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Mutsuyoshi Y, Ito K, Ookawara S, Ueda Y, Shindo M, Hirata M, Nonaka H, Morino J, Kaneko S, Kitano T, Miyazawa H, Hirai K, Morishita Y. Effects to cerebral oxygenation by arteriovenous fistula creation in patients with chronic kidney disease. J Vasc Access 2024:11297298241257431. [PMID: 38825801 DOI: 10.1177/11297298241257431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Vascular access, including arteriovenous fistula (AVF), is essential in patients undergoing hemodialysis (HD). However, the presence of AVF is non-physiological in humans and could pose a burden to the systemic circulation or tissue microcirculation, potentially affecting tissue oxygenation, including in the brain. Recently, near-infrared spectroscopy has been used to measure regional oxygen saturation (rSO2) as a marker of cerebral oxygenation in various settings, including in patients undergoing HD. Thus far, no studies have reported changes in cerebral rSO2 before and after AVF creation. This study aimed to monitor the differences in cerebral oxygenation before and after AVF creation and to clarify the clinical factors affecting the changes in cerebral rSO2. METHODS Forty-eight patients (34 men, 14 women) with chronic kidney disease (CKD) who were not undergoing dialysis and newly created AVF were recruited. Cerebral rSO2 values before and after AVF creation were evaluated using near-infrared spectroscopy (INVOS 5100c). RESULTS Cerebral rSO2 values were significantly changed from 60.3% ± 7.5% to 58.4% ± 6.8% before and after AVF creation in all patients (p < 0.001). Cerebral rSO2 were also lower in patients with diabetes mellitus (DM) than in those without DM (57.5 ± 7.1 vs 63.7 ± 6.5, p = 0.003) before surgery; however, no differences of changes in cerebral rSO2 were observed between the two groups after AVF creation. Additionally, multivariate regression analysis identified changes in HR (standardized coefficient: 0.436) as independent factors associated with changes in cerebral rSO2. CONCLUSION Surgically created AVF was associated with the deterioration of cerebral rSO2 in patients with CKD not undergoing dialysis. Notably, AVF could cause cerebral hypoxia, and thus further studies are needed to clarify the clinical factors influencing changes in cerebral oxygenation after AVF creation.
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Affiliation(s)
- Yuko Mutsuyoshi
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuichiro Ueda
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | - Momoko Hirata
- Division of Nephrology, Chofu Touzan Hospital, Tokyo, Japan
| | - Hiroaki Nonaka
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Junki Morino
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shohei Kaneko
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taisuke Kitano
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Haruhisa Miyazawa
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Kaiser HA, Bauer T, Riva T, Greif R, Riedel T, Theiler L, Nabecker S. Carbon dioxide and cardiac output as major contributors to cerebral oxygenation during apnoeic oxygenation. Sci Rep 2024; 14:3617. [PMID: 38351038 PMCID: PMC10864331 DOI: 10.1038/s41598-023-49238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/06/2023] [Indexed: 02/16/2024] Open
Abstract
Apnoeic oxygenation has experienced a resurgence in interest in critical care and perioperative medicine. However, its effect on cerebral oxygenation and factors influencing it, have not yet been investigated in detail. By using near-infrared spectroscopy, we intended to provide further evidence for the safety of apnoeic oxygenation and to increase our understanding of the association between cerebral perfusion, haemodynamic, respiratory and demographic factors. In this secondary analysis of a prospective randomized controlled noninferiority trial, we recruited 125 patients, who underwent surgery under general anaesthesia with neuromuscular blockade. Arterial blood samples were taken every 2 min for a total of 15 min under apnoeic oxygenation with 100% oxygen. Near-infrared spectroscopy and cardiac output were continuously measured. Statistical analysis was performed using uni- and multivariable statistics. Ninety-one complete data sets were analysed. In six patients the SpO2 fell below 92% (predefined study termination criterion). The significant average increase of cerebral oxygenation was 0.5%/min and 2.1 mmHg/min for the arterial pressure of carbon dioxide (paCO2). The median cardiac output increased significantly from 5.0 l/min (IQR 4.5-6.0) to 6.5 l/min (IQR 5.7-7.5). The most significant effect on cerebral oxygenation was exhibited by the variable paCO2 and non-specific patient factors, followed by cardiac output and paO2. Apnoeic oxygenation proves to have a high safety profile while significantly increasing cerebral oxygenation, paCO2 and cardiac output. In reverse, NIRS might act as a reliable clinical surrogate of paCO2 and cardiac output during stable arterial oxygenation.
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Grants
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
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Affiliation(s)
- Heiko Andreas Kaiser
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Bauer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Unit for Research and Innovation, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubünden, Chur, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, University Children's Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Theiler
- Department of Anaesthesia, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Sabine Nabecker
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Anaesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada.
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3
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Hirai N, Saito J, Nakai K, Noguchi S, Hashiba E, Hirota K. Association between regional oxygen saturation and central venous saturation in pediatric patients undergoing cardiac surgery: A prospective observational study. Paediatr Anaesth 2023; 33:913-922. [PMID: 37534800 DOI: 10.1111/pan.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND We evaluated the correlation between regional oxygen saturation (rSO2 ) in the frontal and right renal dorsum (cerebral rSO2 and somatic rSO2 ) measured by near-infrared spectroscopy (INVOS™ 5100C, Medtronic) and central venous oxygen saturation (ScvO2 ) measured with a fiber-optic oximetry catheter (PediaSat™, Edwards Lifesciences) during surgery in order to determine whether noninvasive rSO2 could be used as an alternative to ScvO2 in pediatric cardiac surgery patients. We evaluated the correlation between regional tissue oxygen saturation (cerebral rSO2 and somatic rSO2 ) measured by near-infrared spectroscopy and other patient measures with central venous oxygen saturation (ScvO2 ) measured with a fiber-optic oximetry catheter to track global oxygen supply demand as a potential alternative or supplement to ScvO2 . PATIENTS AND METHODS This single-center prospective observational study enrolled 33 children (weight < 10 kg) who underwent cardiac surgery for congenital heart disease between February 2018 and November 2021. ScvO2 , cerebral rSO2 , and somatic rSO2 were recorded simultaneously after anesthesia induction and central venous catheter placement. Pearson's correlation coefficient and Bland-Altman analysis were used to determine the relationship between ScvO2 and rSO2 . We conducted correlation, Bland Altman, and multiple regression analyses to identify associations between rSO2 , patient measures, and ScvO2 values. RESULTS The patients' median age was 11.0 (quartile 2.0-16.0) months. Their weight was 7.2 (quartile 4.5-9.2) kg. Cerebral rSO2 was significantly positively correlated with ScvO2 (r2 = 0.29, p = .002 in all patients; r2 = 0.61, p = .013 in the patients without mixing at the atrial level), whereas somatic rSO2 was not. The Bland-Altman analysis demonstrated biases [95% confidence interval; 95% CI] (lower and upper limits of agreement [95% CI]) of 0.27% [-4.26 to 4.80] (-24.79 [-32.61 to -16.96] to 25.33 [17.50 to 33.16]) between cerebral rSO2 and ScvO2 and 0.91% [-5.48 to 7.30] (-34.43 [-45.47 to -23.39] to 36.25 [25.21 to 47.29]) between somatic rSO2 and ScvO2 . Preoperative brain natriuretic peptide (BNP) and SpO2 were independent variables associated with ScvO2 and cerebral and somatic rSO2 . CONCLUSION Cerebral rSO2 , SpO2 , and BNP were significantly correlated with ScvO2 , although the cerebral rSO2 correlation was greater for lesions without atrial mixing. rSO2 , BNP, and SpO2 might be used to track changes in ScvO2 but cerebral rSO2 is not sufficiently precise to replace it.
