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Title: Near-infrared spectroscopy in adult cardiac surgery patients: a systematic review and meta-analysis
Austin Authors: Chan, Matthew J;Chung, Tricia;Glassford, Neil J;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University Alfred Hospital, Melbourne, Victoria, Australia
School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Issue Date: Aug-2017
Date: 2017-02-24
Publication information: Journal of Cardiothoracic and Vascular Anesthesia 2017; 31(4): 1155-1165
Abstract: OBJECTIVES: To identify the normal baseline preoperative range of cerebral tissue oxygen saturation (SctO2) derived using near-infrared spectroscopy (NIRS) and the efficacy of perioperative interventions designed to modulate SctO2 in cardiac surgical patients. DESIGN: Systematic review and meta-analysis of relevant randomized controlled trials (RCTs) extracted from the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. SETTING: Hospitals performing cardiac surgery. PARTICIPANTS: The study comprised 953 participants from 11 RCTs. INTERVENTIONS: Interventions included the following: (1) SctO2 monitoring protocol compared with no monitoring; (2) use of cardiopulmonary bypass (CPB) compared with no CPB; (3) normothermic CPB compared with hypothermic CPB; (4) glyceryl trinitrate during surgery compared with placebo; (5) midazolam during induction of anesthesia compared with propofol; (6) sevoflurane anesthesia compared with total intravenous anesthesia; (7) sevoflurane anesthesia compared with propofol-based anesthesia; and (8) norepinephrine during CPB compared with phenylephrine. MEASUREMENTS AND MAIN RESULTS: Eleven RCTs with 953 participants measured baseline preoperative SctO2 using NIRS. The pooled mean baseline SctO2 was 66.4% (95% CI 65.0-67.7), generating a reference range of 51.0% to 81.8%. Four interventions (1, 3, 4, and 6 described in the Interventions section above) increased intraoperative SctO2 across the majority of reported time points. Postoperative follow-up of SctO2 occurred in only 1 study, and postoperative cognitive assessment correlating SctO2 with cognitive function was applied in only 4 studies using variable methodology. CONCLUSIONS: The authors have established that reference values for baseline NIRS-derived SctO2 in cardiac surgery patients are varied and have identified interventions that modulate SctO2. This information opens the door to standardized research and interventional studies in this field.
DOI: 10.1053/j.jvca.2017.02.187
ORCID: 0000-0002-1650-8939
Journal: Journal of Cardiothoracic and Vascular Anesthesia
PubMed URL:
Type: Journal Article
Subjects: Cardiac surgery
Cerebral oxygenation
Cerebral tissue oxygen saturation
Near-infrared spectroscopy
Postoperative cognitive dysfunction
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