The Effect of Intraoperative Cerebral Oximetry Monitoring on Postoperative Cognitive Dysfunction and ICU Stay in Adult Patients Undergoing Cardiac Surgery: An Updated Systematic Review and Meta-Analysis.

Li-Juan Tian,Su Yuan,Fu-Xia Yan,Cheng-Hui Zhou

doi:10.3389/fcvm.2021.814313

Abstract

AimDetermining whether intraoperative cerebral oximetry monitoring-guided intervention reduces the risk of postoperative cognitive dysfunction remains controversial. The objective of this study was to conduct an up-to-date meta-analysis to comprehensively assess the effects of regional cerebral oxygen saturation (rSO2) monitoring-guided intervention on cognitive outcomes after cardiac surgery.MethodsPubMed, EMBASE, Ovid, and Cochrane Library databases were systematically searched using the related keywords for cardiac surgical randomized-controlled trials (RCTs) published from their inception to July 31, 2021. The primary outcome was postoperative delirium (POD). The secondary outcomes were postoperative cognitive decline (POCD) and other major postoperative outcomes. The odds ratio (OR) or weighted mean differences (WMDs) with 95% confidence interval (CI) were used to pool the data. The random-effect model was used for the potential clinical inconsistency. We performed meta-regression and subgroup analyses to assess the possible influence of rSO2 monitoring-guided intervention on clinical outcomes.ResultsIn total, 12 RCTs with 1,868 cardiac surgical patients were included. Compared with controls, the incidences of POD (n = 6 trials; OR, 0.28; 95% CI, 0.09–0.84; p = 0.02; I2 = 81%) and POCD (n = 5 trials; OR, 0.38; 95% CI, 0.16–0.93; p = 0.03; I2 = 78%) were significantly lower in the intervention group. Cerebral oximetry desaturation also showed a positive association with the incidence of POD (n = 5 trials; OR, 2.02; 95% CI, 1.25–3.24; p = 0.004; I2 = 81%). The duration of intensive care unit (ICU) stay was markedly shorter in the intervention group than in the control group (n = 10 trials; WMD, −0.22 days; 95% CI, −0.44 to −0.00; p = 0.05; I2 = 74%). Univariate meta-regression analyses showed that the major sources of heterogeneity were age (p = 0.03), body mass index (BMI, p = 0.05), and the proportion of congenital heart disease (CHD, p = 0.02) for POD, age (p = 0.04) for POCD, diabetes mellitus (DM, p = 0.07), cerebrovascular accident (CVA, p = 0.02), and chronic obstructive pulmonary disease (COPD, p = 0.09) for ICU stay. Subsequent subgroup analyses also confirmed these results.ConclusionAvailable evidence from the present study suggests that an intraoperative cerebral oximetry desaturation is associated with an increased POD risk, and the rSO2 monitoring-guided intervention is correlated with a lower risk of POD and POCD, and a shorter ICU stay in adults undergoing cardiac surgery. These clinical benefits may be limited in patients with older age, diabetes status, high BMI, non-CHD, non-COPD, or a previous cardiovascular accident.Systematic Review Registration: [PROSPREO], identifier: [CRD42021252654].

Highlights

Transient cognitive dysfunction following cardiac surgery with cardiopulmonary bypass (CPB) is a common and clinically important complication [1]
Some previous studies showed that patients were susceptible to neurocognitive disorders from hypoperfusion and microemboli resulting in impaired cerebrovascular autoregulation during cardiac surgery undergoing CPB [8]
PubMed, EMBASE, Ovid, and Cochrane Library databases were searched for English articles published from their inception to July 31, 2021, for randomized-controlled trials (RCTs) evaluating the effects of intraoperative anesthetic practice followed cerebral oximetry monitoring on post-cardiac surgery cognitive outcomes

Summary

Introduction

Transient cognitive dysfunction following cardiac surgery with cardiopulmonary bypass (CPB) is a common and clinically important complication [1]. There are very few literature studies supporting that anesthetic practice based on optimizing cerebral oxygenation during cardiac surgery leads to improved postoperative outcomes [13, 14]. This conclusion was still controversial as some recently randomized-controlled trials (RCTs) have demonstrated that NIRS-guided intervention has no effect on the reduction of neurocognitive disorders after cardiac and non-cardiac surgeries [15, 16]. Two prospective randomized studies, including highrisk patients conducted by Lei et al and Deschamps et al, found that NIRS-guided intervention could attenuate the decreases of rSO2 in cardiac surgery but did not affect the incidence of POD [17, 18]

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