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Affiliation(s)
- Naoki Hirai
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kishiko Nakai
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoko Noguchi
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Hashiba
- Division of Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Perioperative Medicine for Community Healthcare, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Perioperative Stress Management, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Lanning KM, Ylikauma LA, Erkinaro TM, Ohtonen PP, Vakkala MA, Kaakinen TI. Changes in transcranial near-infrared spectroscopy values reflect changes in cardiac index during cardiac surgery. Acta Anaesthesiol Scand 2023; 67:599-605. [PMID: 36740457 DOI: 10.1111/aas.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/27/2022] [Accepted: 01/26/2023] [Indexed: 02/07/2023]
Abstract
To determine whether changes in transcranial near-infrared spectroscopy (NIRS) values reflect changes in cardiac index (CI) in adult cardiac surgical patients. Single-center prospective post hoc analysis. University hospital. One hundred and twenty-four adult patients undergoing cardiac surgery. In each patient, several CI measurements were taken, and NIRS values were collected simultaneously. We used a hierarchical linear regression model to assess the association between NIRS values and CI. We calculated a crude model with NIRS as the only factor included, and an adjusted model, where mean arterial pressure, end-tidal CO2 , and oxygen saturation were used as confounding factors. A total of 1301 pairs of NIRS and CI values were collected. The analysis of separate NIRS and CI pairs revealed a poor association, which was not statistically significant when adjusted with the chosen confounders. However, when the changes in NIRS from baseline or from the previous measurement were compared to those of CI, a clinically and statistically significant association between NIRS and CI was observed also in the adjusted model. Compared to the baseline and to the previous measurement, respectively, the regression coefficients with 95% confidence intervals were 0.048 (0.041-0.056) and 0.064 (0.055-0.073) in off-pump coronary artery bypass patients and 0.022 (0.016-0.029) and 0.026 (0.020-0.033) in patients who underwent cardiopulmonary bypass. In an unselected cardiac surgical population, the changes in NIRS values reflect those in CI, especially in off-pump coronary artery bypass patients. In this single-center post hoc analysis of data from a prospectively collected database of cardiac surgery patients, paired measurements of cardiac output and NIRS revealed that while there was a no correlation between individual paired measurements, a small correlation was found in changes in the two measurements from baseline values. This highlights a potential to utilize changes in NIRS from baseline to suggest changes in cardiac output in cardiac surgical populations.
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Affiliation(s)
- Katriina M Lanning
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Laura A Ylikauma
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tiina M Erkinaro
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Pasi P Ohtonen
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.,Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Merja A Vakkala
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Timo I Kaakinen
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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Associations among preoperative transthoracic echocardiography variables and cerebral near-infrared spectroscopy values at baseline before anesthesia in patients undergoing cardiac surgery: a retrospective observational study. Heart Vessels 2023; 38:839-848. [PMID: 36692544 DOI: 10.1007/s00380-023-02233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023]
Abstract
Cerebral tissue oximetry with near-infrared spectroscopy (NIRS) is used to monitor cerebral oxygenation during cardiac surgery. To date, reduced baseline cerebral NIRS values have been attributed to reduced cerebral blood flow primarily based on a significant positive correlation between left ventricular ejection fraction (LVEF) and baseline rSO2 measured with the INVOS 5100C oximeter. Reportedly, however, rSO2, but not StO2 measured with the FORESIGHT Elite oximeter, correlated with LVEF. We, thus, investigated associations among baseline NIRS values measured with three different oximeters before anesthesia for cardiac surgery and preoperative transthoracic echocardiography (TTE) variables, including LVEF, to examine whether there are inter-device differences in associations among baseline NIRS values and TTE variables. Using Spearman's correlation coefficient, we retrospectively investigated associations among 15 preoperative TTE variables, including LVEF, and baseline NIRS values, including rSO2, StO2, and TOI with the NIRO-200NX oximeter in 1346, 515, and 301 patients, respectively. Only rSO2 (p < 0.00001), but not TOI or StO2 (p > 0.05), positively correlated with LVEF. On the other hand, baseline rSO2, TOI, and StO2 consistently, negatively correlated with the left atrial diameter index (LADI), early diastolic transmitral flow velocity (E), E-to-early diastolic mitral annular velocity ratio (E/e'), estimated right ventricular systolic pressure (eRVP), and inferior vena cava diameter index (IVCDI) (p < 0.0005 to p < 0.00001). Because all of these five TTE variables could be positively associated with right as well as left ventricular filling pressure, our results indicated that reduced baseline NIRS values were consistently associated not with reduced LVEF but with TTE findings indicative of elevated biventricular filling pressure. Our data suggest that regional venous congestion greatly contributes to reduced baseline NIRS values in patients undergoing cardiac surgery.
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6
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Low Intraoperative Cerebral Oxygen Saturation Is Associated with Acute Kidney Injury after Off-Pump Coronary Artery Bypass. J Clin Med 2023; 12:jcm12010359. [PMID: 36615159 PMCID: PMC9821185 DOI: 10.3390/jcm12010359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
By monitoring the brain as the index organ of global oxygen supply-demand balance including major organs, regional cerebral oxygen saturation (rScO2) may indicate adequacy of renal perfusion. The aim of this study was to investigate the relationship between perioperative rScO2 and acute kidney injury (AKI) after off-pump coronary artery bypass (OPCAB). AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. Collected rScO2 variables were baseline, mean, and lowest value during surgery, maximal percentage decrease from baseline, and areas under the threshold below an absolute value of 50% (AUT50) and of 80% of baseline (AUT80%base). Among 580 patients, AKI developed in 143 (24.7%) patients. Patients with AKI had lower baseline, mean, and lowest rScO2 and higher AUT50 and AUT80%base than those without AKI despite routine efforts to restore the rScO2 values within 20% of the baseline. Among the rScO2 variables, the area under the receiver operating characteristic curve of mean rScO2 was the highest (0.636), which was used for the multivariable logistic regression. Multivariable logistic regression revealed mean rScO2 as an independent predictor of AKI (odds ratio, 0.964; 95% confidence interval, 0.937-0.990; p = 0.008), along with chronic kidney disease and emergency surgery. Low intraoperative mean rScO2 was independently associated with AKI after OPCAB, which may serve as an early marker of renal injury.
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Seppelt PC, Mas-Peiro S, Van Linden A, Iken S, Zacharowski K, Walther T, Fichtlscherer S, Vasa-Nicotera M. Cerebral oxygen saturation as outcome predictor after transfemoral transcatheter aortic valve implantation. Clin Res Cardiol 2022; 111:955-965. [PMID: 35505123 PMCID: PMC9334442 DOI: 10.1007/s00392-022-02019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/31/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cerebral oxygen saturation (ScO2) can be measured non-invasively by near-infrared spectroscopy (NIRS) and correlates with cerebral perfusion. We investigated cerebral saturation during transfemoral transcatheter aortic valve implantation (TAVI) and its impact on outcome. METHODS AND RESULTS Cerebral oxygenation was measured continuously by NIRS in 173 analgo-sedated patients during transfemoral TAVI (female 47%, mean age 81 years) with self-expanding (39%) and balloon-expanding valves (61%). We investigated the periprocedural dynamics of cerebral oxygenation. Mean ScO2 at baseline without oxygen supply was 60%. During rapid ventricular pacing, ScO2 dropped significantly (before 64% vs. after 55%, p < 0.001). ScO2 at baseline correlated positively with baseline left-ventricular ejection fraction (0.230, p < 0.006) and hemoglobin (0.327, p < 0.001), and inversely with EuroSCORE-II ( - 0.285, p < 0.001) and length of in-hospital stay ( - 0.229, p < 0.01). Patients with ScO2 < 56% despite oxygen supply at baseline had impaired 1 year survival (log-rank test p < 0.01) and prolonged in-hospital stay (p = 0.03). Furthermore, baseline ScO2 was found to be a predictor for 1 year survival independent of age and sex (multivariable adjusted Cox regression, p = 0.020, hazard ratio (HR 0.94, 95% CI 0.90-0.99) and independent of overall perioperative risk estimated by EuroSCORE-II and hemoglobin (p = 0.03, HR 0.95, 95% CI 0.91-0.99). CONCLUSIONS Low baseline ScO2 not responding to oxygen supply might act as a surrogate for impaired cardiopulmonary function and is associated with worse 1 year survival and prolonged in-hospital stay after transfemoral TAVI. ScO2 monitoring is an easy to implement diagnostic tool to screen patients at risk with a potential preserved recovery and worse outcome after TAVI.
