Decrease In Cerebral Saturation Research Articles

Intraoperative cerebral oxygen saturation and neurological outcomes following surgical management of necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis.

The goal of the present study was to investigate intraoperative factors associated with major neurological complications at 1year following surgery for necrotizing enterocolitis. The study consisted of a retrospective review of medical charts of patients operated for over one calendar year in one institution. Data collected included demographic data, cardiac resuscitation at birth, Bell classification, antibiotics usage, time of day of surgery, surgical technique, surgical duration, type of ventilation, intraoperative vasoactive agents, and albumin use, nadir cerebral saturation, the decrease in cerebral saturation from baseline, the time period when cerebral saturation was at least 20% below baseline, and the mean arterial pressure at nadir cerebral saturation. Reported follow-up complications were assessed during formal neonatologist consultation and additional imaging exploration as needed. Analyses included descriptive statistics, and univariable and multivariable statistics. The study included 32 patients with no prior clinical neurological complications, of which 25had normal cerebral imaging. Severe neurological complications occurred in nine patients at 1year: Intraventricular hemorrhage (N=2) and Periventricular leukomalacia (N=7). However, preoperative cerebral imaging was lacking in seven patients. Consequently, the observed neurological complications at 1year might be present before the surgery. Multivariable analysis found the decrease in cerebral saturation ≥36% from baseline as the only factor associated with the occurrence of those complications. Intraoperative decrease of cerebral oxygen saturation below ≥36% from baseline is associated with severe neurological complications in neonates undergoing surgery for necrotizing enterocolitis.

Konjenital Kalp Cerrahisi Geçiren Pediatrik Hastalarda Serebral Desatürasyon İle Komplikasyonlar Arasındaki İlişki: Prospektif Kohort Çalışması

Objective: In this study, we aimed to investigate the incidence of cerebral desaturation and the possible relationship between intraoperative cerebral desaturation and postoperative complications. Methods: A prospective, observational study was performed 115 patients under 18 years of age who required open heart surgery in a university hospital. Cerebral desaturation was defined as a 25% decrease in cerebral saturation (low alarm limit) when compared with the basal value. Duration (second) was referred to the amount of time the patient stays below low alarm limit. Depth (%) was referred to gap between the patient’s cerebral regional oxygen saturation (rSO2) level and the rSO2 low alarm limit. The cerebral desaturation score was calculated using the %*seconds. The patients were divided into two groups: group 1 (desaturation score >3000 %sec) and group 2 (desaturation score ≤ 3000 %sec). The groups were compared in terms of demographic data, intraoperative and postoperative variables, postoperative complications, and duration of intensive care and hospital stays. Results: In the study, 59 patients (51.3%) were male and 28 patients (24.3%) had cyanotic heart disease. A total of 55 patients (47.8%) experienced over 3000 %sec desaturation. Postoperative complications were found to be increased in group 1 (71% vs 3.3%; χ²=57.119, p<0.001). In the multiple logistic regression analysis, desaturation score>3000 %sec (p<0.001), low body surface area (p=0.001) and prolonged cardiopulmonary bypass (p=0.006) were found to be associated with postoperative complications. Conclusion: In patients undergoing congenital heart surgery, cerebral desaturation score >3000 %sec is associated with a negative effect on patient prognosis.

Feasibility of studying the association between intraoperative regional cerebral oxygen saturation and postoperative functional decline (ReFUNCTION): a pilot sub-study of NeuroVISION-Cardiac Surgery

