Near-Infrared Spectroscopy in Adult Cardiac Surgery Patients: A Systematic Review and Meta-Analysis.

OBJECTIVES To identify the normal baseline preoperative range of cerebral tissue oxygen saturation (SctO2) derived using near-infrared spectroscopy (NIRS) and the efficacy of perioperative interventions designed to modulate SctO2 in cardiac surgical patients. DESIGN Systematic review and meta-analysis of relevant randomized controlled trials (RCTs) extracted from the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. SETTING Hospitals performing cardiac surgery. PARTICIPANTS The study comprised 953 participants from 11 RCTs. INTERVENTIONS Interventions included the following: (1) SctO2 monitoring protocol compared with no monitoring; (2) use of cardiopulmonary bypass (CPB) compared with no CPB; (3) normothermic CPB compared with hypothermic CPB; (4) glyceryl trinitrate during surgery compared with placebo; (5) midazolam during induction of anesthesia compared with propofol; (6) sevoflurane anesthesia compared with total intravenous anesthesia; (7) sevoflurane anesthesia compared with propofol-based anesthesia; and (8) norepinephrine during CPB compared with phenylephrine. MEASUREMENTS AND MAIN RESULTS Eleven RCTs with 953 participants measured baseline preoperative SctO2 using NIRS. The pooled mean baseline SctO2 was 66.4% (95% CI 65.0-67.7), generating a reference range of 51.0% to 81.8%. Four interventions (1, 3, 4, and 6 described in the Interventions section above) increased intraoperative SctO2 across the majority of reported time points. Postoperative follow-up of SctO2 occurred in only 1 study, and postoperative cognitive assessment correlating SctO2 with cognitive function was applied in only 4 studies using variable methodology. CONCLUSIONS The authors have established that reference values for baseline NIRS-derived SctO2 in cardiac surgery patients are varied and have identified interventions that modulate SctO2. This information opens the door to standardized research and interventional studies in this field.

[1]  S. D. De Hert,et al.  Evaluation of different near-infrared spectroscopy technologies for assessment of tissue oxygen saturation during a vascular occlusion test , 2017, Journal of Clinical Monitoring and Computing.

[2]  C. Hogue,et al.  Cerebral and tissue oximetry. , 2014, Best practice & research. Clinical anaesthesiology.

[3]  D. Kazancı,et al.  The effect of sevoflurane vs. TIVA on cerebral oxygen saturation during cardiopulmonary bypass--randomized trial. , 2014, Advances in clinical and experimental medicine : official organ Wroclaw Medical University.

[4]  E. J. Straub,et al.  A systematic review of cerebral oxygenation-monitoring devices in cardiac surgery , 2014, Perfusion.

[5]  P. Ainslie,et al.  Influence of norepinephrine and phenylephrine on frontal lobe oxygenation during cardiopulmonary bypass in patients with diabetes. , 2014, Journal of cardiothoracic and vascular anesthesia.

[6]  O. Tucha,et al.  A pilot study of cerebral tissue oxygenation and postoperative cognitive dysfunction among patients undergoing coronary artery bypass grafting randomised to surgery with or without cardiopulmonary bypass * , 2014, Anaesthesia.

[7]  M. Rollins,et al.  Factors Affecting the Performance of 5 Cerebral Oximeters During Hypoxia in Healthy Volunteers , 2013, Anesthesia and analgesia.

[8]  Menelaos Karanikolas,et al.  Monitoring of brain oxygen saturation (INVOS) in a protocol to direct blood transfusions during cardiac surgery: a prospective randomized clinical trial , 2013, Journal of Cardiothoracic Surgery.

[9]  M. Kirov,et al.  Normothermic cardiopulmonary bypass increases cerebral tissue oxygenation during combined valve surgery: a single-centre, randomized trial. , 2013, Interactive cardiovascular and thoracic surgery.

[10]  A. M. Jagadeesh,et al.  Impact of monitoring cerebral oxygen saturation on the outcome of patients undergoing open heart surgery. , 2013, Annals of cardiac anaesthesia.

[11]  Charles W. Hogue,et al.  Cerebral Near-Infrared Spectroscopy Monitoring and Neurologic Outcomes in Adult Cardiac Surgery Patients: A Systematic Review , 2013, Anesthesia and analgesia.

[12]  Michelle Fiander,et al.  THE EFFECT OF ENGLISH-LANGUAGE RESTRICTION ON SYSTEMATIC REVIEW-BASED META-ANALYSES: A SYSTEMATIC REVIEW OF EMPIRICAL STUDIES , 2012, International Journal of Technology Assessment in Health Care.

[13]  M Heringlake,et al.  Cognitive function after sevoflurane- vs propofol-based anaesthesia for on-pump cardiac surgery: a randomized controlled trial. , 2011, British journal of anaesthesia.

[14]  L. Dibbelt,et al.  Preoperative Cerebral Oxygen Saturation and Clinical Outcomes in Cardiac Surgery , 2011, Anesthesiology.

[15]  Eun Mi Kim,et al.  Assessment of cerebral oxygen supply-demand balance by near-infrared spectroscopy during induction of anesthesia in patients undergoing coronary artery bypass graft surgery: comparison of midazolam with propofol. , 2009, Korean journal of anesthesiology.

[16]  A. Denault,et al.  Effect of intravenous nitroglycerin on cerebral saturation in high-risk cardiac surgery , 2007, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[17]  E. Schmid,et al.  Cerebral near-infrared spectroscopy in adult patients after cardiac surgery is not useful for monitoring absolute values but may reflect trends in venous oxygenation under clinical conditions. , 2007, Journal of cardiothoracic and vascular anesthesia.

[18]  D. Bainbridge,et al.  Monitoring Brain Oxygen Saturation During Coronary Bypass Surgery: A Randomized, Prospective Study , 2007, Anesthesia and analgesia.

[19]  H. Kiene,et al.  Bias in meta-analysis , 2006, Homeopathy.

[20]  F. Yao,et al.  Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. , 2004, Journal of cardiothoracic and vascular anesthesia.

[21]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[22]  D. Prough,et al.  Cerebral near-infrared spectroscopy: ready for prime time? , 1995, Critical care medicine.

[23]  G. Albert,et al.  An Update on Cerebral Oxygenation Monitoring, an Innovative Application in Cardiac Arrest and Neurological Emergencies , 2015 .

[24]  S. Sanaie,et al.  THE RELATIONSHIP BETWEEN CEREBRAL OXYGEN SATURATION CHANGES AND POST OPERATIVE NEUROLOGIC COMPLICATIONS IN PATIENTS UNDERGOING CARDIAC SURGERY , 2007 .

[25]  A. Denault,et al.  Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy , 2005, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[26]  G. Nollert.  Cerebral oxygenation measured by near-infrared spectroscopy. , 1997, The Annals of thoracic surgery.

[27]  L. Eckel,et al.  Cerebral oxygenation measured by near-infrared spectroscopy. , 1997, The Annals of thoracic surgery.

[28]  W. Erdmann,et al.  Assessment of cerebral oxygenation via the conjunctiva. , 1985, Advances in experimental medicine and biology.

[29]  M. Blue,et al.  Influence of norepinephrine on cortical development , 1981 .