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Affiliation(s)
- Philipp C Seppelt
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
- DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany.
| | - Silvia Mas-Peiro
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
| | - Arnaud Van Linden
- DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
- Department of Cardiothoracic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Sonja Iken
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Thomas Walther
- DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
- Department of Cardiothoracic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
| | - Mariuca Vasa-Nicotera
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
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Gas embolism under standard versus low pneumoperitoneum pressure during laparoscopic liver resection (GASES): study protocol for a randomized controlled trial. Trials 2021; 22:807. [PMID: 34781988 PMCID: PMC8591437 DOI: 10.1186/s13063-021-05678-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Gas embolism induced by CO2 pneumoperitoneum is commonly identified as a risk factor for morbidity, especially cardiopulmonary morbidity, after laparoscopic liver resection (LLR) in adults. Increasing pneumoperitoneum pressure (PP) contributes to gas accumulation following laparoscopy. However, few studies have examined the effects of PP in the context of LLR. In LLR, the PP-central venous pressure (CVP) gradient is increased due to hepatic vein rupture, hepatic sinusoid exposure, and low CVP management, which together increase the risk of CO2 embolization. The aim of this study is to primarily determine the role of low PP (10 mmHg) on the incidence of severe gas embolism. Methods Adult participants (n = 140) undergoing elective LLR will be allocated to either a standard (15 mmHg) or low (10 mmHg) PP group. Anesthesia management, postoperative care, and other processes will be performed similarly in both groups. The occurrence of severe gas embolism, which is defined as gas embolism ≥ grade 3 according to the Schmandra microbubble method, will be detected by transesophageal echocardiography (TEE) and recorded as the primary outcome. The subjects will be followed up until discharge and followed up by telephone 1 and 3 months after surgery. Postoperative outcomes, such as the Post-Operative Quality of Recovery Scale, pain severity, and adverse events, will be assessed. Serum cardiac markers and inflammatory factors will also be assessed during the study period. The correlation between intraoperative inferior vena cava-collapsibility index (IVC-CI) under TEE and central venous pressure (CVP) will also be explored. Discussion This study is the first prospective randomized clinical trial to determine the effect of low versus standard PP on gas embolism using TEE during elective LLR. These findings will provide scientific and clinical evidence of the role of PP. Trial status Protocol version: version 1 of 21-08-2020 Trial registration ChiCTR2000036396 (http://www.chictr.org.cn). Registered on 22 August 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05678-8.
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Huppert EL, Parnia S. Cerebral oximetry: a developing tool for monitoring cerebral oxygenation during cardiopulmonary resuscitation. Ann N Y Acad Sci 2021; 1509:12-22. [PMID: 34780070 DOI: 10.1111/nyas.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/25/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
Despite improvements in cardiopulmonary resuscitation (CPR), survival and neurologic recovery after cardiac arrest remain very poor because of the impact of severe ischemia and subsequent reperfusion injury. As the likelihood of survival and favorable neurologic outcome decreases with increasing severity of ischemia during CPR, developing methods to measure the magnitude of ischemia during resuscitation, particularly cerebral ischemia, is critical for improving overall outcomes. Cerebral oximetry, which measures regional cerebral oxygen saturation (rSO2 ) by near-infrared spectroscopy, has emerged as a potentially beneficial marker of cerebral ischemia during CPR. In numerous preclinical and clinical studies, higher rSO2 during CPR has been associated with improved cardiac arrest survival and neurologic outcome. In this narrative review, we summarize the scientific rationale and validation of cerebral oximetry across populations and pathophysiologic states, discuss the evidence surrounding its use to predict return of spontaneous circulation, rearrest, and neurologic outcome, and provide suggestions for incorporation of cerebral oximetry into CPR practice.
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Affiliation(s)
- Elise L Huppert
- Critical Care and Resuscitation Research Center, New York University Grossman School of Medicine, New York University Langone Health, New York, New York.,Division of Pulmonary, Critical Care & Sleep Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, New York
| | - Sam Parnia
- Critical Care and Resuscitation Research Center, New York University Grossman School of Medicine, New York University Langone Health, New York, New York.,Division of Pulmonary, Critical Care & Sleep Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, New York.,Division of Pulmonary, Critical Care & Sleep Medicine, New York University Langone Health, New York, New York
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10
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Asano M, Doi K, Nomura M, Nagasaka Y. Cerebral oximetry-guided pulmonary artery banding for end-stage heart failure in a child with left ventricular noncompaction cardiomyopathy: a case report. Transl Pediatr 2021; 10:3082-3090. [PMID: 34976774 PMCID: PMC8649599 DOI: 10.21037/tp-21-340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
Pulmonary artery banding (PAB) may reduce the need for left ventricular assist devices and heart transplantation in children with end-stage heart failure. However, excessive banding may increase the right ventricular afterload, leading to worsening of heart failure. The estimated right ventricular pressure and the shifting of the interventricular septum by transesophageal echocardiography (TEE), pulmonary artery pressure, right atrial and ventricular pressure, percutaneous oxygen saturation, and mixed venous oxygen saturation are utilized to determine the optimal circumference for PAB. Here, we report the case of a 5-month-old patient with end-stage heart failure due to left ventricular noncompaction cardiomyopathy (LVNC), with a gene mutation of MYH7, who underwent successful PAB. The exact PAB placement was additionally guided by using cerebral regional oxygen saturation (rSO2) measurement to achieve a tolerable and optimal PAB effect. We monitored rSO2 and other hemodynamic parameters while surgeons banded the pulmonary artery to achieve both highest rSO2 levels and stable hemodynamics. rSO2 was 68% before banding, and increased and remained at over 90% after the banding at same FiO2. Patient's heart failure improved gradually, and the child was discharged home at 6 months after PAB. The rSO2 is a simple and non-invasive monitor for the measurement of oxygen delivery to the brain tissue. rSO2 alone would not be able to guide PAB placement in the vulnerable DCM patients, but it may be of one further monitoring value for the optimal pulmonary artery circumference while patients are undergoing PAB.
