Optimizing Intraoperative Cerebral Oxygen Delivery Using Noninvasive Cerebral Oximetry Decreases the Incidence of Stroke for Cardiac Surgical Patients

Goldman, Scott; Sutter, Francis P.; Ferdinand, Francis D.; Trace, Candace

doi:10.1532/hsf98.20041062

Cited by 215 publications

(158 citation statements)

References 6 publications

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“…As brain oxygen demand remains relatively stable under anesthesia, changes in SctO 2 typically represent reductions in cerebral oxygen supply, which are often due to reductions in blood pressure, carbon dioxide partial pressure, cardiac output, hemoglobin concentration, and/or arterial oxygen content. [5][6][7][8][9][10][11][12] The accuracy of SctO 2 measurements under a variety of clinical conditions is essential if appropriate assessment and management of brain oxygenation is to be possible. Nevertheless, previous studies suggest that extracranial contamination can influence the measurement of SctO 2 and result in measured values that do not entirely reflect the status of oxygenation in the brain.…”

Section: Résumémentioning

confidence: 99%

“…[1][2][3][4][5][6] The INVOS 5100C used in this study uses two wavelengths of infrared light (730 and 810 nm) and two light detectors at two different fixed distances (proximal and distal) from the light source. 1,[9][10][11][12] The secondgeneration FORE-SIGHT ELITE device used in this study uses an enhanced proprietary algorithm coupled with five wavelengths of infrared light (680, 730, 770, 805, and 870 nm) to improve the accuracy of the blood oxygenation measurements. 14 MacLeod et al examined the accuracy of the first-and second-generation FORE-SIGHT monitors in volunteers.…”

Section: Extracranial Contamination Of Nirs 27mentioning

confidence: 99%

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Extracranial contamination in the INVOS 5100C versus the FORE-SIGHT ELITE cerebral oximeter: a prospective observational crossover study in volunteers

Greenberg

Murphy

Shear

et al. 2015

Can J Anesth/J Can Anesth

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Purpose Previous studies have found that most cerebral oximeters are subject to inaccuracies secondary to extracranial contamination of the cerebral oximetric signals. We hypothesized that the more advanced secondgeneration FORE-SIGHT ELITE cerebral oximeter would be significantly less affected by extracranial tissue hypoxemia than the more widely used first-generation INVOS TM 5100C monitor. Methods Twenty healthy volunteers aged 18-45 yr had the INVOS and FORE-SIGHT probes placed on their forehead in a random sequence while in the supine position. A pneumatic head cuff was then placed around each volunteer's head just below both the oximeter and a concomitantly placed scalp forehead pulse oximeter probe. The subjects' scalp cerebral oxygen saturation (SctO 2 ) values were measured and compared using the two different devices in sequence, both before and after scalp tissue ischemia was induced by the pneumatic cuff. Results Extracranial ischemia resulted in a significant reduction in SctO 2 values from baseline in both devices. The INVOS 5100C recorded a median [interquartile range] decrease in SctO 2 from baseline at five minutes of 15.1% [12.6 -17.6], while that recorded by the FORESIGHT ELITE device was 8.6% [4.0 -12.3] at five minutes (median difference, 7.9%; 99% confidence interval, 1.9 to 16.5; P = 0.002). Conclusion Updated technological algorithms employed in the FORE-SIGHT ELITE cerebral oximeter may be responsible for less extracranial contamination than was observed in the previous-generation INVOS 5100C device. The impact that this extracranial contamination may have on the clinical use of these devices remains to be determined. RésuméObjectif Selon les études réalisées par le passé, la plupart des oxymètres cérébraux sont sujets à des inexactitudes suite à une contamination extracrânienne des signaux d'oxymétrie cérébrale. Nous avons émis l'hypothèse que l'oxymètre cérébral FORE-SIGHT ELITE, l'oxymètre cérébral de deuxième génération le plus innovant à ce jour, serait significativement moins affecté par l'hypoxémie des tissus extracrâniens que le moniteur de première génération INVOS TM 5100C, plus répandu.

