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Prolonged postoperative cerebral oxygen desaturation after cardiac surgery: A prospective observational study
Luca Cioccari1, Laurent Bitker, Lisa Toh
1From the Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia (LC, LB, LT, SLC, EAO, FY, TN, NL, SW, GME, RB), Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland (LC), Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia (LC, FY, NL, RB), Service de médecine intensive et réanimation, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France (LB), Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia (DH, LW), Dipartimento di Scienze dell'emergenza, anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A, Gemelli IRCCS (SLC), Università Cattolica del Sacro Cuore, Rome, Italy (SLC), Department of Intensive Care, Siriraj Hospital, Mahidol University, Bangkok, Thailand (TN), Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland (NL), Department of Surgery, Austin Hospital (AM, JW), School of Medicine, The University of Melbourne (RB) and Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital and The University of Melbourne, Melbourne, Victoria, Australia (RB).
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 non-cardiac 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 non-cardiac 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.