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Affiliation(s)
- Mayu Asano
- Department of Anesthesia, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Doi
- Department of Anesthesia, Tokyo Women's Medical University, Tokyo, Japan
| | - Minoru Nomura
- Department of Anesthesia, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuko Nagasaka
- Department of Anesthesia, Tokyo Women's Medical University, Tokyo, Japan
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Larson S, Anderson L, Thomson S. Effect of phenylephrine on cerebral oxygen saturation and cardiac output in adults when used to treat intraoperative hypotension: a systematic review. JBI Evid Synth 2021; 19:34-58. [PMID: 32941358 DOI: 10.11124/jbisrir-d-19-00352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective of this review was to examine the effect of phenylephrine on cerebral oxygen saturation, cardiac output, and middle cerebral artery blood flow velocity when used to treat intraoperative hypotension. INTRODUCTION While the etiology of postoperative cognitive dysfunction in adults following surgery is likely multifactorial, intraoperative cerebral hypoperfusion is a commonly proposed mechanism. Research evidence and expert opinion are emerging that suggest phenylephrine adversely affects cerebral oxygen saturation and may also adversely affect cerebral perfusion via a reduction in cardiac output or cerebral vascular vasoconstriction. The administration of phenylephrine to treat intraoperative hypotension is common anesthesia practice, despite a lack of evidence to show it improves cerebral perfusion. Therefore, a systematic review of the effect of phenylephrine on cerebral hemodynamics has significant implications for anesthesia practice and future research. INCLUSION CRITERIA Studies of adults 18 years and over undergoing elective, non-neurosurgical procedures involving anesthesia were included. In these studies, participants received phenylephrine to treat intraoperative hypotension. The effect of phenylephrine on cerebral oxygen saturation, cardiac output, or middle cerebral artery blood flow velocity was measured. METHODS Key information sources searched included MEDLINE (Ovid), Embase, CINAHL (EBSCO), and Google Scholar. The scope of the search was limited to English-language studies published from 1999 through 2017. The recommended JBI approach to critical appraisal, study selection, data extraction, and data synthesis were used. RESULTS This systematic review found that phenylephrine consistently decreased cerebral oxygen saturation values despite simultaneously increasing mean arterial pressure to normal range. Results also found that ephedrine and dopamine were superior to phenylephrine in maintaining or increasing values. Phenylephrine was found to be similar to vasopressin in the extent to which both decreased cerebral oxygen saturation values. Results also showed that phenylephrine resulted in statistically significant declines in cardiac output, or failed to improve abnormally low preintervention values. The effect of phenylephrine on middle cerebral artery blood flow velocity was only measured in one study and showed that phenylephrine increased flow velocity by about 20%. Statistical pooling of the study results was not possible due to the gross variation in how the intervention was administered and how effect was measured. CONCLUSIONS This review found that phenylephrine administration resulted in declines in cerebral oxygen saturation and cardiac output. However, the research studies were ineffective in informing phenylephrine's mechanism of action or its impact on postoperative cognitive function. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO (CRD42018100740).
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Affiliation(s)
- Sandra Larson
- Rosalind Franklin University of Medicine and Science: A JBI Affiliated Group, Chicago, IL, USA
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Kadokura Y, Hayashida M, Kakemizu-Watanabe M, Yamamoto M, Endo D, Oishi A, Nakanishi K, Hata H. Cerebral oxygen saturation (rSO 2) during cardiopulmonary bypass (CPB) measured using the INVOS oximeter closely correlates with baseline rSO 2. J Artif Organs 2021; 24:433-441. [PMID: 33826034 DOI: 10.1007/s10047-021-01263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
Baseline cerebral regional saturation (rSO2) measured using the INVOS 5100C (Medtronic, MN, USA) varies widely among patients with cardiac and/or renal diseases. To identify significant correlates of baseline rSO2 and to investigate intraoperative rSO2 changes, we conducted a retrospective study in 494 patients undergoing on-pump cardiovascular surgery. Correlations between preoperative blood laboratory test variables and baseline rSO2 before anesthesia were examined. Intraoperative rSO2 changes were analyzed. Of all the variables examined, log-transformed B-type natriuretic peptide (BNP) most significantly and negatively correlated with baseline rSO2 (r = - 0.652, p < 0.0001). Intraoperatively, rSO2 showed the lowest value during cardiopulmonary bypass (CPB) (median rSO2: 56.2% during CPB vs. 63.9% at baseline, p < 0.0001). Although rSO2 during CPB correlated positively with hemoglobin concentration and oxygen delivery during CPB (r = 0.192, p < 0.0001; and r = 0.172, p = 0.0001, respectively), it correlated much more closely with baseline rSO2 (r = - 0.589, p < 0.0001). Thus, patients showing low baseline rSO2 primarily associated with preoperatively high BNP continued to show low rSO2 even during CPB independent of hemodynamics artificially controlled by CPB. Our findings suggest that low baseline rSO2 in patients with high BNP due to cardiac and/or renal diseases is more likely to result from tissue edema causing alterations in optical pathlength and thus in calculated rSO2 values, not readily modifiable with CPB, rather than actual cerebral hemodynamic alterations readily modifiable with CPB. These may partly explain why the INVOS oximeter is a trend monitor requiring baseline measures.
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Affiliation(s)
- Yumiko Kadokura
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Maho Kakemizu-Watanabe
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Makiko Yamamoto
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Daisuke Endo
- Department of Cardiovascular Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Atsumi Oishi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Keisuke Nakanishi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroaki Hata
- Department of Cardiovascular Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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Association between Cerebral Oxygen Saturation with Outcome in Cardiac Surgery: Brain as an Index Organ. J Clin Med 2020; 9:jcm9030840. [PMID: 32204551 PMCID: PMC7141352 DOI: 10.3390/jcm9030840] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 01/12/2023] Open
Abstract
While both baseline regional cerebral oxygen saturation (rSO2) and intraoperative rSO2 decreases have prognostic importance in cardiac surgery, evidence is limited in patients who received interventions to correct rSO2 decreases. The primary aim was to examine the association between rSO2 values (both baseline rSO2 and intraoperative decrease in rSO2) with the composite of morbidity endpoints. We retrospectively analyzed 356 cardiac surgical patients having continuously recorded data of intraoperative rSO2 values. Per institutional guidelines, patients received interventions to restore the rSO2 value to ≥80% of the baseline value. Analyzed rSO2 variables included baseline value, and area under the threshold below an absolute value of 50% (AUT50). Their association with outcome was analyzed with multivariable logistic regression. AUT50 (odds ratio, 1.05; 95% confidence interval; 1.01–1.08; p = 0.015) was shown to be an independent risk factor (along with age, chronic kidney disease, and cardiopulmonary bypass time) of adverse outcomes. In cardiac surgical patients who received interventions to correct decreases in rSO2, increased severity of intraoperative decrease in rSO2 as reflected by AUT below an absolute value of 50% was associated with a composite of adverse outcomes, implicating the importance of cerebral oximetry to monitor the brain as an index organ.
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Denault A, Shaaban Ali M, Couture EJ, Beaubien-Souligny W, Bouabdallaoui N, Brassard P, Mailhot T, Jacquet-Lagrèze M, Lamarche Y, Deschamps A. A Practical Approach to Cerebro-Somatic Near-Infrared Spectroscopy and Whole-Body Ultrasound. J Cardiothorac Vasc Anesth 2019; 33 Suppl 1:S11-S37. [DOI: 10.1053/j.jvca.2019.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Carmona García P, Mateo E, Zarragoikoetxea I, López Cantero M, Peña Borrás JJ, Vicente R. Can regional cerebral oxygen saturation guide red blood cell transfusion in high risk cardiac surgery? ACTA ACUST UNITED AC 2019; 66:355-361. [PMID: 31053417 DOI: 10.1016/j.redar.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cardiac surgery (CS) is associated with a significant use of blood products. The aim of this study was to evaluate the effect of red blood cells concentrates (RBC) transfusion on regional cerebral oxygen saturation (SrO2) in patients undergoing CS with additive EuroSCORE I > 6. MATERIAL AND METHODS This is a prospective descriptive study. Patients with additive EuroSCORE I > 6 undergoing CS with extracorporeal circulation were included in the study. The demographic values, perioperative complications, hospital/ICU length of stay (LOS), as well as the preinduction baseline SrO2values, the lowest SrO2 value during surgery, number of blood products transfused, hemoglobine (HB) and pre and postransfusional SrO2 values were recorded, and events of significant decrease in SrO2 below 20% of basal value or decrease below 50%. We considered responders those who had an increase post-transfusion SrO2 at least 20% of pre-transfusion value, an increase of standar deviation (7.9) or an increase up to basal SrO2. RESULTS Data from 57 patients were collected. The average additive EuroSCORE I was 7.4 (SD 2.6) and the EuroSCORE II was 6.1 (SD 7.4). 52% were male. 35.1% of patients received intraoperative transfusion of at least one unit of RBC. The overall mortality was 8.7% (N = 5). During surgery 29.8% of the overall sample presented a decrease of more than 20% of baseline SrO2 or a value lower than 50%. Patients with a significant decrease in SrO2 presented a higher rate of perioperative complications (P=0.04) and longer ICU-LOS 4.3 (SD 3.6) vs. 6.8 (SD 8.2) days (P=0.01) and hospital LOS 10.1 (SD 3.1) vs. 14.2 (SD 9.4) days (P=0.01). Pretransfusional HB was 7.4 (SD 0.8) mg/dl and postransfusional value was 8.4 (SD 0.8) (P =0.00). Pretransfusional SrO2 was 59 (SD 8.6) and increased non- significantly after RBC transfusion to 61.1 (SD 7.9) (P=0.1). Only 6 patients out of 21 could be considered responders. There were no significant differences in morbidity, mortality or LOS between responders and non-responders. DISCUSSION In our population a non statistically significant increase in SrO2 was observed after RBC transfusion. When considering responders few patients were identified by SrO2. In conclusion SrO2 might not be reliable triger to decide transfusion.
