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

  • Matthew J. Chan
    Affiliations
    Department of Intensive Care, Austin Hospital, Heidelberg, Australia

    The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University Alfred Hospital, Melbourne, Australia
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  • Tricia Chung
    Affiliations
    Department of Intensive Care, Austin Hospital, Heidelberg, Australia
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  • Neil J. Glassford
    Affiliations
    Department of Intensive Care, Austin Hospital, Heidelberg, Australia

    The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University Alfred Hospital, Melbourne, Australia
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  • Rinaldo Bellomo
    Correspondence
    Address reprint requests to Rinaldo Bellomo, MBBS, MD, FRACP, FCICM, PGDipEcho, FAHMS, Department of Intensive Care Medicine, Austin Hospital, 145 Studley Rd, Heidelberg, Vic 3084, Australia.
    Affiliations
    Department of Intensive Care, Austin Hospital, Heidelberg, Australia

    The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University Alfred Hospital, Melbourne, Australia

    School of Medicine, University of Melbourne, Melbourne, Australia
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      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.

      Key Words

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