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Differences in regional cerebral oximetry during cardiac surgery for patients with or without postoperative cerebral ischaemic lesions evaluated by magnetic resonance imaging.
Holmgaard, F; Vedel, A G; Langkilde, A; Lange, T; Nilsson, J C; Ravn, H B.
Afiliação
  • Holmgaard F; Department of Cardiothoracic Anaesthesiology, Heart Centre, University of Copenhagen, Copenhagen, Denmark. Electronic address: frederik.holmgaard@regionh.dk.
  • Vedel AG; Department of Cardiothoracic Anaesthesiology, Heart Centre, University of Copenhagen, Copenhagen, Denmark.
  • Langkilde A; Department of Radiology, Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Lange T; Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark; Center for Statistical Science, Peking University, Beijing, China.
  • Nilsson JC; Department of Cardiothoracic Anaesthesiology, Heart Centre, University of Copenhagen, Copenhagen, Denmark.
  • Ravn HB; Department of Cardiothoracic Anaesthesiology, Heart Centre, University of Copenhagen, Copenhagen, Denmark.
Br J Anaesth ; 121(6): 1203-1211, 2018 Dec.
Article em En | MEDLINE | ID: mdl-30442245
ABSTRACT

BACKGROUND:

Near infrared spectroscopy (NIRS) is widely used to monitor regional cerebral tissue oxygenation (rScO2). We compared rScO2 values during cardiac surgery in patients with or without new cerebral ischaemic lesions on diffusion weighted magnetic resonance imaging (DWI). We hypothesised patients with new cerebral lesions would have impaired tissue oxygenation reflected in their rScO2 values.

METHODS:

NIRS and DWI data were collected in 152 elective cardiac surgery patients. Absolute rScO2 values, duration of desaturation below thresholds (baseline, 10%, and 20%), and accumulated cerebral desaturation load were compared between patients with or without new cerebral lesions on DWI. Primary outcome was time below 10% from rScO2 baseline.

RESULTS:

The time below 10% from rScO2 baseline was significantly longer for patients with new cerebral lesions than for patients without [median (inter-quartile range) 11.0 (0.4; 37.5) min vs 1.8 inter-quartile range (0.05; 20.9) min, P=0.02]. Furthermore, they had a higher accumulated desaturation load below baseline (P=0.02) and 10% below baseline (P=0.02). Finally, their absolute minimum rScO2 value was significantly lower (P=0.01). However, the frequency of patients with desaturation below 10% and 20% was comparable between patients with and without new cerebral lesions. Receiver-operating characteristic curve analysis did not identify a clear-cut critical threshold among the investigated rScO2 variables.

CONCLUSIONS:

Use of NIRS identified significant group differences in rScO2 values between patients with or without new ischaemic lesions. However, a critical threshold could not be identified because of a high variation in NIRS values across both groups. CLINICAL TRIAL REGISTRATION NCT 02185885.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Oxigênio / Complicações Pós-Operatórias / Encéfalo / Isquemia Encefálica / Imagem de Difusão por Ressonância Magnética / Procedimentos Cirúrgicos Cardíacos Tipo de estudo: Prognostic_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Anaesth Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Oxigênio / Complicações Pós-Operatórias / Encéfalo / Isquemia Encefálica / Imagem de Difusão por Ressonância Magnética / Procedimentos Cirúrgicos Cardíacos Tipo de estudo: Prognostic_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Anaesth Ano de publicação: 2018 Tipo de documento: Article