Abstract
BackgroundCardiac surgery with extracorporeal circulation (ECC) can induce microvascular dysfunction and tissue hypoperfusion. We hypothesized that the alterations in near-infrared spectroscopy (NIRS)-derived parameters would be associated with post-operative complications in cardiac surgery patients.MethodsProspective observational study performed at two University Hospitals. Ninety patients undergoing cardiac surgery with ECC were enrolled. The NIRS sensor was applied on the thenar eminence. A vascular occlusion test (VOT, 3-min ischemia) was performed at baseline (t0), at Intensive Care Unit (ICU) admission (t1), 3 (t2) and 6 (t3) hours later. Baseline tissue oxygen saturation (StO2), oxygen extraction rate and microvascular reactivity indices were calculated.ResultsIn the first hours after cardiac surgery, StO2 tended to increase (86% [80–89] at T3 versus 82% [79–86] at T0, p = ns), while both tissue oxygen extraction and microvascular reactivity tended to decrease, as indicated by increasing occlusion slope (− 8.1%/min [− 11.2 to − 7] at T3 versus − 11.2%/min [− 13.9 to − 7.9] at T0, p = ns) and decreasing recovery slope (1.9%/sec [1.1–2.9] at T3 versus 3.1%/sec [2.3–3.9] at T0, p = ns). No substantial differences were found in NIRS-derived variables and their changes over time between patients with complications and those without complications.ConclusionsPeripheral tissue oxygen extraction and microvascular reactivity were reduced during the first hours after cardiac surgery. NIRS-derived parameters were not able to predict complications in this population of cardiac surgery patients.
Highlights
Cardiac surgery with extracorporeal circulation (ECC) can induce microvascular dysfunction and tissue hypoperfusion
Postoperative complications and persistent elevated arterial lactate concentrations were associated with low Tissue oxygen saturation (StO2) after Intensive Care Unit (ICU) admission [9, 12]
By using a vascular occlusion test (VOT), some studies showed that alterations in the desaturation and reperfusion slopes in the early post-operative phase following cardiac surgery were associated with poor outcome, duration of mechanical ventilation, length of ICU stay, and mortality [11, 13, 15]
Summary
Cardiac surgery with extracorporeal circulation (ECC) can induce microvascular dysfunction and tissue hypoperfusion. We hypothesized that the alterations in near-infrared spectroscopy (NIRS)-derived parameters would be associated with post-operative complications in cardiac surgery patients. A few single-centre studies investigated the relationship between peripheral NIRS-derived parameters and patients’ outcome in cardiac surgery, showing conflicting results and using different devices to assess tissue oxygen saturation [9,10,11,12,13,14,15]. By using a vascular occlusion test (VOT), some studies showed that alterations in the desaturation and reperfusion slopes in the early post-operative phase following cardiac surgery were associated with poor outcome, duration of mechanical ventilation, length of ICU stay, and mortality [11, 13, 15]. Other studies failed to demonstrate the association between NIRS-derived parameters and outcome [10, 14]
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