Use of cerebral oxygen saturation and hemoglobin concentration to predict acute kidney injury after cardiac surgery

Objective Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with significant morbidity and mortality. Near infrared spectroscopy (NIRS) is a noninvasive technique for real-time measurement of cerebral tissue oxygenation. The purpose of the present study was to evaluate the correlation of AKI with hemoglobin and regional cerebral oxygen saturation (rScO2) measured intraoperatively and postoperatively in patients undergoing cardiac surgery. Methods We retrospectively analyzed the prospectively collected data of 45 adult patients with normal renal function who underwent isolated coronary artery bypass grafting (CABG) from January 2014 to May 2014. Kidney injury was assessed according to the Acute Kidney Injury Network criteria. rScO2 and hemoglobin were measured every hour intraoperatively and for the first 24 hours postoperatively. Results The hemoglobin concentration and rScO2 were significantly lower in patients with than without AKI, and no linear trends were observed. No exact cut-off values were obtained. Conclusion This retrospective study shows that a lower rScO2 and hemoglobin concentration are correlated with AKI after CABG in patients with no peripheral vascular disease or recent myocardial infarction. We suggest that cerebral oximetry alone may predict postoperative AKI well.

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Does cerebral oxygen desaturation as measured by near-infrared spectroscopy predict acute kidney injury after cardiac surgery?

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2016.03.092 ◽

2016 ◽

Vol 30 ◽

pp. S1

Author(s):

Kevin Humblet ◽

C Watremez ◽

M Momeni

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Infrared Spectroscopy ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Kidney Injury ◽

Oxygen Desaturation ◽

Cerebral Oxygen

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Near-Infrared–Based Cerebral Oximetry for Prediction of Severe Acute Kidney Injury in Critically Ill Children After Cardiac Surgery

Critical Care Explorations ◽

10.1097/cce.0000000000000063 ◽

2019 ◽

Vol 1 (12) ◽

pp. e0063

Author(s):

Marine Flechet ◽

Fabian Güiza ◽

Isabelle Scharlaeken ◽

Dirk Vlasselaers ◽

Lars Desmet ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Critically Ill ◽

Near Infrared ◽

Kidney Injury ◽

Cerebral Oximetry ◽

Critically Ill Children

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Cerebral oximetry monitoring to maintain NORMal Cerebral Oxygen SATuration (NORMOSAT during high-risk cardiac surgery: a randomized controlled feasibility trial

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2016.03.125 ◽

2016 ◽

Vol 30 ◽

pp. S16-S17 ◽

Cited By ~ 1

Author(s):

Alain Deschamps ◽

A Denault ◽

H Grocott ◽

E de Medicis ◽

J Buissières ◽

...

Keyword(s):

Cardiac Surgery ◽

High Risk ◽

Oxygen Saturation ◽

Cerebral Oximetry ◽

Cerebral Oxygen Saturation ◽

Feasibility Trial ◽

Cerebral Oxygen ◽

Randomized Controlled

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Near-infrared spectroscopy as a possible device for continuous monitoring of arterial carbon dioxide tension during cardiac surgery

Perfusion ◽

10.1177/0267659111419034 ◽

2011 ◽

Vol 26 (6) ◽

pp. 524-528 ◽

Cited By ~ 3

Author(s):

CS Park ◽

JG Kwak ◽

C Lee ◽

C-H Lee ◽

SK Lee ◽

...

Keyword(s):

