Association of Intraoperative Cerebral and Somatic Tissue Oxygen Saturation with Postoperative Cognitive Dysfunction After Spine Open Surgery in Patients with Hypertension: An Observational Study

Abstract Background: Intraoperative cerebral desaturations have been associated with worse neurological outcomes after supine surgery. However, it is not clear whether intraoperative somatic tissue oxygenation is more associated with postoperative cognitive dysfunction (POCD) than cerebral oxygenation in patients with hypertension after prone spine surgery.Methods: Patients with hypertension scheduled for spine open surgery were included from 2020 to 2021 in a single-center, prospective, observational study. Baseline both cerebral and somatic tissue oxygen saturation were measured in operating room before surgery. Cerebral and somatic tissue oxygen saturations were monitored continuously throughout surgery. The presence of POCD was assessed using the Mini-Mental Status Examination (MMSE). Association with POCD was evaluated with unadjusted analyses and multivariable logistic regression.Results: One hundred and one of 112 patients were included, and 28 (27.8%) developed POCD. None of the investigated SctO2 variables was predictive of POCD. On the contrary, the patients with POCD had a higher decrease in intraoperative absolute SstO2 decrease and relative SstO2 decrease compared with the patients without POCD (4.9%±3.8% vs. 3.6%±2.6%, P=0.037; 7.4%±5.6% vs. 5.3%±3.8%, P=0.036; respectively). Finally, three SstO2 parameters respectively were associated with POCD, including a higher absolute SstO2 decrease (OR, 1.223; 95%CI, 1.031-1.451; P=0.021), a higher absolute SstO2 decrease (OR, 1.138; 95%CI, 1.011-1.281; P=0.032) and falling below 90% of baseline SstO2 (OR, 11.388; 95%CI, 2.367-54.785; P=0.002), independent of ASA III, preoperative platelet and postoperative sepsis. Conclusions: Twenty-eight (27.8%) of 101patients developed POCD. Somatic tissue oxygenation has a stronger association with POCD than cerebral tissue oxygenation after spine open surgery in patients with hypertension.Clinical trial registration: ChiCTR1900028392. Registered 20 December 2019.

Download Full-text

Tissue Oxygenation Monitoring as a Guide for Trauma Resuscitation

Critical Care Nurse ◽

10.4037/ccn2016206 ◽

2016 ◽

Vol 36 (3) ◽

pp. 12-70 ◽

Cited By ~ 2

Author(s):

Cathy Mitchell

Keyword(s):

Oxygen Saturation ◽

Tissue Oxygenation ◽

Central Venous Oxygen Saturation ◽

Multiple Organ ◽

Tissue Oxygen Saturation ◽

Multiple Organ Dysfunction ◽

Tissue Oxygen ◽

Trauma Resuscitation ◽

Central Venous ◽

Venous Oxygen Saturation

Hypoperfusion is the most common event preceding the onset of multiple organ dysfunction syndrome during trauma resuscitation. Detecting subtle changes in perfusion is crucial to ensure adequate tissue oxygenation and perfusion. Traditional methods of detecting physiological changes include measurements of blood pressure, heart rate, urine output, serum levels of lactate, mixed venous oxygen saturation, and central venous oxygen saturation. Continuous noninvasive monitoring of tissue oxygen saturation in muscle has the potential to indicate severity of shock, detect occult hypoperfusion, guide resuscitation, and be predictive of the need for interventions to prevent multiple organ dysfunction syndrome. Tissue oxygen saturation is being used in emergency departments, trauma rooms, operating rooms, and emergency medical services. Tissue oxygen saturation technology is just as effective as mixed venous oxygen saturation, central venous oxygen saturation, serum lactate, and Stewart approach with strong ion gap, yet tissue oxygen saturation assessment is also a direct, noninvasive microcirculatory measurement of oxygen saturation.

Download Full-text

Abstract 276: The Effects of Peep and Blood Pressure on Cerebral Tissue Oxygen Saturation During Hemorrhage in Swine

Circulation ◽

10.1161/circ.142.suppl_4.276 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Jeff R Gould ◽

Joshua W Lampe ◽

Lyra Clark ◽

George Beck ◽

Brian C Harvey ◽

...

Keyword(s):

