Prediction of safe duration of hypothermic circulatory arrest by near-infrared spectroscopy

Sakamoto, Takahiko; Hatsuoka, Shinichi; Stock, Ulrich A.; Duebener, Lennart F.; Lidov, Hart G.W.; Holmes, Gregory L.; Sperling, Jason S.; Munakata, Mamoru; Laussen, Peter C.; Jonas, Richard A.

doi:10.1067/mtc.2001.115242

Cited by 74 publications

(61 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Use of NIRS is supported by both animal and clinical data, as studies in a piglet model of CPB with deep hypothermic circulatory arrest (DHCA) showed the nadir of rSO 2 occurred sooner at higher temperatures, lower hematocrits, and with ␣-stat blood gas management, with time spent at nadir of rSO 2 correlated with neurological outcome both behaviorally and histologically (8,9); and in humans, lower intraoperative rSO 2 levels during the myocardial ischemic period of CPB is associated with postoperative brain injury (10). TCD has been used extensively in pediatric cardiac surgery research to examine cerebrovascular hemodynamics under a variety of hypothermic and flow conditions.…”

mentioning

confidence: 99%

Improved Cerebral Oxygen Saturation and Blood Flow Pulsatility With Pulsatile Perfusion During Pediatric Cardiopulmonary Bypass

Guan

Barnes

et al. 2011

Pediatr Res

View full text Add to dashboard Cite

Brain monitoring techniques near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) ultrasound were used in pediatric patients undergoing cardiopulmonary bypass for congenital heart defect (CHD) repair to analyze the effect of pulsatile or nonpulsatile flow on brain protection. Regional cerebral oxygen saturation (rSO 2 ) and cerebrovascular pulsatility index (PI) were measured by NIRS and TCD, respectively, in 111 pediatric patients undergoing bypass for CHD repair randomized to pulsatile (n ϭ 77) or nonpulsatile (n ϭ 34) perfusion. No significant differences in demographic and intraoperative data, including surgical risk stratification, existed between groups. Patients undergoing pulsatile perfusion had numerically lower decreases in rSO 2 from baseline for all time points analyzed compared with the nonpulsatile group, with significant ϳ12% lower decreases at 40 and 60 min after crossclamp. Patients undergoing pulsatile perfusion had numerically lower decreases in PI from baseline for the majority of time points compared with the nonpulsatile group, with significant ϳ30% lower decreases between 5 and 40 min after crossclamp. Pulsatile flow has advantages over nonpulsatile flow as measured by NIRS and TCD, especially at advanced time points, which may improve postoperative neurodevelopmental outcomes. A dvances in intraoperative surgical techniques and postoperative intensive care have substantively improved patient outcomes and decreased mortality rates in pediatric cardiac surgery for the repair of congenital heart defects (CHDs). With in-hospital mortality reported to be below 3% for categorized operations in a recent study despite an increase in case complexity (1), there is a growing need to address the paradoxical increased incidence of adverse neurological outcomes in the survivors of surgery. Cardiopulmonary bypass (CPB) presents unique challenges in this regard, with the extreme conditions encountered during extracorporeal support coupled with requisite surgical techniques that place severe stress on the patient acting in tandem to cause insult and injury to the brain. With increased incidence of postoperative neurologic complications reported in pediatric patients undergoing CPB, including neuromotor disabilities, learning disabilities, and behavioral abnormalities (2,3), there is increasing relevance for intra-and early postoperative brain monitoring techniques, which may predict neurologic outcomes and provide medical professionals actionable information to aid in the minimization of adverse sequelae (4).The debate between pulsatile and nonpulsatile perfusion modes further complicates considerations of best practices during pediatric CPB with the aim of minimizing neurological morbidity (5). Although current findings suggest that pulsatile flow imparts distinct advantages including increased hemodynamic energy leading to better blood flow to major organs such as brain, movement of lymph that prevents edema and sludging in microcapillaries, maintained microcirculatory flow, improve...

