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Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery.

Authors :
Rogers, C. A.
Stoica, S.
Ellis, L.
Stokes, E. A.
Wordsworth, S.
Dabner, L.
Clayton, G.
Downes, R.
Nicholson, E.
Bennett, S.
Angelini, G. D.
Reeves, B. C.
Murphy, G. J.
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]

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