Function describes an individual's ability to perform everyday activities. In the context of cardiac surgery, functional changes quantify the effect of surgery on one's day-to-day life. Decreases in regional cerebral oxygen saturation (rScO2) measured using near-infrared spectroscopy (NIRS) has been associated with postoperative cognitive decline but its relationship with function has not been studied. We sought to determine the feasibility of conducting a large observational study examining the relationship between decreases in rScO2 during cardiac surgery and postoperative functional decline. We undertook a single-centre, pilot sub-study of the NeuroVISION-Cardiac Surgery pilot study, which included adults undergoing isolated coronary artery bypass grafting on cardiopulmonary bypass; all patients enrolled in NeuroVISION-Cardiac Surgery were included. Function was evaluated at baseline, 30 days, and three months using the Standardized Assessment of Global activities in the Elderly (SAGE) scale. Blinded NIRS monitors were affixed for the duration of surgery. Our feasibility outcomes were to recruit one patient per week, obtain complete NIRS data in ≥ 90%, obtain SAGE at all time-points in ≥ 90%, and determine the time required for NIRS data to be transcribed into case report forms. 49/50 patients enrolled in NeuroVISION-Cardiac Surgery were recruited over 48 weeks (1.02 patients/week). Of the 49 included patients, 49 (100%) had complete NIRS data and 44 (90%) had complete SAGE data. The time required for NIRS data collection was a mean (standard deviation) of 5.5 (1.8) min per patient. This pilot study shows the feasibility of conducting a large observational study examining the relationship between decreases in cerebral saturation during cardiac surgery and postoperative functional decline. www.clinicaltrials.gov (NCT04241289); registered 27 January 2020.

Monitoring of cerebral oximetry in patients with postural orthostatic tachycardia syndrome

Aims Postural orthostatic tachycardia syndrome (POTS) is a disorder of unknown aetiology characterized by orthostatic intolerance and tachycardia with diverse other symptoms, including neurocognitive deficits. Cerebral oximetry non-invasively measures cerebral tissue saturation (SctO2) and has been shown to be informative in syncope evaluation. We aimed to assess SctO2 in POTS patients and those with normal response to orthostatic provocation, relative to haemodynamic parameters and symptoms.Methods and results Thirty-four patients with POTS (29.1 ± 9.5 years; 26 females) and 34 age-/sex-matched controls with normal head-up tilt tests (HUTs) were included. SctO2 at rest and during HUT were compared between POTS and controls. The relation between SctO2, systolic blood pressure (SBP), and heart rate (HR) during HUT was linearly assessed. SctO2 values were related to dizziness or syncope during HUT. The minimum SctO2-value during HUT was lower (65.4 ± 5.6 vs. 68.2 ± 4.2%, P = 0.023) and changes in SctO2 from supine to minimum HUT value were more pronounced in POTS patients (−5.7 ± 2.9% vs. −4.3 ± 2.1%, P = 0.028). Decrease in SBP from supine to minimum HUT value (P = 0.004) and increase in HR from supine to HUT value at 3 min (P = 0.022) correlated with more pronounced SctO2 decrease in POTS but not controls. SctO2 did not predict syncope or dizziness during HUT.Conclusion Postural orthostatic tachycardia syndrome patients have lower cerebral tissue saturation during orthostatic provocation compared with those subjects having normal haemodynamic response to tilt. Orthostatic decrease in cerebral saturation only weakly correlates with HR increase and does not predict vasovagal reflex in POTS. Other hitherto unknown factors may affect cerebral tissue saturation in POTS.

CAR 4. Transcranial Cerebral Oximetry as Neuromonitoring During Carotid Endarterectomy

Cross-clamp ischemia during carotid endarterectomy can be prevented with carotid shunts in vulnerable patients identified by cerebral monitoring. We evaluated transcranial cerebral oximetry for selective shunt use in 654 patients. We retrospectively collected data on 654 consecutive patients operated on under general anesthesia between 2011 and 2017. Shunts were inserted for a drop of 20% or more in cerebral saturation. Seventy-five patients, 11.4% of our patients, were shunted. The indication for shunt insertion was a decrease in cerebral saturation of >20% after carotid clamping. A total of 11 patients suffered stroke and 3 patients died in the postoperative period; 30-day death/stroke ratio for the whole group was 2.1%. One patient died and one patient suffered stroke in the shunted group in the postoperative period (2.6% 30-day death/stroke ratio). There were 2 deaths and 10 strokes in the group of nonshunted patients (2.1% 30-day death/stroke ratio). There was no significant difference in 30-day death/stroke ratio between the shunted and nonshunted patients. These results suggest that transcranial cerebral oximetry can be used as reliable, noninvasive, and continuous real-time monitoring during carotid endarterectomy.