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Affiliation(s)
- P Carmona García
- Departamento de Anestesiología y Reanimación, Hospital General Universitario La Fe, Valencia, España.
| | - E Mateo
- Departamento de Anestesiología y Reanimación, Consorcio Hospital General Valencia, Valencia, España
| | - I Zarragoikoetxea
- Departamento de Anestesiología y Reanimación, Hospital General Universitario La Fe, Valencia, España
| | - M López Cantero
- Departamento de Anestesiología y Reanimación, Hospital General Universitario La Fe, Valencia, España
| | - J J Peña Borrás
- Departamento de Anestesiología y Reanimación, Consorcio Hospital General Valencia, Valencia, España
| | - R Vicente
- Departamento de Anestesiología y Reanimación, Hospital General Universitario La Fe, Valencia, España
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Huber W, Zanner R, Schneider G, Schmid R, Lahmer T. Assessment of Regional Perfusion and Organ Function: Less and Non-invasive Techniques. Front Med (Lausanne) 2019; 6:50. [PMID: 30968023 PMCID: PMC6438879 DOI: 10.3389/fmed.2019.00050] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 02/25/2019] [Indexed: 12/13/2022] Open
Abstract
Sufficient organ perfusion essentially depends on preserved macro- and micro-circulation. The last two decades brought substantial progress in the development of less and non-invasive monitoring of macro-hemodynamics. However, several recent studies suggest a frequent incoherence of macro- and micro-circulation. Therefore, this review reports on interactions of macro- and micro-circulation as well as on specific regional and micro-circulation. Regarding global micro-circulation the last two decades brought advances in a more systematic approach of clinical examination including capillary refill time, a graded assessment of mottling of the skin and accurate measurement of body surface temperatures. As a kind of link between macro- and microcirculation, a number of biochemical markers can easily be obtained. Among those are central-venous oxygen saturation (ScvO2), plasma lactate and the difference between central-venous and arterial CO2 (cv-a-pCO2-gap). These inexpensive markers have become part of clinical routine and guideline recommendations. While their potential to replace parameters of macro-circulation such as cardiac output (CO) is limited, they facilitate the interpretation of the adequacy of CO and other macro-circulatory markers. Furthermore, they give additional hints on micro-circulatory impairment. In addition, a number of more sophisticated technical approaches to quantify and visualize micro-circulation including video-microscopy, laser flowmetry, near-infrared spectroscopy (NIRS), and partial oxygen pressure measurement have been introduced within the last 20 years. These technologies have been extensively used for scientific purposes. Moreover, they have been successfully used for educational purposes and to visualize micro-circulatory disturbances during sepsis and other causes of shock. Despite several studies demonstrating the association of these techniques and parameters with outcome, their practical application still is limited. However, future improvements in automated and “online” diagnosis will help to make these technologies more applicable in clinical routine. This approach is promising with regard to several studies which demonstrated the potential to guide therapy in different types of shock. Finally several organs have specific patterns of circulation related to their special anatomy (liver) or their auto-regulatory capacities (brain, kidney). Therefore, this review also discusses specific issues of monitoring liver, brain, and kidney circulation and function.
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Affiliation(s)
- Wolfgang Huber
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Robert Zanner
- Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Gerhard Schneider
- Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Roland Schmid
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Tobias Lahmer
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Preoperative cerebral and renal oxygen saturation and clinical outcomes in pediatric patients with congenital heart disease. J Clin Monit Comput 2019; 33:1015-1022. [DOI: 10.1007/s10877-019-00260-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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Yamamoto M, Hayashida M, Kakemizu-Watanabe M, Ando N, Mukaida H, Kawagoe I, Yusuke S, Inada E. B-Type Natriuretic Peptide and Hemoglobin are Two Major Factors Significantly Associated With Baseline Cerebral Oxygen Saturation Measured Using the INVOS Oximeter in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2018; 32:187-196. [DOI: 10.1053/j.jvca.2017.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Indexed: 12/14/2022]
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Tsaroucha A, Paraskeva A, Fassoulaki A. Measurements of oxygen saturation of brain, liver and heart areas in the supine and sitting position using near infrared spectrophotometry. Rom J Anaesth Intensive Care 2017; 24:101-106. [PMID: 29090261 DOI: 10.21454/rjaic.7518.242.fss] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND AIMS Regional oxygen saturation (rSO2) monitoring of the brain by near-infrared spectroscopy (NIRS) has been mainly used during carotid endarterectomy. The present study was conducted in volunteers and investigates the rSO2 values of the brain, heart and liver tissue as assessed by NIRS in the supine and the sitting position. METHODS After obtaining written informed consent from forty-nine healthy volunteers, rSO2 values were recorded in the heart and liver areas in the supine and the sitting position, while simultaneously the rSO2 values of the brain. RESULTS The rSO2 brain values in the supine and the sitting position were 69 ± 6.0 and 66 ± 6.1 respectively (p = 0.0001). The rSO2 values in the supine and the sitting position were 76 ± 10.5 and 79 ± 6.7 for the heart (p > 0.05) and 85 ± 6.8 and 82 ± 7.2 for the liver, (p = 0.007). Heart rSO2 values were higher than the brain rSO2 values in both the supine (76 ± 10.4 versus 69 ± 6.6; p = 0.0001) and the sitting position (79 ± 6.7 versus 66 ± 6.1; p = 0.0001). The liver rSO2 values were also higher than the brain rSO2 values in the supine (85 ± 6.8 versus 69 ± 6.0; p = 0.0001) and in the sitting position (82 ± 7.2 versus 66 ± 5.7; p = 0.0001). Arterial blood pressure and arterial oxygen saturation (SpO2) did not differ between the two positions but the heart rate was higher in the sitting position (p = 0.030). CONCLUSIONS We conclude that brain and liver (but not heart) rSO2 values are higher in the supine than sitting position. Additionally, NIRS may be used to assess oxygenation of the heart and liver.
