Does cerebral oxygen desaturation as measured by near-infrared spectroscopy predict acute kidney injury after cardiac surgery?

Goal-directed therapy based on brain-oxygen saturation (bSo2) is controversial and hotly debated. While meta-analyses of aggregated data have shown no clinical benefit for brain near-infrared spectroscopy (NIRS)-based interventions after cardiac surgery, no network meta-analyses involving both major cardiac and noncardiac procedures have yet been undertaken. Randomized controlled trials involving NIRS monitoring in both major cardiac and noncardiac surgery were included. Aggregate-level data summary estimates of critical outcomes (postoperative cognitive decline (POCD)/postoperative delirium (POD), acute kidney injury, cardiovascular events, bleeding/need for transfusion, and postoperative mortality) were obtained. NIRS was only associated with protection against POCD/POD in cardiac surgery patients (pooled odds ratio (OR)/95% confidence interval (CI)/I2/number of studies (n): 0.34/0.14–0.85/75%/7), although a favorable effect was observed in the analysis, including both cardiac and noncardiac procedures. However, the benefit of the use of NIRS monitoring was undetectable in Bayesian network meta-analysis, although maintaining bSo2 > 80% of the baseline appeared to have the most pronounced impact. Evidence was imprecise regarding acute kidney injury, cardiovascular events, bleeding/need for transfusion, and postoperative mortality. There is evidence that brain NIRS-based algorithms are effective in preventing POCD/POD in cardiac surgery, but not in major noncardiac surgery. However, the specific target bSo2 threshold has yet to be determined.

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Perioperative optimal blood pressure as determined by ultrasound tagged near infrared spectroscopy and its association with postoperative acute kidney injury in cardiac surgery patients

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivv371 ◽

2016 ◽

Vol 22 (4) ◽

pp. 445-451 ◽

Cited By ~ 23

Author(s):

Daijiro Hori ◽

Charles Hogue ◽

Hideo Adachi ◽

Laura Max ◽

Joel Price ◽

...

Keyword(s):

Blood Pressure ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Infrared Spectroscopy ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Kidney Injury ◽

Optimal Blood Pressure

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Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case–control study

Critical Care ◽

10.1186/s13054-015-0760-9 ◽

2015 ◽

Vol 19 (1) ◽

pp. 27 ◽

Cited By ~ 49

Author(s):

Bettina Ruf ◽

Vittorio Bonelli ◽

Gunter Balling ◽

Jürgen Hörer ◽

Nicole Nagdyman ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Infrared Spectroscopy ◽

Cardiopulmonary Bypass ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Case Control Study ◽

Kidney Injury ◽

Case Control ◽

Control Study

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Cerebral Oxygen Desaturation Events Assessed by Near-Infrared Spectroscopy During Shoulder Arthroscopy in the Beach Chair and Lateral Decubitus Positions

Anesthesia & Analgesia ◽

10.1213/ane.0b013e3181e33bd9 ◽

2010 ◽

Vol 111 (2) ◽

pp. 496-505 ◽

Cited By ~ 180

Author(s):

Glenn S. Murphy ◽

Joseph W. Szokol ◽

Jesse H. Marymont ◽

Steven B. Greenberg ◽

Michael J. Avram ◽

...

Keyword(s):

Infrared Spectroscopy ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Shoulder Arthroscopy ◽

Oxygen Desaturation ◽

Cerebral Oxygen ◽

Lateral Decubitus ◽

Beach Chair

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Cerebral oxygen desaturation monitored by intraoperative near-infrared spectroscopy, and incidence of post-operative cognitive dysfunction: a systematic review protocol

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/jbisrir-2013-531 ◽

2013 ◽

Vol 11 (8) ◽

pp. 146-158 ◽

Cited By ~ 1

Author(s):

Omar Lopez ◽

Timothy Gollaher ◽

Dru Riddle

Keyword(s):

Systematic Review ◽

Infrared Spectroscopy ◽

Cognitive Dysfunction ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Oxygen Desaturation ◽

Cerebral Oxygen ◽

Systematic Review Protocol ◽

Review Protocol

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Use of cerebral oxygen saturation and hemoglobin concentration to predict acute kidney injury after cardiac surgery

Journal of International Medical Research ◽

10.1177/0300060517741064 ◽

2017 ◽

Vol 46 (3) ◽

pp. 1130-1137 ◽

Cited By ~ 3

Author(s):

Canan Balci ◽

Engin Haftaci ◽

Atike Tekeli Kunt

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Oxygen Saturation ◽

Near Infrared ◽

Artery Bypass ◽

Kidney Injury ◽

Hemoglobin Concentration ◽

Cerebral Oximetry ◽

Cerebral Oxygen Saturation ◽

Cerebral Oxygen

Objective Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with significant morbidity and mortality. Near infrared spectroscopy (NIRS) is a noninvasive technique for real-time measurement of cerebral tissue oxygenation. The purpose of the present study was to evaluate the correlation of AKI with hemoglobin and regional cerebral oxygen saturation (rScO2) measured intraoperatively and postoperatively in patients undergoing cardiac surgery. Methods We retrospectively analyzed the prospectively collected data of 45 adult patients with normal renal function who underwent isolated coronary artery bypass grafting (CABG) from January 2014 to May 2014. Kidney injury was assessed according to the Acute Kidney Injury Network criteria. rScO2 and hemoglobin were measured every hour intraoperatively and for the first 24 hours postoperatively. Results The hemoglobin concentration and rScO2 were significantly lower in patients with than without AKI, and no linear trends were observed. No exact cut-off values were obtained. Conclusion This retrospective study shows that a lower rScO2 and hemoglobin concentration are correlated with AKI after CABG in patients with no peripheral vascular disease or recent myocardial infarction. We suggest that cerebral oximetry alone may predict postoperative AKI well.

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