Physiology, intervention, and outcome: three critical questions about cerebral tissue oxygen saturation monitoring

Meng, Lingzhong; Gruenbaum, Shaun E.; Dai, Feng; Wang, Tianlong

doi:10.23736/s0375-9393.18.12476-x

Cited by 19 publications

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“…Cerebral tissue oxygen saturation (SctO 2 ) measured using near-infrared spectroscopy (NIRS)-based cerebral oximetry is the percentage of oxyhemoglobin over total hemoglobin in mixed blood in the tissue bed interrogated by near-infrared light. 1,2 It was previously suggested that SctO 2 reflects the balance between CMRO 2 and CDO 2 ; however, this hypothesis has not been validated. The principles of cerebral oximetry and the relationship between SctO 2 and the CMRO 2 -CDO 2 are summarized in Supplementary Figure 1 (Supplemental Digital Content 1, http://links.lww.com/ JNA/A449).…”

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confidence: 98%

“…Clinical decision-making can be facilitated by continuous monitoring of the balance between CMRO 2 and CDO 2 . Cerebral tissue oxygen saturation (SctO 2 ) measured using near-infrared spectroscopy (NIRS)-based cerebral oximetry is the percentage of oxyhemoglobin over total hemoglobin in mixed blood in the tissue bed interrogated by near-infrared light 1,2. It was previously suggested that SctO 2 reflects the balance between CMRO 2 and CDO 2 ; however, this hypothesis has not been validated.…”

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confidence: 99%

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Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration

Koch

Zhao²,

Mikkelsen³

et al. 2021

Journal of Neurosurgical Anesthesiology

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Background: The speculation that cerebral tissue oxygen saturation (SctO 2 ) measured using tissue near-infrared spectroscopy reflects the balance between cerebral metabolic rate of oxygen and cerebral oxygen delivery has not been validated. Our objective was to correlate SctO 2 with cerebral oxygen extraction fraction (OEF) measured using positron emission tomography; OEF is the ratio between cerebral metabolic rate of oxygen and cerebral oxygen delivery and reflects the balance between these 2 variables.Materials and Methods: This cohort study was based on data collected in a previously published trial assessing phenylephrine versus ephedrine treatment in anesthetized patients undergoing brain tumor surgery. The variables of interest were measured twice over the healthy hemisphere before surgery: the first measurement performed after anesthesia induction and the sec-ond measurement performed after induction of a ∼20% increase in blood pressure using either phenylephrine or ephedrine.Results: Data from 24 patients were analyzed. The overall vasopressor-induced relative changes in SctO 2 (ΔSctO 2 ) and OEF (ΔOEF) were 3.16% [interquartile range, −0.73% to 6.04%] and −12.5% [interquartile range, −24.0% to −6.19%], respectively. ΔSctO 2 negatively correlated with ΔOEF after phenylephrine treatment (Spearman rank correlation coefficient [r s ] = -0.76; P = 0.007), ephedrine treatment (r s = -0.76; P = 0.006), and any treatment (r s = -0.79; P < 0.001). ΔSctO 2 significantly associated with ΔOEF based on multivariable analysis with ΔOEF, relative changes in mean arterial pressure, arterial blood oxygen tension, and the bispectral index as covariates (P = 0.036). Conclusions:The negative correlation between changes in SctO 2 and OEF suggests that SctO 2 may reflect the cerebral metabolic demand-supply balance during vasopressor treatment. The generalizability of our findings in other clinical scenarios remains to be determined.

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confidence: 98%

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confidence: 99%

Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration

Koch

Zhao²,

Mikkelsen³

et al. 2021

Journal of Neurosurgical Anesthesiology

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“…Subsequently, the transmitter emits infrared light, which is absorbed by haemoglobin. Oxygenated and deoxygenated haemoglobin absorb infrared light differently, allowing real-time monitoring of regional cerebral oxygenation by comparing the balance between cerebral oxygen consumption and supply ( 101 , 102 ). NIRS does not distinguish between arterial and venous blood but reflect the overall regional balance of oxygen supply and demand.…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Smith

2022

Front. Psychiatry

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Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015–present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyse the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs. intravenous anaesthesia, and the efficacy of dexmedetomidine.

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“…A lower SstO 2 (measured at the forearm 1 h after graft reperfusion) increased the likelihood of early postoperative kidney dysfunction. SstO 2 measured at the forearm provides an estimate of hemoglobin oxygen saturation in the mixed arterial, capillary, and venous blood in the tissue bed being probed, and is largely determined by the balance between organ/peripheral tissue oxygen consumption/supply and perfusion [31]. LT patients require large resuscitation and inotrope infusion volumes for vascular homeostasis; thus, SstO 2 measured at the forearm may represent organ/peripheral tissue microcirculation, which is closely related to cardiac and systemic resistive indices [32,33].…”

Section: Plos Onementioning

confidence: 99%

Clinical application of intraoperative somatic tissue oxygen saturation for detecting postoperative early kidney dysfunction patients undergoing living donor liver transplantation: A propensity score matching analysis

Park

Jung

et al. 2022

PLoS ONE

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Background Somatic tissue oxygen saturation (SstO2) is associated with systemic hypoperfusion. Kidney dysfunction may lead to increased mortality and morbidity in patients who undergo living donor liver transplantation (LDLT). We investigated the clinical utility of SstO2 during LDLT for identifying postoperative kidney dysfunction. Patients and methods Data from 304 adults undergoing elective LDLT between January 2015 and February 2020 at Seoul St. Mary’s Hospital were retrospectively collected. Thirty-six patients were excluded based on the exclusion criteria. In total, 268 adults were analyzed, and 200 patients were 1:1 propensity score (PS)-matched. Results Patients with early kidney dysfunction had significantly lower intraoperative SstO2 values than those with normal kidney function. Low SstO2 (< 66%) 1 h after graft reperfusion was more highly predictive of early kidney dysfunction than the values measured in other intraoperative phases. A decline in the SstO2 was also related to kidney dysfunction. Conclusions Kidney dysfunction after LDLT is associated with patient morbidity and mortality. Our results may assist in the detection of early kidney dysfunction by providing a basis for analyzing SstO2 in patients undergoing LDLT. A low SstO2 (< 66%), particularly 1 h after graft reperfusion, was significantly associated with early kidney dysfunction after surgery. SstO2 monitoring may facilitate the identification of early kidney dysfunction and enable early management of patients.

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Physiology, intervention, and outcome: three critical questions about cerebral tissue oxygen saturation monitoring

Cited by 19 publications

References 0 publications

Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration

Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Clinical application of intraoperative somatic tissue oxygen saturation for detecting postoperative early kidney dysfunction patients undergoing living donor liver transplantation: A propensity score matching analysis

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