Tissue oxygen saturation during anaesthesia, cardiopulmonary bypass and intensive care stay for cardiac surgery

AbstractThe brain has high oxygen extraction, thus the regional cerebral tissue oxygen saturation (rSO2) is lower than the central venous oxygen saturation (ScvO2). We hypothesised that diabetes widens the physiological saturation gap between ScvO2 and rSO2 (gSO2), and the width of this gap may vary during various phases of cardiac surgery. Cardiac surgery patients with (n = 48) and without (n = 91) type 2 diabetes mellitus (T2DM) underwent either off-pump coronary artery bypass (OPCAB) or other cardiac surgery necessitating cardiopulmonary bypass (CPB) were enrolled. rSO2 was measured by near-infrared spectroscopy (NIRS) and ScvO2 was determined simultaneously from central venous blood. rSO2 was registered before and after anaesthesia induction and at different stages of the surgery. ScvO2 did not differ between the T2DM and control patients at any stage of surgery, whereas rSO2 was lower in T2DM patients, compared to the control group before anaesthesia induction (60.4 ± 8.1%[SD] vs. 67.2 ± 7.9%, p<0.05), and this difference was maintained throughout the surgery. After anaesthesia induction, the gSO2 was higher in diabetic patients undergoing CPB (20.2 ± 10.4% vs. 12.4 ± 8.6%, p < 0.05) and OPCAB grafting surgeries (17.0 ± 7.5% vs. 9.5 ± 7.8%, p < 0.05). While gSO2 increased at the beginning of CPB in T2DM and control patients, no significant intraoperative changes were observed during the OPCAB surgery. The wide gap between ScvO2 and rSO2 and their uncoupled relationship in patients with diabetes indicate that disturbances in the cortical oxygen saturation cannot be predicted from the global clinical parameter, the ScvO2. Thus, our findings advocate the monitoring value of NIRS in T2DM.

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Soft tissue oxygen saturation predicts risk of mortality but not intensive care unit admission

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2015.08.082 ◽

2015 ◽

Vol 221 (4) ◽

pp. e70

Author(s):

Biniam Kidane ◽

Sami A. Chadi ◽

Suzana Buac ◽

Anthony Di Labio ◽

Fran Priestap ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Soft Tissue ◽

Intensive Care Unit Admission ◽

Oxygen Saturation ◽

Tissue Oxygen Saturation ◽

Tissue Oxygen ◽

Risk Of Mortality

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Effective method of monitoring cerebral tissue oxygen saturation in cardiac surgery patients by combined use of tNIRS-1 and bispectral index

Scientific Reports ◽

10.1038/s41598-021-03527-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

A. Sugiura ◽

K. Torii ◽

H. Tsutsumi ◽

T. Someya ◽

D. Yasuoka ◽

...

Keyword(s):

Cardiac Surgery ◽

Oxygen Saturation ◽

Bispectral Index ◽

Hemoglobin Concentration ◽

Tissue Oxygen Saturation ◽

Cerebral Hypoxia ◽

Tissue Oxygen ◽

Cerebral Tissue ◽

Combined Use ◽

The Relationship

AbstractTo continuously and noninvasively monitor the cerebral tissue oxygen saturation (StO2) and hemoglobin concentration (gasHb) in cardiac surgery patients, a method combining the use of a cerebral tissue oximeter using near infrared time-resolved spectroscopy (tNIRS-1) and the bispectral index (BIS) was developed in this study. Moreover, the correlation between the estimated hemoglobin concentration (estHb), measured via tNIRS-1, and the hemoglobin concentration (gasHb), analyzed using a blood gas analyzer, were compared. The relationship between the BIS and gasHb was also examined. Through the comparison of BIS and StO2 (r1), and estHb and gasHb (r2), the correlation between the two was clarified with maximum r1 and r2 values of 0.617 and 0.946, respectively. The relationship between BIS and gasHb (r3), showed that there was a favorable correlation with a maximum r3 value of 0.969. There was also a continuous correlation between BIS and StO2 in patients undergoing cardiac surgery. In addition, a strong correlation was found between estHb and gasHb, and between BIS and gasHb. It was therefore concluded that the combined use of BIS and tNIRS-1 is useful to evaluate cerebral hypoxia, allowing for quick response to cerebral hypoxia and reduction of hemoglobin concentration during the operation.

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Tissue oxygen saturation changes and postoperative complications in cardiac surgery: a prospective observational study

BMC Anesthesiology ◽

10.1186/s12871-019-0905-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Sabino Scolletta ◽

Federico Franchi ◽

Elisa Damiani ◽

Armando Cennamo ◽

Roberta Domizi ◽

...

Keyword(s):

Cardiac Surgery ◽

Observational Study ◽

Oxygen Saturation ◽

Prospective Observational Study ◽

Near Infrared ◽

Oxygen Extraction ◽

Tissue Oxygen Saturation ◽

Tissue Oxygen ◽

University Hospitals ◽

Microvascular Reactivity

Abstract Background Cardiac surgery with extracorporeal circulation (ECC) can induce microvascular dysfunction and tissue hypoperfusion. We hypothesized that the alterations in near-infrared spectroscopy (NIRS)-derived parameters would be associated with post-operative complications in cardiac surgery patients. Methods Prospective observational study performed at two University Hospitals. Ninety patients undergoing cardiac surgery with ECC were enrolled. The NIRS sensor was applied on the thenar eminence. A vascular occlusion test (VOT, 3-min ischemia) was performed at baseline (t0), at Intensive Care Unit (ICU) admission (t1), 3 (t2) and 6 (t3) hours later. Baseline tissue oxygen saturation (StO2), oxygen extraction rate and microvascular reactivity indices were calculated. Results In the first hours after cardiac surgery, StO2 tended to increase (86% [80–89] at T3 versus 82% [79–86] at T0, p = ns), while both tissue oxygen extraction and microvascular reactivity tended to decrease, as indicated by increasing occlusion slope (− 8.1%/min [− 11.2 to − 7] at T3 versus − 11.2%/min [− 13.9 to − 7.9] at T0, p = ns) and decreasing recovery slope (1.9%/sec [1.1–2.9] at T3 versus 3.1%/sec [2.3–3.9] at T0, p = ns). No substantial differences were found in NIRS-derived variables and their changes over time between patients with complications and those without complications. Conclusions Peripheral tissue oxygen extraction and microvascular reactivity were reduced during the first hours after cardiac surgery. NIRS-derived parameters were not able to predict complications in this population of cardiac surgery patients.

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