Well‐being and cerebral oxygen saturation during acute heart failure in humans

Abstract

Cerebral symptoms and near-infrared spectrophotometry-determined cerebral oxygen saturation (ScO2) were followed in patients treated for normotensive acute congestive heart failure. The reproducibility and normal range for ScO2 were established from 39 resting subjects without cardio-respiratory disease: the ScO2 ranged from 55 to 78% with a coefficient of variation for triple determination of 6%. Patients rated cerebral symptoms on a scale with end-points of 0 (best) and 10 (worst). In eight patients with acute heart failure, arterial oxygen tension increased during decongestive treatment, from 9.1 (4.9-10) to 10.4 kPa (7.3-17); median with range, as did arterial oxygen saturation, from 94 (48-97) to 97% (87-99) (P<0.02), whereas the mean arterial pressure, heart rate and arterial carbon dioxide tension remained unchanged. The cerebral symptom score improved from 8 (3-10) to 1 (1-9) and the ScO2 increased from 34 (20-58) to 50% (19-91) (P<0.02). A ninth patient presented with a silent but massive myocardial infarction: she was cerebrally obtunded with a ScO2 of 18% and soon died. In patients with normotensive acute heart failure and cerebral symptoms, cerebral oxygen saturation is low, and during successful treatment ScO2 increases with the well-being of the patient.

Preoperative Cerebral Oxygen Saturation and Clinical Outcomes in Cardiac Surgery

“…Second, these findings offer scientific perspectives for using ScO 2 as a noninvasive technology for guiding therapy in patients with heart failure as already suggested by Madsen et al more than 10 yr ago. 24 The accuracy of ScO 2 for predicting 30-day mortality in the total cohort was lower than the additive EuroSCORE but comparable with established (NTproBNP) 28,29 and emerging (hsTNT) 10,30 humoral markers of postoperative risk in cardiac surgery. As derived from the ROC and the KaplanMeier analyses, the accuracy of ScO 2 for predicting short-and long-term prognosis in high-risk patients is clearly superior to the EuroSCORE.…”

“…23 Madsen et al showed that patients presenting with acute heart failure had lower ScO 2 concentrations than healthy control patients and that ScO 2 increased during heart failure therapy. 24 Koike et al showed that the decrease in ScO 2 during exercise in patients with coronary artery disease had prognostic effect and was associated with an unfavorable outcome in these patients. 25 Paquet et al observed that baseline ScO 2 was related to LVEF in patients undergoing cardiac surgery and that ScO 2 had an acceptable accuracy to identify left ventricular dysfunction in these patients.…”

Central and Peripheral Blood Flow During Exercise With a Continuous-Flow Left Ventricular Assist Device

“…21 The normal resting value is Ϸ75% (range, 59% to 91%), and a clinically significant decrease in cerebral perfusion is associated with a decrease in ScO 2 of 10% to 15%. [21][22][23] Another optode was placed over the left rectus femoris muscle for detection of the exercising skeletal muscle oxygen saturation (SmO 2 ; normal resting value Ϸ75; range, 70% to 87%). [21][22][23] …”

Fatal Basilar Arterial Thrombosis after Cardiac Surgery

“…The measurement is thought to reflect 16% arterial and 84% venous contributions. This ratio remains nearly constant in normoxia, hypoxia, and hypocapnia and offered an objective measure of regional hypoperfusion (13)(14)(15)(16).…”