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.
Key Words
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Article info
Publication history
Published online: October 18, 2013
Identification
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