Decreases in cerebral saturation in patients with septic shock are associated with increased risk of death: a prospective observational single center study

BackgroundThe mortality rate from septic shock has been declining. Cerebral hypoxia, measured non-invasively with cerebral oximetry, has been correlated with neurologic and non-neurologic sequelae. Whether cerebral desaturations occur in septic shock patients and what consequences these may have is untested.MethodsAdult patients with septic shock had cerebral saturation monitoring initiated. The primary objective was to determine if the incidence and magnitude of cerebral desaturations in septic shock patients correlated with delirium. We also compared the incidence and magnitude of cerebral desaturations in patients with septic shock with patients undergoing high-risk non-cardiac surgical procedures, a group known to be at high risk for cerebral desaturations.ResultsFifteen patients were enrolled. Twelve (80 %) patients had a decrease in SctO2 below 65 %. Delirium was not associated with the area under the curve of an SctO2 of 65 % (p = 0.84).Patients who died of septic shock had more significant decreases in SctO2 than those who survived (p = 0.04).Decreased SctO2 was more common in patients with septic shock and was of greater magnitude than those undergoing high-risk non-cardiac surgery.ConclusionsCerebral desaturations occur more commonly and are of a greater magnitude in septic shock patients compared with those undergoing high-risk non-cardiac surgery. There did not appear to be a relationship between the incidence or magnitude of decreases in SctO2 and ICU delirium. Patients who died of septic shock had more significant decreases in SctO2 than patients who survived.

Reversal of Decreases in Cerebral Saturation in High-Risk Cardiac Surgery

To measure the incidence of cerebral desaturation during high-risk cardiac surgery and to evaluate strategies to reverse cerebral desaturation. Prospective observational study followed by a randomized controlled study with 1 intervention group and 1 control group. Tertiary care center specialized in cardiac surgery. All patients were scheduled for high-risk cardiac surgery, 279 consecutive patients in the prospective study and 48 patients in the randomized study. An algorithmic approach of strategies to reverse cerebral desaturation. In the control group, no attempts were made to reverse cerebral desaturation. 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. 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.

Evaluation of Autonomic Reserves in Cardiac Surgery Patients

Autonomic nervous system dysfunction is a well-recognized but rarely evaluated risk factor for patients undergoing cardiac surgery. By measuring autonomic reserves in patients scheduled for cardiac surgery, the authors aimed to identify those with autonomic dysfunction and to evaluate their risk of perioperative complications. This was a prospective, observational study. The study was conducted in a single academic center. Sixty-seven patients completed the study. Autonomic reserves were evaluated using analysis of heart rate variability (HRV) and blood pressure variability (BPV) after a Valsalva maneuver. The patients were divided into 2 groups depending on their response to the autonomic challenge, a group with autonomic reserves (AR, n = 38) and a group with negligible autonomic reserves (NAR, n = 29). The groups were compared for baseline psychologic distress, demographic and medical profiles, autonomic response to morphine premedication and the induction of anesthesia, hemodynamic instability, the occurrence of decreases in cerebral oxygen saturation, and postoperative complications. Patients in the NAR group had significantly higher psychologic distress scores (p < 0.001), a higher baseline parasympathetic tone (p = 0.003), were unable to increase parasympathetic tone with morphine premedication, had more severe hypotension at the induction of anesthesia (p < 0.001), more episodes of decreases in cerebral saturation (p = 0.0485), and a higher overall complication rate (p = 0.0388) independent of other variables studied. Patients with diminished autonomic reserves can be identified before cardiac surgery using analysis of HRV and BPV of the response to the Valsalva maneuver, and some evidence suggests that they may be at increased risk of perioperative complications.