial cerebral oxygen saturation value in patients undergoing cardiac surgery

Cited by 31 publications

References 31 publications

The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial

The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial

Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery

The response of a standardized fluid challenge during cardiac surgery on cerebral oxygen saturation measured with near-infrared spectroscopy

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