Cerebral Oximetry to Reduce Organ Dysfunction After Non-cardiac Surgery

Abstract Background Cerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue, especially during cardiac surgery. Despite its popularity, there have been inconsistent results on the use of cerebral oximetry during cardiac surgery, and few studies have evaluated cerebral oximetry during off pump coronary artery bypass graft surgery (OPCAB). Methods To evaluate the relationship between intraoperative cerebral oximetry and postoperative delirium in patients who underwent OPCAB, we included 1439 patients who underwent OPCAB between October 2004 and December 2016 and among them, 815 patients with sufficient data on regional cerebral oxygen saturation (rSO2) were enrolled in this study. We retrospectively analyzed perioperative variables and the reduction in rSO2 below cut-off values of 75, 70, 65, 60, 55, 50, 45, 40, and 35%. Furthermore, we evaluated the relationship between the reduction in rSO2 and postoperative delirium. Results Delirium occurred in 105 of 815 patients. In both univariable and multivariable analyses, the duration of rSO2 reduction was significantly longer in patients with delirium at cut-offs of < 50 and 45% (for every 5 min, adjusted odds ratio (OR) 1.007 [95% Confidence interval (CI) 1.001 to 1.014] and adjusted OR 1.012 [1.003 to 1.021]; p = 0.024 and 0.011, respectively). The proportion of patients with a rSO2 reduction < 45% was significantly higher among those with delirium (adjusted OR 1.737[1.064 to 2.836], p = 0.027). Conclusions In patients undergoing OPCAB, intraoperative rSO2 reduction was associated with postoperative delirium. Duration of rSO2 less than 50% was 40% longer in the patients with postoperative delirium. The cut-off value of intraoperative rSO2 that associated with postoperative delirium was 50% for the total patient population and 55% for the patients younger than 68 years.

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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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