Back to Search
Start Over
Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery.
- Source :
-
BJA: The British Journal of Anaesthesia . Sep2017, Vol. 119 Issue 3, p384-393. 10p. 1 Diagram, 2 Charts, 2 Graphs. - Publication Year :
- 2017
-
Abstract
- <bold>Background: </bold>We assessed whether a near-infrared spectroscopy (NIRS)-based algorithm for the personalized optimization of cerebral oxygenation during cardiopulmonary bypass combined with a restrictive red cell transfusion threshold would reduce perioperative injury to the brain, heart, and kidneys.<bold>Methods: </bold>In a randomized controlled trial, participants in three UK centres were randomized with concealed allocation to a NIRS (INVOS 5100; Medtronic Inc., Minneapolis, MN, USA)-based 'patient-specific' algorithm that included a restrictive red cell transfusion threshold (haematocrit 18%) or to a 'generic' non-NIRS-based algorithm (standard care). The NIRS algorithm aimed to maintain cerebral oxygenation at an absolute value of > 50% or at > 70% of baseline values. The primary outcome for the trial was cognitive function measured up to 3 months postsurgery.<bold>Results: </bold>The analysis population comprised eligible randomized patients who underwent valve or combined valve surgery and coronary artery bypass grafts using cardiopulmonary bypass between December 2009 and January 2014 ( n =98 patient-specific algorithm; n =106 generic algorithm). There was no difference between the groups for the three core cognitive domains (attention, verbal memory, and motor coordination) or for the non-core domains psychomotor speed and visuo-spatial skills. The NIRS group had higher scores for verbal fluency; mean difference 3.73 (95% confidence interval 1.50, 5.96). Red cell transfusions, biomarkers of brain, kidney, and myocardial injury, adverse events, and health-care costs were similar between the groups.<bold>Conclusions: </bold>These results do not support the use of NIRS-based algorithms for the personalized optimization of cerebral oxygenation in adult cardiac surgery.<bold>Clinical Trial Registration: </bold>http://www.controlled-trials.com , ISRCTN 23557269. [ABSTRACT FROM AUTHOR]
- Subjects :
- *NEAR infrared spectroscopy
*CARDIAC surgery
*CARDIOPULMONARY bypass
*RANDOMIZED controlled trials
*BRAIN injuries
*BRAIN physiology
*COGNITION disorders
*ALGORITHMS
*BRAIN
*CEREBRAL circulation
*COMPARATIVE studies
*RED blood cell transfusion
*LONGITUDINAL method
*NEUROPSYCHOLOGICAL tests
*RESEARCH methodology
*MEDICAL cooperation
*RESEARCH
*RESEARCH funding
*EVALUATION research
*PREVENTION
PREVENTION of surgical complications
Subjects
Details
- Language :
- English
- ISSN :
- 00070912
- Volume :
- 119
- Issue :
- 3
- Database :
- Academic Search Index
- Journal :
- BJA: The British Journal of Anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 125239473
- Full Text :
- https://doi.org/10.1093/bja/aex182