Prolonged postoperative cerebral oxygen desaturation after cardiac surgery: A prospective observational study.

Cioccari, Luca; Bitker, Laurent; Toh, Lisa; Hacking, Douglas; Cutuli, Salvatore L; Osawa, Eduardo A; Yanase, Fumitaka; Naorungroj, Thummaporn; Luethi, Nora; Michalopoulos, Adrian; Woo, Shanan; Wang, Judy; Eastwood, Glenn M; Weinberg, Laurence; Bellomo, Rinaldo (2021). Prolonged postoperative cerebral oxygen desaturation after cardiac surgery: A prospective observational study. European journal of anaesthesiology, 38(9), pp. 966-974. European Society of Anaesthesiology 10.1097/EJA.0000000000001391

Text 2020 - Cioccari - Eur J Anaesthesiol - PMID 33186311.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (1MB) | Request a copy

BACKGROUND

Near-infrared spectroscopy (NIRS) is used routinely to monitor cerebral tissue oxygen saturation (SctO2) during cardiopulmonary bypass (CPB) but is rarely employed outside the operating room. Previous studies indicate that patients are at risk of postoperative cerebral oxygen desaturation after cardiac surgery.

OBJECTIVES

We aimed to assess perioperative and postoperative changes in NIRS-derived SctO2 in cardiac surgery patients.

DESIGN

Prospective observational study.

SETTING

The study was conducted in a tertiary referral university hospital in Australia from December 2017 to December 2018.

PATIENTS

We studied 34 adult patients (70.6% men) undergoing cardiac surgery requiring CPB and a reference group of 36 patients undergoing noncardiac surgical procedures under general anaesthesia.

MAIN OUTCOME MEASURES

We measured SctO2 at baseline, during and after surgery, and then once daily until hospital discharge, for a maximum of 7 days. We used multivariate linear mixed-effects modelling to adjust for all relevant imbalances between the two groups.

RESULTS

In the cardiac surgery group, SctO2 was 63.7% [95% confidence interval (CI), 62.0 to 65.5] at baseline and 61.0% (95% CI, 59.1 to 62.9, P = 0.01) on arrival in the ICU. From day 2 to day 7 after cardiac surgery, SctO2 progressively declined. At hospital discharge, SctO2 was significantly lower than baseline, at 53.5% (95% CI, 51.8 to 55.2, P < 0.001). In the reference group, postoperative SctO2 was not significantly different from baseline. On multivariable analysis, cardiac surgery, peripheral vascular disease and time since the operation were associated with greater cerebral desaturation, whereas higher haemoglobin concentrations were associated with slightly better cerebral oxygenation.

CONCLUSION

After cardiac surgery on CPB, but not after noncardiac surgery, most patients experience prolonged cerebral desaturation. Such postoperative desaturation remained unresolved 7 days after surgery. The underlying mechanisms and time to resolution of such cerebral desaturations require further investigation.

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