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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Article info
Footnotes
N.J. Glassford is supported by the Avant Doctors-in-Training Research Scholarship.
Identification
Copyright
© 2017 Published by Elsevier Inc.