Tissue near infra red spectroscopy change is not correlated with patients' outcome in elective cardiac surgery

Morel, J.; Bouchet, J. B.; Vola, Marco; Béraud, A M; Clerc, M.; Awad, Samir A.; Auboyer, C.; Molliex, Serge

doi:10.1111/aas.12329

Cited by 19 publications

(20 citation statements)

References 33 publications

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“…Few studies have evaluated the relationship between dynamic StO 2 parameters and clinical outcomes in patients undergoing cardiac surgery. In a recent study by Morel et al [ 18 ], recovery slope was not correlated with ICU length of stay or SOFA score in cardiac surgery (Additional file 5 : Table S4). However, they enrolled fewer patients ( n = 40) than this study ( n = 232).…”

Section: Discussionmentioning

confidence: 93%

“…As SIRS impairs the microcirculation and ultimately can lead to multiorgan failure, we hypothesized and showed in this study that a perioperative decrease in microcirculatory function may be associated with adverse clinical outcomes in cardiac surgery patients. Several studies have shown that VOT recovery slope decreases during CPB but returns to the baseline value postoperatively [ 18 , 24 ]. This perioperative change in the recovery slope was also seen in the present study.…”

Section: Discussionmentioning

confidence: 99%

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Microvascular reactivity and clinical outcomes in cardiac surgery

et al. 2015

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IntroductionMicrovascular reactivity is decreased in patients with septic shock; this is associated with worse clinical outcomes. The objectives of the present study were to investigate microvascular reactivity in cardiac surgery patients and to assess any association with clinical outcomes.MethodsWe retrospectively analyzed a prospectively collected registry. In total, 254 consecutive adult patients undergoing cardiac and thoracic aortic surgeries from January 2013 through May 2014 were analyzed. We performed a vascular occlusion test (VOT) by using near-infrared spectroscopy to measure microvascular reactivity. VOT was performed three times per patient: prior to the induction of anesthesia, at the end of surgery, and on postoperative day 1. The primary endpoint was a composite of major adverse complications, including death, myocardial infarction, acute kidney injury, acute respiratory distress syndrome, and persistent cardiogenic shock.ResultsVOT recovery slope decreased during the surgery. VOT recovery slope on postoperative day 1 was significantly lower in patients with composite complications than those without (3.1 ± 1.6 versus 4.0 ± 1.5 %/s, P = 0.001), although conventional hemodynamic values, such as cardiac output and blood pressure, did not differ between the groups. On multivariable regression and linear analyses, low VOT recovery slope on postoperative day 1 was associated with increases of composite complications (odds ratio 0.742; 95 % confidence interval (CI) 0.584 to 0.943; P = 0.015) and hospital length of stay (regression coefficient (B) −1.276; 95 % CI −2.440 to −0.112; P = 0.032).ConclusionMicrovascular reactivity largely recovered on postoperative day 1 in the patients without composite complications, but this restoration was attenuated in patients with composite complications.Trial registrationClinicalTrials.gov NCT01713192. Registered 22 October 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1025-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Microvascular reactivity and clinical outcomes in cardiac surgery

et al. 2015

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“…This may verify that optimal tissue perfusion cannot be appropriately guided by conventional hemodynamic monitoring in cardiac surgery with CPB. Notably, microcirculatory disturbances, which was related to delayed lactate clearance or hyperlactatemia, could be detected using the NIRS-tissue RSO 2 monitoring or sublingual video-microscopy in cardiac surgical patients [ 23 , 24 ]. However, these devices lack consistency regarding their usefulness to predict clinical deterioration associated with tissue hypoperfusion during CPB [ 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