Regression Model ◽

Oxygen Saturation ◽

Cerebral Oxygenation ◽

Cerebral Oxygen Saturation ◽

Right Atrial ◽

Tissue Oxygen Saturation ◽

Cerebral Oxygen ◽

Tissue Oxygen ◽

Cerebral Tissue ◽

Cerebral Tissue Oxygen Saturation

Introduction: Positive end-expiratory pressure (PEEP) is used to increase oxygen delivery by preventing end-expiratory alveolar collapse. However, the associated increased intrathoracic pressure can lead to an increase in right atrial pressure, and a decrease in venous return and cardiac output. Near infrared spectroscopy (NIRS) can be used as a non-invasive tool to continuously monitor cerebral tissue oxygen saturation. In this pilot study, we examined the effects of PEEP on cerebral oxygen saturation during a controlled hemorrhage. Methods: Four female, domestic swine (~30 kg), were bled to 3 target levels of mean arterial pressure (MAP; 55, 45, and 35 mm Hg). At each MAP target, 3 levels of PEEP were applied using a mechanical ventilator (5, 10, and 15 cm H 2 O) for ~10 minutes each. Following the reinfusion of shed blood and a recovery period, these interventions were repeated. Measurements included invasive aortic pressure and cerebral oxygen saturation using a commercially available tissue oximeter. A total of 61 epochs were entered into the following regression model: cerebral oxygen saturation = MAP + PEEP + animal number. Each epoch contained data from the last ~2 minutes of each MAP target and PEEP level. Results: The regression model yielded a coefficient of 0.30 for MAP ( P < 0.001) and -0.08 for PEEP ( P = 0.09) and overall, explained 94% of the variance in cerebral oxygenation (adjusted R 2 = 0.94, P < 0.001). While MAP was a stronger predictor in the model, higher PEEP levels appear to result in lower levels of cerebral oxygenation (see figure). Conclusions: Cerebral tissue oxygen saturation declines with lower mean arterial pressures and increased levels of PEEP. NIRS to measure cerebral oxygen saturation may be a useful clinical tool to ensure adequate cerebral oxygenation in patients with hypotension related to hemorrhage, particularly in those patients that require greater than physiologic PEEP to maintain central oxygenation.

Download Full-text

Cerebral and Skeletal Muscle Tissue Oxygenation during Exercise in Children with Sickle Cell Anemia

Blood ◽

10.1182/blood-2019-124262 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2280-2280

Author(s):

Christina M Barriteau ◽

Abraham Chiu ◽

Mark Rodeghier ◽

Robert I Liem

Keyword(s):

Skeletal Muscle ◽

Oxygen Saturation ◽

Exercise Testing ◽

Sickle Cell Anemia ◽

Tissue Oxygenation ◽

Vastus Lateralis ◽

Work Load ◽

Tissue Oxygen Saturation ◽

Tissue Oxygen ◽

Warm Up

Introduction: Sickle cell anemia (SCA) causes impaired tissue oxygenation. Children with SCA have lower peak fitness levels compared to controls. The contribution of alterations in skeletal muscle and cerebral tissue oxygenation to exercise limitation in SCA remains unclear. Near infrared spectroscopy (NIRS) is a validated, non-invasive method to measure tissue oxygen saturation. We hypothesize that compared to controls, children with SCA will exhibit greater reductions in regional tissue oxygen saturation (StO2) measured in the quadriceps (vastus lateralis) and pre frontal cortex (PFC) across all workloads during maximal cardiopulmonary exercise testing (CPET). Methods: We used the CASMED ELITE NIRS tissue oximeter to measure tissue oxygen saturation in the PFC and vastus lateralis (VL) muscle during all phases of maximal CPET, including warm up, active exercise and recovery, in 17 subjects with SCA (mean age 13.5 years) and 13 controls (mean age 15.2 years). Maximal CPET was conducted by cycle ergometry using a standard ramp protocol until volitional exhaustion was reached by all participants. Peak oxygen consumption (VO2) was measured from breath-by breath gas exchange data collected during CPET. Results: All subjects and controls completed maximal CPET without adverse events. Peak VO2 was not statistically different in subjects with SCA versus controls (25.3±4.7 vs 29.5±8.9 mL/kg/min, p=0.22). Compared to controls, subjects with SCA had significantly lower PFC StO2 at all time points during exercise, including warm up, 20%, 40%, 60%, 80% and 100% of peak work load (p<0.01) (Figure 1a). Subjects with SCA demonstrated a significant decrease in PFC StO2 from warm up to 80% peak work load (-3.0±2.9% , p=0.002) and from warm up to 100% peak work load (-5.4±3.4 %, p<0.001) (Figure 1b). In contrast, controls did not demonstrate significant decreases in PFC StO2 from warm up to any point during exercise testing. VL StO2 did not significantly differ between subjects and controls during exercise (p=0.149, Figure 1c). Subjects with SCA demonstrated a significant increase in VL StO2 from warm up to 0% (+3.2±2.8%, p<0.001) and 20% peak work load (+2.3±2.5%, p=0.002) and a significant decrease in StO2 from warm up to 60% (-4.8±4.6%, p<0.001), 80% (-8.6±5.9%, p<0.001) and 100% peak work load (-10.5±6.3%, p<0.001) (Figure 1d). Controls had significant increase in VL StO2 from warm up to 0% peak work load (+4.3±4.0%, p=0.02) and a significant decrease only at 80% (-6.5±6.3%, p=0.003). Differences in PFC and VL StO2 between subjects and controls were also examined at the highest VO2 achieved by all participants. At a VO2 of 17.6 mL/kg/min, PFC StO2 was significantly lower in subjects with SCA versus controls (69.2±6.6 vs 79.5±5.3%, p<0.001). There was a trend toward lower VL StO2 in subjects versus controls (67.7±9.0 vs 73.2±7.9%, p=0.09). Conclusion: Unlike VL tissue oxygenation, PFC tissue oxygenation is relatively well preserved in subjects with SCA and controls during maximal CPET. However, compared to controls, subjects with SCA have lower PFC tissue oxygenation at warm up and during exercise as well as demonstrate significantly greater decreases in PFC tissue oxygenation during later stages of exercise. In contrast, VL tissue oxygenation is similar at warm up and during exercise for subjects and controls. VL tissue oxygenation increases during initial stages of exercise in a similar fashion in subjects with SCA and controls but subsequent decreases from warm up are greater in subjects with SCA during later stages of exercise. Future studies may further elucidate how SCA contributes to these observed differences in regional tissue oxygenation during exercise and their potential impact on exercise safety and fitness in this population. Disclosures No relevant conflicts of interest to declare.

Download Full-text