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Affiliation(s)
- Athanasia Tsaroucha
- National and Kapodistrian University of Athens, Aretaieio Hospital, Department of Anesthesiology, Athens, Greece
| | - Anteia Paraskeva
- National and Kapodistrian University of Athens, Aretaieio Hospital, Department of Anesthesiology, Athens, Greece
| | - Argyro Fassoulaki
- National and Kapodistrian University of Athens, Aretaieio Hospital, Department of Anesthesiology, Athens, Greece
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Michels P, Bräuer A, Bauer M, Söhle M. Neurophysiologisches Monitoring bei operativen Eingriffen. Anaesthesist 2017; 66:645-659. [DOI: 10.1007/s00101-017-0356-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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21
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Mukaida H, Hayashida M, Matsushita S, Yamamoto M, Nakamura A, Amano A. Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery. PLoS One 2017; 12:e0181154. [PMID: 28704502 PMCID: PMC5507540 DOI: 10.1371/journal.pone.0181154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/27/2017] [Indexed: 01/08/2023] Open
Abstract
Purpose A previous study reported that low baseline cerebral oxygen saturation (ScO2) (≤50%) measured with near-infrared spectroscopy was predictive of poor clinical outcomes after cardiac surgery. However, such findings have not been reconfirmed by others. We conducted the current study to evaluate whether the previous findings would be reproducible, and to explore mechanisms underlying the ScO2-based outcome prediction. Methods We retrospectively investigated 573 consecutive patients, aged 20 to 91 (mean ± standard deviation, 67.1 ± 12.8) years, who underwent major cardiovascular surgery. Preanesthetic baseline ScO2, lowest intraoperative ScO2, various clinical variables, and hospital mortality were examined. Results Bivariate regression analyses revealed that baseline ScO2 correlated significantly with plasma brain natriuretic peptide concentration (BNP), hemoglobin concentration (Hgb), estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LVEF) (p < 0.0001 for each). Baseline ScO2 correlated with BNP in an exponential manner, and BNP was the most significant factor influencing ScO2. Logistic regression analyses revealed that baseline and lowest intraoperative ScO2 values, but not relative ScO2 decrements, were significantly associated with hospital mortality (p < 0.05), independent of the EuroSCORE (p < 0.01). Receiver operating curve analysis of ScO2 values and hospital mortality revealed an area under the curve (AUC) of 0.715 (p < 0.01) and a cutoff value of ≤50.5% for the baseline and ScO2, and an AUC of 0.718 (p < 0.05) and a cutoff value of ≤35% for the lowest intraoperative ScO2. Low baseline ScO2 (≤50%) was associated with increases in intubation time, intensive care unit stay, hospital stay, and hospital mortality. Conclusion Baseline ScO2 was reflective of severity of systemic comorbidities and was predictive of clinical outcomes after major cardiovascular surgery. ScO2 correlated most significantly with BNP in an exponential manner, suggesting that BNP plays a major role in the ScO2-based outcome prediction.
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Affiliation(s)
- Hiroshi Mukaida
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Clinical Engineering, Juntendo University Hospital, Tokyo, Japan
- * E-mail:
| | - Masakazu Hayashida
- Department of Anesthesiology & Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Matsushita
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Makiko Yamamoto
- Department of Anesthesiology & Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsushi Nakamura
- Department of Clinical Engineering, Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
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Low preoperative regional cerebral oxygen saturation in hemodialysis patients. JA Clin Rep 2017; 3:13. [PMID: 29457057 PMCID: PMC5804589 DOI: 10.1186/s40981-017-0084-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/28/2017] [Indexed: 11/25/2022] Open
Abstract
Background Regional cerebral oxygen saturation (rSO2) monitoring by near-infrared spectroscopy provides valuable information regarding cerebral oxygen delivery, and it has been increasingly used in cardiovascular surgery. Although it has been shown that dialysis-dependent patients [hemodialysis (HD) patients] suffer from low cerebral perfusion, limited information is available on cerebral tissue oxygenation levels in HD patients. Findings In this retrospective study, the preoperative rSO2 values in 9 HD patients undergoing coronary artery bypass graft surgery were compared with those in 40 non-HD patients. HD patients had lower preoperative rSO2 values than non-HD patients (median: 46 vs. 68%, respectively, P < 0.001). Despite adjusting for age, hemoglobin concentration, and left ventricular ejection fraction using multivariable linear regression, HD showed a strong association with low rSO2 (estimated coefficient: −20.4, P < 0.001). Conclusions HD showed a strong association with low preoperative rSO2 values in patients undergoing coronary artery bypass graft surgery, even after adjusting for known factors that affect rSO2 values, including age, hemoglobin concentration, and cardiac systolic function. Further research is required to elucidate the mechanisms decreasing rSO2 values in HD patients.
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Wen SYB, Peng AZY, Boyle S, Cai S, Pope L, Tran MT, Short TG, Aneman A, Jaeger M, Chuan A. A Pilot Study Using Preoperative Cerebral Tissue Oxygen Saturation to Stratify Cardiovascular Risk in Major Non-Cardiac Surgery. Anaesth Intensive Care 2017; 45:202-209. [PMID: 28267942 DOI: 10.1177/0310057x1704500210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This prospective pilot study evaluated whether low preoperative cerebral tissue oxygen saturation is associated with unfavourable outcomes after major elective non-cardiac surgery. Eighty-one patients over 60 years of age, American Society of Anesthesiologists physical status 3 or 4, were recruited. Resting cerebral tissue oxygen saturation was recorded on room air, and after oxygen supplementation, using cerebral oximetry. The primary outcome was 30-day major adverse event of combined mortality or severe morbidity, and the secondary outcome was 30-day new disability. Eleven patients (13.6%) suffered a major adverse event, and 28 patients (34.6%) experienced new disability. Room air cerebral tissue oxygen saturation was significantly different between patients who had a major adverse event, 67% (95% confidence interval [CI] 65–70) versus unaffected, 71% (95% CI 70–72; P=0.04). No statistical difference was found between patients for new disability (range 70%– 74%; P=0.73). Room air cerebral tissue oxygen saturation was significantly associated with major adverse events (odds ratio 1.36 (95% CI 1.03–1.79), P=0.03). Saturation levels ≤68% carried a positive likelihood ratio of 2.2 for death or severe morbidity, P=0.04. A definitive trial is required to confirm if cerebral oximetry can be used to stratify the cardiovascular risk of patients presenting for non-cardiac surgery.
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Affiliation(s)
- S. Y. B. Wen
- South West Sydney Clinical School, University of NSW, Sydney, New South Wales
| | - A. Z. Y. Peng
- South West Sydney Clinical School, University of NSW, Sydney, New South Wales
| | - S. Boyle
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - S. Cai
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - L. Pope
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - M. T. Tran
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - T. G. Short
- Department of Anaesthesia, Auckland City Hospital, New Zealand
| | - A. Aneman
- Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales
| | - M. Jaeger
- South Western Sydney Clinical School, University of NSW, Sydney, New South Wales
| | - A. Chuan
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
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Wally D, Velik-Salchner C. [Near-infrared spectroscopy during cardiopulmonary resuscitation and mechanical circulatory support: From the operating room to the intensive care unit]. Med Klin Intensivmed Notfmed 2015; 110:621-30. [PMID: 25917180 DOI: 10.1007/s00063-015-0012-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 01/07/2015] [Accepted: 01/13/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Near infrared spectroscopy (NIRS) allows continuous measurement of cerebral regional oxygen saturation (rSO2). It is a weighted saturation value derived from approximately 70-75 % venous, 20-25 % arterial and 2.5-5 % capillary blood. In contrast to pulse oximetry, NIRS is independent of pulsatile flow. Therefore, it is also applicable during extracorporeal circulation, cardiopulmonary resuscitation (CPR), and hypothermia. OBJECTIVES The purpose of this work is to describe the application of cerebral and somatic NIRS in cardiology and cardiac surgery patients in the operation room, during and after CPR, and during the intensive care unit stay. MATERIALS AND METHODS This article is based on peer-reviewed literature from PubMed. RESULTS Interventions based on decline of cerebral NIRS values during on-pump cardiac surgery can reduce major organ morbidity and mortality; however, the appearance of a postoperative cognitive dysfunction is scarcely influenced. Persisting of low cerebral oximetry values during resuscitation is a marker for not achieving return of spontaneous circulation under normothermia. NIRS is an additional method for monitoring that can be used during extracorporeal circulation. CONCLUSION NIRS is a rapidly available, user-friendly, and noninvasive method for continuous measurement of rSO2. NIRS provides additional information about tissue oxygenation especially during resuscitation and extracorporeal circulatory assist support. Recommendations concerning the use of NIRS for standard monitoring during resuscitation and mechanical circulatory support are not currently available. Further studies are required to show if use of NIRS can reduce pulse control and hands-off times during resuscitation and if use of NIRS can improve outcome after CPR and mechanical circulatory support.