Skin perfusion pressure as an indicator of tissue perfusion in valvular heart surgery: Preliminary results from a prospective, observational study

et al. 2017

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Hemodynamic management aims to provide adequate tissue perfusion, which is often altered during cardiac surgery with cardiopulmonary bypass (CPB). We evaluated whether skin perfusion pressure (SPP) can be used for monitoring of adequacy of tissue perfusion in patients undergoing valvular heart surgery. Seventy-two patients undergoing valve replacement were enrolled. SPP and serum lactate level were assessed after anaesthesia induction (baseline), during CPB, after CPB-off, end of surgery, arrival at intensive care unit, and postoperative 6 h. Lactate was further measured until postoperative 48 h. Association of SPP with lactate and 30-day morbidity comprising myocardial infarction, acute kidney injury, stroke, prolonged intubation, sternal infection, reoperation, and mortality was assessed. Among the lactate levels, postoperative 6 h peak value was most closely linked to composite of 30-day morbidity. The SPP value during CPB and its % change from the baseline value were significantly associated with the postoperative 6 h peak lactate (r = -0.26, P = 0.030 and r = 0.47, P = 0.001, respectively). Optimal cut-off of % decrease in SPP during CPB from baseline value for the postoperative 6 h hyperlactatemia was 48% (area under curve, 0.808; 95% confidence interval (CI), 0.652–0.963; P = 0.001). Decrease in SPP >48% during CPB from baseline value was associated with a 12.8-fold increased risk of composite endpoint of 30-day morbidity (95% CI, 1.48–111.42; P = 0.021) on multivariate logistic regression. Large decrease in SPP during CPB predicts postoperative 6 h hyperlactatemia and 30-day morbidity, which implicates a promising role of SPP monitoring in the achievement of optimal perfusion during CPB.

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“…If the arterial supply to a region is transiently obstructed by a vascular occlusion test (VOT), the rate of decrease in the StO 2 (desaturation) is a reflection of local oxygen consumption [ 18 ], and the rate of increase (re-saturation) after the VOT is related to the post-occlusive microcirculatory vascular hyperemia [ 19 ]. This dynamic test has been used to demonstrate that microvascular reactivity is altered in patients with sepsis [ 20 ], multiple organ dysfunction [ 21 ], trauma [ 22 ], acute heart failure [ 23 ], cardiac surgery [ 24 ] or after cardiac arrest resuscitation [ 25 ] and that the changes are not entirely explained by global hemodynamic variables. However, there are no data currently available in patients with ARDS.…”

Section: Introductionmentioning

confidence: 99%

Microvascular reactivity is altered early in patients with acute respiratory distress syndrome

et al. 2016

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BackgroundAcute respiratory distress syndrome (ARDS) is associated with vascular endothelial dysfunction. The resultant microvascular reactivity can be assessed non-invasively using near-infrared spectroscopy (NIRS) and a vascular occlusion test (VOT) and changes have been correlated with severity of organ dysfunction and mortality in other critically ill populations. We used NIRS to study the presence of microcirculatory alterations in patients with ARDS.MethodsWe studied 27 healthy volunteers and 32 ARDS patients admitted to our intensive care department. NIRS measurements were performed within 24 h after diagnosis (Berlin definition). VOTs were performed by inflating an arm-cuff to a pressure greater than the systolic pressure for 3 min, followed by rapid deflation. The descending (Desc) and ascending (Asc) thenar muscle oxygen saturation (StO2) slopes were calculated. We compared data from volunteers with those from ARDS patients, from ARDS survivors and non-survivors, and from ARDS survivors who required <7 days ventilatory support (good evolution) with those who required >7 days support or died (poor evolution).ResultsARDS patients had lower StO2 values [75(67–80) vs 79(76–81) %, p = 0.04] and Asc slopes [185(115–233) vs 258(216–306) %/min, p < 0.01] than healthy volunteers, but Desc slopes were similar. The Asc slope was lower in the patients with a poor evolution than in the other patients [121(90–209) vs 222(170–293) %/min, p < 0.01], and in the non-survivors than in the survivors [95(73–120) vs 212(165–252) %/min, p < 0.01].ConclusionsIn ARDS patients, microvascular reactivity is altered early, and the changes are directly related to the severity of the disease. The ascending slope is the best determinant of outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-016-0375-y) contains supplementary material, which is available to authorized users.

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Tissue near infra red spectroscopy change is not correlated with patients' outcome in elective cardiac surgery

Cited by 19 publications

References 33 publications

Microvascular reactivity and clinical outcomes in cardiac surgery

Microvascular reactivity and clinical outcomes in cardiac surgery

Skin perfusion pressure as an indicator of tissue perfusion in valvular heart surgery: Preliminary results from a prospective, observational study

Microvascular reactivity is altered early in patients with acute respiratory distress syndrome

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