show abstract

mentioning

confidence: 99%

Improved Cerebral Oxygen Saturation and Blood Flow Pulsatility With Pulsatile Perfusion During Pediatric Cardiopulmonary Bypass

Guan

Barnes

et al. 2011

Pediatr Res

View full text Add to dashboard Cite

show abstract

“…Brain energy depletion is characterized by increased cerebral lactate, and associated ScO 2 values of 40-45 %, with levels below 35 % associated with cellular injury. [84,[100][101][102]. The threshold for cerebral ischemia is often taken as[20 % desaturation from baseline [77].…”

Section: Clinical Experiencementioning

confidence: 99%

Effects of Positioning on Cerebral Oxygenation

Soeding

2013

Curr Anesthesiol Rep

View full text Add to dashboard Cite

Postural change during anesthesia has a complex effect on the systemic and cerebral circulations which can potentially decrease cerebral blood flow and oxygenation. Cerebral oximetry is emerging as a monitor of cerebral perfusion with widespread application in many types of surgery. The technology is based on the differential absorption of oxygenated and deoxygenated hemoglobin to near-infrared light. However, the dynamic coupling that exists between cerebral arterial, venous and cerebrospinal fluid volumes may influence oximetric readings during postural change. Interpretation of cerebral oxygen saturation measurement must account for these changes in cerebral physiology if monitoring is to predict neurological outcome.

show abstract

“…Although cardiorespiratory data are routinely monitored throughout cardiac surgery, standards for brain monitoring have not yet to be established in cardiac operations. [1,2] Effective brain monitoring improves cerebral homeostatic regulation, decreases neurological injury inherent in CPB, which results in improved functional outcomes. [1,2] The most frequent causes for brain damage in pediatric cardiac surgery are CPB, low flow rate, hypothermia, and global hypoperfusion, which is a result of the variation in cerebral hemodynamics.…”

mentioning

confidence: 99%

“…[1,2] Effective brain monitoring improves cerebral homeostatic regulation, decreases neurological injury inherent in CPB, which results in improved functional outcomes. [1,2] The most frequent causes for brain damage in pediatric cardiac surgery are CPB, low flow rate, hypothermia, and global hypoperfusion, which is a result of the variation in cerebral hemodynamics. [1,2] To avoid hypoxia-, ischemia-, emboli-, or electrophysiological deteriorations-related brain damages, several intraoperative monitoring techniques have been developed.…”

mentioning

confidence: 99%

“…[1,2] The most frequent causes for brain damage in pediatric cardiac surgery are CPB, low flow rate, hypothermia, and global hypoperfusion, which is a result of the variation in cerebral hemodynamics. [1,2] To avoid hypoxia-, ischemia-, emboli-, or electrophysiological deteriorations-related brain damages, several intraoperative monitoring techniques have been developed. These techniques include near-infrared spectroscopy (NIRS), transcranial Doppler ultrasound, measurement of arterial flow and resistance, and electroencephalography.…”

mentioning

confidence: 99%

See 1 more Smart Citation

An evaluation of bilateral cerebral oxygen saturation during cyanotic and non-cyanotic cardiac surgery

Demir¹

2016

Turk Gogus Kalp Dama

View full text Add to dashboard Cite

Prediction of safe duration of hypothermic circulatory arrest by near-infrared spectroscopy

Cited by 74 publications

References 25 publications

Improved Cerebral Oxygen Saturation and Blood Flow Pulsatility With Pulsatile Perfusion During Pediatric Cardiopulmonary Bypass

Improved Cerebral Oxygen Saturation and Blood Flow Pulsatility With Pulsatile Perfusion During Pediatric Cardiopulmonary Bypass

Effects of Positioning on Cerebral Oxygenation

An evaluation of bilateral cerebral oxygen saturation during cyanotic and non-cyanotic cardiac surgery

Contact Info

Product

Resources

About