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.
A prospectively collected survey.
A hospital-based, multi-institutional, multinational study.
By e-mail, the authors surveyed the membership of the Society of Cardiovascular Anesthesiologists and the online Cardiovascular Perfusion Forum.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters.Science. 1977; 198: 1264-1267
- Somanetics INVOS 3100A 510(K) Premarket Notification.Food and Drug Administration, Department of Health and Human Services, Rockville, MD1997
- Near-infrared spectroscopy as an index of brain and tissue oxygenation.Br J Anaesth. 2009; 103i3-i13. 2009;
- Baseline cerebral oximetry values in cardiac and vascular surgery patients: A prospective observational study.J Cardiothorac Surg. 2010; 5: 41
- The influence of positioning on spectroscopic measurements of brain oxygenation.J Neurosurg Anesthesiol. 2000; 12: 75-80
- Influence of patient variables and sensor location on regional cerebral oxygen saturation measured by INVOS 4100 near-infrared spectrophotometers.J Neurosurg Anesthesiol. 2003; 15: 302-306
- Effects of hemoglobin concentration, skull thickness, and the area of the cerebrospinal fluid layer on near-infrared spectroscopy measurements.Anesthesiology. 2007; 106: 458-462
- Does near-infrared spectroscopy provide an early warning of low haematocrit following the initiation of hypothermic cardiopulmonary bypass in cardiac surgery?.J Int Med Res. 2011; 39: 1497-1503
- Impact of extracranial contamination on regional cerebral oxygen saturation: A comparison of three cerebral oximetry technologies.Anesthesiology. 2012; 116: 834-840
- Cerebral monitoring to optimize outcomes after cardiac surgery.Curr Opin Anaesthesiol. 2010; 23: 89-94
- A novel application of cerebral oximetry in cardiac surgery.Ann Thorac Surg. 2010; 90: 1700-1701
Kane JM, Steinhorn DM: Lack of irrefutable validation does not negate clinical utility of near-infrared spectroscopy monitoring: Learning to trust new technology. J Crit Care 24:472.e1-7, 2009
- Cerebral oximetry: Monitoring the brain as the index organ.Anesthesiology. 2011; 114: 12-13
- A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy.Semin Cardiothorac Vasc Anesth. 2007; 11: 274-281
- Evaluation of an intraoperative algorithm based on near-infrared refracted spectroscopy monitoring, in the intraoperative decision for shunt placement, in patients undergoing carotid endarterectomy.Middle East J Anesthesiol. 2011; 21: 367-373
- Perioperative blood transfusion and blood conservation in cardiac surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline.Ann Thorac Surg. 2007; 83: S27-S86
- Monitoring of selective antegrade cerebral perfusion using near infrared spectroscopy in neonatal aortic arch surgery.Eur J Anaesthesiol. 2005; 22: 293-298
- A retrospective study of changes in cerebral oxygenation using a cerebral oximeter in older patients undergoing prolonged major abdominal surgery.Eur J Anaesthesiol. 2007; 24: 230-234
- Diagnosis of inadvertent cannulation of the azygos vein during cardiopulmonary bypass.J Extra Corpor Technol. 2010; 42: 235-237
- Using cerebral oximetry to prevent adverse outcomes during cardiac surgery.Perfusion. 2011; 26: 79-81
- Cerebral air embolism recognized by cerebral oximetry.Semin Cardiothorac Vasc Anesth. 2009; 13: 56-59
- Innominate artery dissection with presentation of sudden right frontal desaturation detected by cerebral oximetry in complicated thoracic aortic aneurysm repair surgery: A case report.J Clin Anesth. 2011; 23: 137-141
- Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants.Pediatrics. 2000; 106: 625-632
- Risks for impaired cerebral autoregulation during cardiopulmonary bypass and postoperative stroke.Br J Anaesth. 2012; 109: 391-398
- Baseline regional cerebral oxygen saturation correlates with left ventricular systolic and diastolic function.J Cardiothorac Vasc Anesth. 2008; 22: 840-846
- Preoperative cerebral oxygen saturation and clinical outcomes in cardiac surgery.Anesthesiology. 2011; 114: 58-69
- Cerebral near-infrared spectroscopy during cardiopulmonary bypass predicts superior vena cava oxygen saturation.J Thorac Cardiovasc Surg. 2011; 142: 359-365
- Correlation between cerebral tissue and central venous oxygen saturation during off-pump coronary bypass graft surgery.Perfusion. 2011; 26: 83-90
- Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia.J Clin Monit Comput. 2000; 16: 191-199
- Predicting the limits of cerebral autoregulation during cardiopulmonary bypass.Anesth Analg. 2011;
- Does use of intra-operative cerebral regional oxygen saturation monitoring during cardiac surgery lead to improved clinical outcomes?.Interact Cardiovasc Thorac Surg. 2009; 9: 318-322
- Benefit of neurophysiologic monitoring for pediatric cardiac surgery.J Thorac Cardiovasc Surg. 1997; 114: 707-715
- Jr: Protective effect of neuromonitoring during cardiac surgery.Ann N Y Acad Sci. 2005; 1053: 12-19
- Noninvasive cerebral oxygenation may predict outcome in patients undergoing aortic arch surgery.J Thorac Cardiovasc Surg. 2011; 141: 815-821
- Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients.Heart Surg Forum. 2004; 7: E376-E381
- Prediction of cognitive dysfunction and patients' outcome following valvular heart surgery and the role of cerebral oximetry.Eur J Cardiothorac Surg. 2008; 33: 560-565
- Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery.J Cardiothorac Vasc Anesth. 2004; 18: 552-558
- Antegrade versus retrograde cerebral protection in repair of acute ascending aortic dissection.Am Surg. 2012; 78: 349-351
- Cerebral near-infrared spectroscopy in adult heart surgery: Systematic review of its clinical efficacy.Can J Anaesth. 2005; 52: 79-87
- Cerebral near-infrared spectroscopy monitoring and neurologic outcomes in adult cardiac surgery patients: A systematic review.Anesth Analg. 2013;
- Monitoring brain oxygen saturation during coronary bypass surgery: A randomized, prospective study.Anesth Analg. 2007; 104: 51-58
- Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery.Ann Thorac Surg. 2009; 87: 36-44
- Effect of the perioperative blood transfusion and blood conservation in cardiac surgery clinical practice guidelines of the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists upon clinical practices.Anesth Analg. 2010; 111: 316-323
- Perioperative cardiac evaluation of simulated patients by practicing anesthesiologists is not consistent with 2007 ACC/AHA guidelines.J Clin Anesth. 2012; 24: 446-455
Published online: October 18, 2013
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.