Carbon Dioxide ◽

Cardiac Surgery ◽

Infrared Spectroscopy ◽

Oxygen Saturation ◽

Continuous Monitoring ◽

Near Infrared ◽

Right Hemisphere ◽

Cerebral Oxygen Saturation ◽

Cerebral Oxygen ◽

Regional Cerebral Oxygen Saturation

Background: Insufflation of carbon dioxide (CO2) to the operative field has been used to prevent major organ injury attributed to air embolisms in cardiac surgery. However, it may be preferable to avoid hypercapnia induced by CO2 insufflation, owing to its potentially harmful effect. To investigate the effectiveness of near-infrared spectroscopy (NIRS) as a possible method for continuous monitoring of arterial CO2 tension during cardiac surgery, we evaluated the correlation between the change in arterial CO2 tension and the change in regional cerebral oxygen saturation (rScO2) obtained from NIRS in as controlled a condition as possible. Methods: Thirty patients who underwent surgical correction for atrial or ventricular septal defects were enrolled in this study. Patients who had pulmonary hypertension or other intracardiac anomalies were excluded. Anesthetic and cardiopulmonary bypass (CPB) management were conducted according to our standard institutional practice. Data obtained from arterial blood gas analyses and corresponding regional cerebral oxygen saturation (rScO2) recorded from NIRS before and after the insufflations of CO2 during CPB were used for analysis. Results: The change in arterial CO2 tension correlated with the change in rScO2 in the left hemisphere (r = 0.681, p <0.001, y = −1.393 + 0.547x) and right hemisphere (r = 0.690, p <0.001, y = −1.999 + 0.486x). To control the effects of other variables, including hematocrit and temperature, these relationship were not reduced (left hemisphere: r=0.678, p<0.001; right hemisphere: r=0.634, p<0.001). Conclusions: Since the change in regional cerebral oxygen saturation was correlated with the change in arterial CO2 tension during mild hypothermic CPB, NIRS might be a possible non-invasive method for monitoring of arterial CO2 tension without incurring additional cost in this setting.

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The response of a standardized fluid challenge during cardiac surgery on cerebral oxygen saturation measured with near-infrared spectroscopy

Journal of Clinical Monitoring and Computing ◽

10.1007/s10877-019-00324-w ◽

2019 ◽

Vol 34 (2) ◽

pp. 245-251

Author(s):

Frederik Holmgaard ◽

Simon T. Vistisen ◽

Hanne B. Ravn ◽

Thomas W. L. Scheeren

Keyword(s):

Cardiac Surgery ◽

Infrared Spectroscopy ◽

Oxygen Saturation ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Fluid Challenge ◽

Cerebral Oxygen Saturation ◽

Cerebral Oxygen

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Association between Cerebral Oxygen Saturation with Outcome in Cardiac Surgery: Brain as an Index Organ

Journal of Clinical Medicine ◽

10.3390/jcm9030840 ◽

2020 ◽

Vol 9 (3) ◽

pp. 840 ◽

Cited By ~ 1

Author(s):

Youn Yi Jo ◽

Jae-Kwang Shim ◽

Sarah Soh ◽

Sungmin Suh ◽

Young Lan Kwak

Keyword(s):

Cardiac Surgery ◽

Oxygen Saturation ◽

Adverse Outcomes ◽

Cerebral Oximetry ◽

Surgical Patients ◽

Cerebral Oxygen Saturation ◽

Cerebral Oxygen ◽

Absolute Value ◽

Recorded Data ◽

Prognostic Importance

While both baseline regional cerebral oxygen saturation (rSO2) and intraoperative rSO2 decreases have prognostic importance in cardiac surgery, evidence is limited in patients who received interventions to correct rSO2 decreases. The primary aim was to examine the association between rSO2 values (both baseline rSO2 and intraoperative decrease in rSO2) with the composite of morbidity endpoints. We retrospectively analyzed 356 cardiac surgical patients having continuously recorded data of intraoperative rSO2 values. Per institutional guidelines, patients received interventions to restore the rSO2 value to ≥80% of the baseline value. Analyzed rSO2 variables included baseline value, and area under the threshold below an absolute value of 50% (AUT50). Their association with outcome was analyzed with multivariable logistic regression. AUT50 (odds ratio, 1.05; 95% confidence interval; 1.01–1.08; p = 0.015) was shown to be an independent risk factor (along with age, chronic kidney disease, and cardiopulmonary bypass time) of adverse outcomes. In cardiac surgical patients who received interventions to correct decreases in rSO2, increased severity of intraoperative decrease in rSO2 as reflected by AUT below an absolute value of 50% was associated with a composite of adverse outcomes, implicating the importance of cerebral oximetry to monitor the brain as an index organ.

