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Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery.
- Source :
-
British journal of anaesthesia [Br J Anaesth] 2017 Sep 01; Vol. 119 (3), pp. 384-393. - Publication Year :
- 2017
-
Abstract
- Background: 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.<br />Methods: 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.<br />Results: 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.<br />Conclusions: These results do not support the use of NIRS-based algorithms for the personalized optimization of cerebral oxygenation in adult cardiac surgery.<br />Clinical Trial Registration: http://www.controlled-trials.com , ISRCTN 23557269.<br /> (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Algorithms
Cardiopulmonary Bypass
Erythrocyte Transfusion
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neuropsychological Tests
Spectroscopy, Near-Infrared methods
United Kingdom
Young Adult
Brain blood supply
Brain physiology
Cardiac Surgical Procedures
Cerebrovascular Circulation physiology
Cognition Disorders prevention & control
Postoperative Complications prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1471-6771
- Volume :
- 119
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- British journal of anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 28969313
- Full Text :
- https://doi.org/10.1093/bja/aex182