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Section: Résumémentioning

confidence: 99%

Section: Extracranial Contamination Of Nirs 27mentioning

confidence: 99%

Extracranial contamination in the INVOS 5100C versus the FORE-SIGHT ELITE cerebral oximeter: a prospective observational crossover study in volunteers

Greenberg

Murphy

Shear

et al. 2015

Can J Anesth/J Can Anesth

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“…In fact, this form of publication delivers insufficient information and a higher risk of reporting errors, compared to peer-reviewed papers. In addition, eight of the most recent abstracts 45,55,56,63,65,66,68,69 were not published yet as full papers, although the full paper of the randomized controlled trial was in press 63 at the time of this systematic review. The small sample sizes and the non-randomized design in many of these studies further limit the strength of the evidence.…”

Section: Clinical Efficacy Of Nirs In Heart Surgerymentioning

confidence: 99%

Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy

Taillefer

Denault

2005

Can J Anesth/J Can Anesth

130

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P Pu ur rp po os se e: : This systematic review is aimed at answering the following questions: 1) Is near-infrared spectroscopy (NIRS) clinically effective in detecting cerebral desaturation during heart surgery? 2) Are these results based on studies with solid methodology?S So ou ur rc ce es s: : MEDLINE, internet, and hand searches up to February 2004 for English and French papers on NIRS.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Forty-eight papers were retrieved, with a total of 5,931 cardiac surgery patients monitored by NIRS. More than 83% of patients underwent coronary artery bypass graft surgery. The majority of studies were prospective for the monitored group. Clinically, NIRS monitoring appears to detect brain desaturation episodes encountered during surgery. However, the majority of studies retrieved suffered from major methodological limitations and a low level of evidence. NIRS validity vs jugular bulb oximetry is questioned together with its predictive value in identifying those who will suffer postoperatively from neurological deficits. The sole randomized controlled trial appears to have recorded negative results in this respect.C Co on nc cl lu us si io on n: : The clinical application of NIRS in heart surgery as a brain-monitoring device seems interesting. However, NIRS has to be investigated more rigorously to prove its clinical utility in cardiac surgery. EUROLOGICAL complications and cognitive deficits are preoccupations in cardiac surgery because of their frequency, variety and long-term impact. [1][2][3] Disparities between prevalence and incidence can be explained by patient characteristics (age and comorbidities), 2,4-6 type of surgery, 4 differences in definitions of deficits, and how and when deficits are measured. Objectif

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“…Case-control and retrospective studies show a correlation between cerebral desaturation and adverse outcome after cardiopulmonary bypass, and improvements in outcome, including a reduced incidence of stroke, which are linked to cerebral oximetry monitoring during bypass [15,16]. However, such clear outcome benefits have not been identified in prospective trials.…”

Section: (A) Cardiac Surgerymentioning

confidence: 99%

Shedding light on the adult brain: a review of the clinical applications of near-infrared spectroscopy

Smith

2011

Phil. Trans. R. Soc. A.

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Near-infrared spectroscopy (NIRS) has potential as a non-invasive brain monitor in a wide range of clinical scenarios. In the last decade, there has been a rapid expansion of clinical experience using NIRS to monitor cerebral oxygenation, particularly in cardiac surgery, where there is some evidence that NIRS-guided brain protection protocols might lead to a reduction in peri-operative neurological complications. There are no data to support the wider application of NIRS to monitor cerebral oxygenation during routine anaesthesia and surgery, and its application in brain injury, where it might be expected to have a key monitoring role, is as yet undefined. Technological developments, including the introduction of broadband and time-resolved spectrometers that are capable of reliably measuring changes in oxidized cytochrome c oxidase, offer real potential for a single NIRS-based device to provide multi-site, regional monitoring of cerebral metabolic status as well as oxygenation and haemodynamics.

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Optimizing Intraoperative Cerebral Oxygen Delivery Using Noninvasive Cerebral Oximetry Decreases the Incidence of Stroke for Cardiac Surgical Patients

Abstract: The treatment group, which underwent all cardiac surgeries with optimized cerebral oxygen delivery using cerebral oximetry monitoring, demonstrated a significantly lower incidence of permanent stroke. Because our study is retrospective, a prospective randomized trial is warranted.

Cited by 215 publications

References 6 publications

Extracranial contamination in the INVOS 5100C versus the FORE-SIGHT ELITE cerebral oximeter: a prospective observational crossover study in volunteers

Extracranial contamination in the INVOS 5100C versus the FORE-SIGHT ELITE cerebral oximeter: a prospective observational crossover study in volunteers

Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy

Shedding light on the adult brain: a review of the clinical applications of near-infrared spectroscopy

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