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Impact of Extracranial Contamination on Regional Cerebral Oxygen Saturation

Anesthesiology ◽

10.1097/aln.0b013e31824c00d7 ◽

2012 ◽

Vol 116 (4) ◽

pp. 834-840 ◽

Cited By ~ 245

Author(s):

Sophie N. Davie ◽

Hilary P. Grocott

Keyword(s):

Oxygen Saturation ◽

Near Infrared ◽

Primary Objective ◽

Cerebral Oximetry ◽

Cerebral Oxygen Saturation ◽

Clinical Settings ◽

Cerebral Oxygen ◽

Regional Cerebral Oxygen Saturation ◽

Medical Systems ◽

Hypoxia Ischemia

Background Cerebral oximetry is a noninvasive technology using near-infrared spectroscopy (NIRS) to estimate regional cerebral oxygen saturation. Although NIRS cerebral oximetry is being increasingly used in many clinical settings, interdevice technologic differences suggest potential variation in the ability to accurately acquire brain oxygenation signals. The primary objective of this study was to determine if NIRS-derived regional cerebral oxygen saturation measurements accurately account for oxygen saturation contamination from extracranial tissue. Methods Twelve healthy volunteers had each of three NIRS devices (FORE-SIGHT [CAS Medical Systems Inc; Brandford, CT], INVOS 5100C-PB [Covidien; Boulder, CO], and EQUANOX Classic 7600 [Nonin Medical Inc; Plymouth, MN]) randomly applied to the forehead. After this, a circumferential pneumatic head cuff was positioned such that when inflated, hypoxia-ischemia would be produced in the extracranial scalp tissue beneath the NIRS cerebral oximeters. Comparisons among the three devices were made of the NIRS measurements before and following hypoxia-ischemia produced in the scalp tissue with inflation of the head cuff. Results The induction of extracranial hypoxia-ischemia resulted in a significant reduction in regional cerebral oxygen saturation measurements in all three NIRS devices studied. At 5 min postinflation of the pneumatic head cuff, the INVOS demonstrated a 16.6 ± 9.6% (mean ± SD) decrease from its baseline (P = 0.0001), the FORE-SIGHT an 11.8 ± 5.3% decrease from its baseline (P < 0.0001), and the EQUANOX a 6.8 ± 6.0% reduction from baseline (P = 0.0025). Conclusions Extracranial contamination appears to significantly affect NIRS measurements of cerebral oxygen saturation. Although the clinical implications of these apparent inaccuracies require further study, they suggest that the oxygen saturation measurements provided by cerebral oximetry do not solely reflect that of the brain alone.

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Brain and Muscle Oxygen Saturation Combined with Kidney Injury Biomarkers Predict Cardiac Surgery Related Acute Kidney Injury

Diagnostics ◽

10.3390/diagnostics11091591 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1591

Author(s):

Wiktor Szymanowicz ◽

Ludmiła Daniłowicz-Szymanowicz ◽

Wojtek Karolak ◽

Maciej Michał Kowalik ◽

Romuald Lango

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Oxygen Saturation ◽

Cystatin C ◽

Near Infrared ◽

Kidney Injury ◽

Tissue Oxygen Saturation ◽

Muscle Oxygen ◽

Patients At Risk ◽

Novel Biomarkers

Background: Early identification of patients at risk for cardiac surgery-associated acute kidney injury (CS-AKI) based on novel biomarkers and tissue oxygen saturation might enable intervention to reduce kidney injury. Aims: The study aimed to ascertain whether brain and muscle oxygenation measured by near-infrared spectroscopy (NIRS), in addition to cystatin C and NGAL concentrations, could help with CS-AKI prediction. Methods: This is a single-centre prospective observational study on adult patients undergoing cardiac surgery using cardiopulmonary bypass (CPB). Brain and muscle NIRS were recorded during surgery. Cystatin C was measured on the first postoperative day, while NGAL directly before and 3 h after surgery. Results: CS-AKI was diagnosed in 18 (16%) of 114 patients. NIRS values recorded 20 min after CPB (with cut-off value ≤ 54.5% for muscle and ≤ 62.5% for the brain) were revealed to be the most accurate predictors of CS-AKI. Preoperative NGAL ≥ 91.5 ng/mL, postoperative NGAL ≥ 140.5 ng/mL, and postoperative cystatin C ≥ 1.23 mg/L were identified as independent and significant CS-AKI predictors. Conclusions: Brain and muscle oxygen saturation 20 min after CPB could be considered early parameters possibly related to CS-AKI risk, especially in patients with increased cystatin C and NGAL levels.

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