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Affiliation(s)
- D Wally
- Universitätsklinik für Anästhesie und Intensivmedizin, Department für Operative Medizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Corinna Velik-Salchner
- Universitätsklinik für Anästhesie und Intensivmedizin, Department für Operative Medizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Laflamme M, Perrault LP, Carrier M, Elmi-Sarabi M, Fortier A, Denault AY. Preliminary Experience With Combined Inhaled Milrinone and Prostacyclin in Cardiac Surgical Patients With Pulmonary Hypertension. J Cardiothorac Vasc Anesth 2015; 29:38-45. [DOI: 10.1053/j.jvca.2014.06.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Indexed: 11/11/2022]
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Denault A, Lamarche Y, Rochon A, Cogan J, Liszkowski M, Lebon JS, Ayoub C, Taillefer J, Blain R, Viens C, Couture P, Deschamps A. Innovative approaches in the perioperative care of the cardiac surgical patient in the operating room and intensive care unit. Can J Cardiol 2014; 30:S459-77. [PMID: 25432139 DOI: 10.1016/j.cjca.2014.09.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/11/2014] [Accepted: 09/24/2014] [Indexed: 02/07/2023] Open
Abstract
Perioperative care for cardiac surgery is undergoing rapid evolution. Many of the changes involve the application of novel technologies to tackle common challenges in optimizing perioperative management. Herein, we illustrate recent advances in perioperative management by focusing on a number of novel components that we judge to be particularly important. These include: the introduction of brain and somatic oximetry; transesophageal echocardiographic hemodynamic monitoring and bedside focused ultrasound; ultrasound-guided vascular access; point-of-care coagulation surveillance; right ventricular pressure monitoring; novel inhaled treatment for right ventricular failure; new approaches for postoperative pain management; novel approaches in specialized care procedures to ensure quality control; and specific approaches to optimize the management for postoperative cardiac arrest. Herein, we discuss the reasons that each of these components are particularly important in improving perioperative care, describe how they can be addressed, and their impact in the care of patients who undergo cardiac surgery.
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Affiliation(s)
- André Denault
- Department of Anesthesiology, Critical Care Program, Montreal Heart Institute, and Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada.
| | - Yoan Lamarche
- Department of Cardiac Surgery and Critical Care Program, Montreal Heart Institute, and Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Antoine Rochon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer Cogan
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mark Liszkowski
- Department of Medicine, Cardiology and Critical Care Program, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Sébastien Lebon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Christian Ayoub
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean Taillefer
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Robert Blain
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Claudia Viens
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Couture
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alain Deschamps
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Vretzakis G, Georgopoulou S, Stamoulis K, Stamatiou G, Tsakiridis K, Zarogoulidis P, Katsikogianis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Mpakas A, Beleveslis T, Koletas A, Siminelakis SN, Zarogoulidis K. Cerebral oximetry in cardiac anesthesia. J Thorac Dis 2014; 6 Suppl 1:S60-9. [PMID: 24672700 DOI: 10.3978/j.issn.2072-1439.2013.10.22] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 01/27/2023]
Abstract
Cerebral oximetry based on near-infrared spectroscopy (NIRS) is increasingly used during the perioperative period of cardiovascular operations. It is a noninvasive technology that can monitor the regional oxygen saturation of the frontal cortex. Current literature indicates that it can stratify patients preoperatively according their risk. Intraoperatively, it provides continuous information about brain oxygenation and allows the use of brain as sentinel organ indexing overall organ perfusion and injury. This review focuses on the clinical validity and applicability of this monitor for cardiac surgical patients.
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Affiliation(s)
- George Vretzakis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Stauroula Georgopoulou
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Stamoulis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Georgia Stamatiou
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Kosmas Tsakiridis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Paul Zarogoulidis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Katsikogianis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Ioanna Kougioumtzi
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Machairiotis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Theodora Tsiouda
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Andreas Mpakas
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Thomas Beleveslis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Alexander Koletas
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Stavros N Siminelakis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Zarogoulidis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
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Denault AY, Couture P. Practical diastology. World J Anesthesiol 2014; 3:96-104. [DOI: 10.5313/wja.v3.i1.96] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 02/07/2023] Open
Abstract
Left ventricular (LV) diastolic dysfunction is being recognized as an important part in the pre-operative evaluation. Pre-operative LV diastolic dysfunction has been associated with increased risk of post-operative complications. Furthermore guidelines have been published on the assessment of LV diastolic function. However LV diastolic function is significantly influenced by loading conditions which are typically altered during cardiac and non-cardiac surgery. In addition, waveform analysis from the pulmonary artery catheter tend to correlate with diastolic function and loading conditions. The advantage of hemodynamic monitoring being that they are continuously displayed as opposed to intermittent diastolic parameters. Finally if the importance of diastolic function assessment is to estimate filling pressure, the presence of B lines with the use of lung ultrasound is a simpler method in detecting pulmonary edema. Another indirect evidence of either LV systolic or diastolic dysfunction is an abnormal near-infrared spectroscopy value. Finally it might be more important to evaluate right ventricular (RV) diastolic dysfunction as RV dysfunction is significantly associated with pulmonary hypertension and consequently mortality. Such assessment of RV diastolic dysfunction can be obtained continuously with the use of RV pressure waveform monitoring.
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Zacharias DG, Lilly K, Shaw CL, Pirundini P, Rizzo RJ, Body SC, Longford NT. Survey of the clinical assessment and utility of near-infrared cerebral oximetry in cardiac surgery. J Cardiothorac Vasc Anesth 2013; 28:308-16. [PMID: 24140084 DOI: 10.1053/j.jvca.2013.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Near-infrared cerebral oximetry increasingly is used for monitoring during cardiac surgery. Nonetheless, the scientific basis for incorporating this technology into clinical practice, the indications for when to do so, and standard diagnostic and treatment algorithms for defining abnormal values are yet to be rigorously defined. The authors hypothesized that there would be (1) variation in clinical use and practices for near-infrared spectroscopy (NIRS), and (2) variation in management of patients when clinicians are provided with NIRS information. In order to test this hypothesis, they sought to assess the nature and strength of response heterogeneity among anesthesiologists and cardiac perfusionists when provided with cardiac surgery patient scenarios and cerebral oximetry data. DESIGN A prospectively collected survey. SETTING A hospital-based, multi-institutional, multinational study. PARTICIPANTS By e-mail, the authors surveyed the membership of the Society of Cardiovascular Anesthesiologists and the online Cardiovascular Perfusion Forum. INTERVENTIONS This survey was focused on ascertaining what actions clinicians would take in each scenario, given case information and cerebral oximetry tracings. Questions were based on 11 patient scenarios selected to represent small, large, symmetric, or asymmetric decreases in measured regional cerebral oxygen saturation (rScO2) encountered during cardiac surgery. Information on the respondents' (n = 796; 73% anesthesiologists) clinical practice, demography, and cerebral oximetry utilization was collected. An index of dispersion was used to assess response heterogeneity overall and within demographic subgroups. MEASUREMENTS AND MAIN RESULTS The majority of respondents indicated that cerebral oximetry monitoring was either useful or an essential monitor, especially perfusionists and clinicians who used cerebral oximetry most frequently. There were marked differences in responses between perfusionists and anesthesiologists for 4 of the 6 scenarios (p<0.005 for each of these 4 scenarios) occurring during cardiopulmonary bypass. Scenarios having greatest rScO2 reduction or asymmetry in rScO2 were associated with the highest dispersion, indicating least agreement in management. Scenarios with mild or moderate rScO2 reduction were associated with the lowest dispersion, indicating greater agreement in management. CONCLUSIONS Although experimental data gradually are accumulating to support the role for cerebral oximetry monitoring during cardiac surgery, the results of the present survey support the view that its role remains poorly defined, and consensus for its appropriate use is lacking. Importantly, the authors observed marked variation in the use, perceived utility, and management of patients for 4 of the 6 CPB scenarios between perfusionists and anesthesiologists who share the management of CPB. These findings support the need for well-designed, adequately-powered clinical trials examining the value of this technology.
