Limitations of Current Near-Infrared Spectroscopy Configuration in Detecting Focal Cerebral Ischemia During Cardiac Surgery: An Observational Case-Series Study.

Erdös, Gabor; Rummel, Christian; Basciani, Reto Marco; Verma, Rajeev Kumar; Carrel, Thierry; Banz Wälti, Yara; Eberle, Balthasar; Schroth, Gerhard (2018). Limitations of Current Near-Infrared Spectroscopy Configuration in Detecting Focal Cerebral Ischemia During Cardiac Surgery: An Observational Case-Series Study. Artificial organs, 42(10), pp. 1001-1009. Wiley-Blackwell 10.1111/aor.13150

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Cerebral oximetry using near-infrared spectroscopy (NIRS) allows for continuous monitoring of cerebral perfusion and immediate treatment of hemodynamic perturbations. In configurations used in current clinical practice, NIRS optodes are placed on the patient`s forehead and cerebral oxygen saturation (ScO ) is determined in bilateral frontal cortical samples. However, focal cerebral ischemic lesions outside of the NIRS field of view may remain undetected. The objective of this observational case-series study was to investigate ScO measurements in patients with acute iatrogenic stroke not located in the frontal cortical region. Adult patients undergoing cardiac surgery with cardiopulmonary bypass or interventional cardiology procedures and suffering stroke in the early postoperative period were identified from the Bernese Stroke Registry and analyzed for their intraoperative ScO values and brain imaging data. Main outcome measures were the ScO values, computed tomography and magnetic resonance imaging findings. In six patients, the infarct areas were localized in the vascular territories of the posterior and/or dorsal middle cerebral arteries. One patient had watershed stroke and another one excellent collaterals resulting in normal cerebral blood volume and only subtle decrease of cerebral blood flow in initially critically perfused watershed brain areas. Intraoperative ScO values were entirely unremarkable or nonindicative for brain damage. Our results indicate that uneventful intraoperative NIRS monitoring does not exclude severe cerebral ischemia due to the limited field of view of commercially available NIRS devices. False negative NIRS may occur as a consequence of stroke localized outside the frontal cortex.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute of Pathology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Erdös, Gabor; Rummel, Christian; Basciani, Reto Marco; Verma, Rajeev Kumar; Carrel, Thierry; Banz Wälti, Yara; Eberle, Balthasar and Schroth, Gerhard

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

0160-564X

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

09 May 2018 15:10

Last Modified:

31 Oct 2018 01:31

Publisher DOI:

10.1111/aor.13150

PubMed ID:

29726003

Uncontrolled Keywords:

-Cardiac surgery -Cardiopulmonary bypass -Cerebral oxygen saturation -Stroke Near-infrared spectroscopy

BORIS DOI:

10.7892/boris.116413

URI:

https://boris.unibe.ch/id/eprint/116413

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