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Affiliation(s)
- David G Zacharias
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Deschamps A, Lambert J, Couture P, Rochon A, Lebon JS, Ayoub C, Cogan J, Denault A. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. J Cardiothorac Vasc Anesth 2013; 27:1260-6. [PMID: 23791498 DOI: 10.1053/j.jvca.2013.01.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To measure the incidence of cerebral desaturation during high-risk cardiac surgery and to evaluate strategies to reverse cerebral desaturation. DESIGN Prospective observational study followed by a randomized controlled study with 1 intervention group and 1 control group. SETTING Tertiary care center specialized in cardiac surgery. PARTICIPANTS All patients were scheduled for high-risk cardiac surgery, 279 consecutive patients in the prospective study and 48 patients in the randomized study. INTERVENTIONS An algorithmic approach of strategies to reverse cerebral desaturation. In the control group, no attempts were made to reverse cerebral desaturation. MEASUREMENTS AND MAIN RESULTS Cerebral saturation was measured using near-infrared reflectance spectroscopy. A decrease of 20% from baseline for 15 seconds defined cerebral desaturation. The success or failure of the interventions was noted. Demographic data were collected. Models for predicting the probability and the reversal of cerebral desaturation were based on multiple logistic regressions. In the randomized study, 12 hours of measurements were continued in the intensive care unit without interventions. Differences in desaturation load (% desaturation × time) were compared between groups. Half of the high-risk patients had cerebral desaturation that could be reversed 88% of the time. Interventions resulted in smaller desaturation loads in the operating room and in the intensive care unit. CONCLUSIONS Cerebral desaturation in high-risk cardiac surgery is frequent but can be reversed most of the time resulting in a smaller desaturation load. A large randomized study will be needed to measure the impact of reversing cerebral desaturation on patient's outcome.
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Abstract
Cerebral oximetry allows continuous real-time and non-invasive monitoring of cerebral oxygen saturation (cSO(2)), by measuring oxyhaemoglobin and deoxyhaemoglobin near infrared light absorption, similarly to pulse oximetry. cSO(2) measurement predominantly reflects brain venous compartment, and is correlated with jugular venous saturation. As jugular venous saturation, cSO(2) must therefore be interpreted as a measure of balance between transport and consumption of O(2) in the brain. Cerebral oximetry should be used as a trend monitoring, because its accuracy is insufficient to be considered as reliable measure of absolute value of ScO(2). In adult, correction of intraoperative cerebral desaturation reduces hospital stay, heavy morbidity and mortality, and serious postoperative neurocognitive impairment after cardiac and major abdominal surgery. In children, the occurrence of intra- and postoperative cerebral desaturations during congenital heart surgery is associated with increased neurological morbi-mortality. Cerebral oximetry could be a useful monitoring during anaesthesia of (ex) preterm neonates, due to the risk of impaired cerebral blood flow autoregulation in these patients.
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Miller MA, Dukkipati SR, Koruth JS, d'Avila A, Reddy VY. How to perform ventricular tachycardia ablation with a percutaneous left ventricular assist device. Heart Rhythm 2012; 9:1168-76. [PMID: 22322326 DOI: 10.1016/j.hrthm.2012.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Marc A Miller
- Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York, USA
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Danduran MJ, Dixon JE, Rao RP. Near infrared spectroscopy describes physiologic payback associated with excess postexercise oxygen consumption in healthy controls and children with complex congenital heart disease. Pediatr Cardiol 2012; 33:95-102. [PMID: 21892649 DOI: 10.1007/s00246-011-0097-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 08/19/2011] [Indexed: 10/17/2022]
Abstract
Exercise creates a physiologic burden with recovery from such effort crucial to adaptation. Excess postexercise oxygen consumption (EPOC) refers to the body's increased metabolic need after work. This investigation was designed to determine the role of near infrared spectroscopy (NIRS) in the description of exercise recovery in healthy controls (NL) and children with congenital heart disease (CHD). Subjects were recruited with exercise testing performed to exhaustion. Exercise time (EXT), heart rate (HR), and oxygen consumption (VO(2)) were measured. Four-site NIRS (brain, kidney, deltoid, and vastus lateralis) were measured during exercise and into recovery to establish trends. Fifty individuals were recruited for each group (NL = 26 boys and 24 girls; CHD = 33 boys and 17 girls). Significant differences existed between EXT, VO(2), and peak HR (P < 0.01). NIRS values were examined at four distinct intervals: rest, peak work, and 2 and 5 min after exercise. Significant cerebral hyperemia was seen in children with CHD post exercise when compared to normal individuals in whom redistribution patterns were directed to somatic muscles. These identified trends support an immediate compensation of organ systems to re-establish homeostasis in peripheral beds through enhanced perfusion. Noninvasive NIRS monitoring helps delineate patterns of redistribution associated with EPOC in healthy adolescents and children with CHD.
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Affiliation(s)
- Michael J Danduran
- Herma Heart Center, Children's Hospital of Wisconsin, PO Box 1997, Milwaukee, WI 53201-1997, USA.
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Wilson MH, Imray CH, Hargens AR. The Headache of High Altitude and Microgravity—Similarities with Clinical Syndromes of Cerebral Venous Hypertension. High Alt Med Biol 2011; 12:379-86. [DOI: 10.1089/ham.2011.1026] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Mark H. Wilson
- National Hospital for Neurology and Neurosurgery and University College London, London, United Kingdom
| | | | - Alan R. Hargens
- University of California San Diego Medical Center, San Diego, California
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Duration of cerebral desaturation time during single-lung ventilation correlates with mini mental state examination score. J Anesth 2011; 25:345-9. [DOI: 10.1007/s00540-011-1136-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
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Gélinas C, Choinière M, Ranger M, Denault A, Deschamps A, Johnston C. Toward a new approach for the detection of pain in adult patients undergoing cardiac surgery: near-infrared spectroscopy--a pilot study. Heart Lung 2010; 39:485-93. [PMID: 20561850 DOI: 10.1016/j.hrtlng.2009.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 10/26/2009] [Accepted: 10/30/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This pilot study examined the discriminant validity and criterion validity of regional cerebral oxygenation measurement (rSO₂), using the near-infrared spectroscopy (NIRS) technique (INVOS-4100 system, Somanetics, Troy, MI) for measuring pain during nociceptive procedures in adults undergoing cardiac surgery. METHODS A repeated-measures, within-subjects design was used, and 40 adult patients participated. Data collection was completed during 2 test periods: (1) while patients were awake, before the induction of anesthesia (first test period); and (2) after the induction of anesthesia, while patients remained under the effects of anesthesia (second test period). Each test period included a baseline, a tactile stimulus (skin disinfection), nociceptive stimuli (e.g., intravenous and arterial line insertions, sternal bone incision and thorax opening), and a postprocedure evaluation. RESULTS Increased rSO₂ values (P < .001) were acquired during nociceptive procedures in both test periods. No significant associations were evident between rSO₂, pain behaviors, and the patient's self-report of pain intensity, but this may be attributable to a low range of variability. CONCLUSIONS Although further research is needed in critically ill adult patients undergoing more painful procedures, the NIRS may become a promising technique for assessing pain.
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Affiliation(s)
- Céline Gélinas
- School of Nursing, McGill University, Montreal, Quebec, Canada.
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