Association of early perioperative stroke after cardiothoracic surgery with intraoperative regional cerebral oxygenation using near-infrared spectroscopy: an observational cohort study comparing affected versus non-affected hemispheres.

IF 2 3区医学 Q2 ANESTHESIOLOGY

Journal of Clinical Monitoring and Computing Pub Date : 2024-11-20 DOI:10.1007/s10877-024-01241-3

Ramon Pierik, Thomas W L Scheeren, Michiel E Erasmus, Walter M van den Bergh

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引用次数: 0

Abstract

Purpose: Patients undergoing cardiothoracic surgery are at risk of developing perioperative stroke, but residual effects of anesthesia may hamper timely detection. This study aims to determine if there is an association between intraoperative regional cerebral oxygenation (ScO₂) monitoring using near-infrared spectroscopy (NIRS) and the occurrence of early perioperative stroke within three days after cardiothoracic surgery.

Methods: We performed a single-center retrospective observational cohort study including all consecutive cardiothoracic surgery patients with routinely perioperative ScO₂ monitoring admitted postoperatively to the Intensive Care Unit (ICU) between 2008 and 2017. Patients with a confirmed stroke in the anterior cerebral circulation on brain imaging were included in the analysis. Intraoperative area under the curve (AUC), duration, and total ScO₂ excursions below predefined thresholds (< 50% ScO₂ or > 20% reduction below baseline) were calculated for each hemisphere. Stroke-affected and non-affected hemispheres were compared using logistic regression analyses to investigate a potential association between ScO₂ values and stroke.

Results: Of the 2454 cardiothoracic surgery patients with perioperative ScO₂ monitoring, 39 had a anterior stroke on brain imaging. ScO₂ readings of 44 affected hemispheres were compared to 34 non-affected hemispheres. Only the duration of ScO₂ < 50% or a > 20% drop from baseline were significantly associated with global ischemia (OR 1.30 (0.95%CI; 1.09-2.30)) when comparing affected (72 [5 to 33] min.) versus non-affected (28 [4 to 44] min.) hemispheres.

Conclusion: The duration of ScO₂ values < 50% or a drop > 20% from baseline were associated with the occurrence of early perioperative global cerebral ischemia within three days after cardiothoracic surgery.

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心胸手术后围术期早期中风与术中使用近红外光谱的区域脑氧合的关系：一项观察性队列研究，比较受影响和未受影响的半球。

目的：接受心胸手术的患者有发生围术期卒中的风险，但麻醉的残余效应可能会妨碍及时发现。本研究旨在确定使用近红外光谱（NIRS）监测术中区域脑氧合（ScO2）与心胸手术后三天内发生早期围术期中风之间是否存在关联：我们进行了一项单中心回顾性观察队列研究，研究对象包括2008年至2017年期间重症监护室（ICU）收治的所有连续心胸手术患者，这些患者术后均接受了常规围手术期ScO2监测。脑成像证实为脑前部循环卒中的患者也纳入分析范围。计算每个半球的术中曲线下面积（AUC）、持续时间和低于预定阈值（比基线降低2%或>20%）的总ScO2偏移量。使用逻辑回归分析比较受中风影响的半球和未受影响的半球，以研究 ScO2 值与中风之间的潜在关联：结果：在2454名接受围手术期ScO2监测的心胸外科患者中，有39名患者在脑成像中出现前脑卒中。44 个受影响半球的 ScO2 读数与 34 个未受影响半球的 ScO2 读数进行了比较。比较受影响半球（72 [5 to 33] min.）与非受影响半球（28 [4 to 44] min.），只有ScO2从基线下降20%的持续时间与全身缺血显著相关（OR 1.30 (0.95%CI; 1.09-2.30)）：结论：ScO2 值从基线下降 20% 的持续时间与心胸外科手术后三天内围术期早期全脑缺血的发生有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Monitoring and Computing ANESTHESIOLOGY-

CiteScore

4.30

自引率

13.60%

发文量

144

审稿时长

6-12 weeks

期刊介绍： The Journal of Clinical Monitoring and Computing is a clinical journal publishing papers related to technology in the fields of anaesthesia, intensive care medicine, emergency medicine, and peri-operative medicine. The journal has links with numerous specialist societies, including editorial board representatives from the European Society for Computing and Technology in Anaesthesia and Intensive Care (ESCTAIC), the Society for Technology in Anesthesia (STA), the Society for Complex Acute Illness (SCAI) and the NAVAt (NAVigating towards your Anaestheisa Targets) group. The journal publishes original papers, narrative and systematic reviews, technological notes, letters to the editor, editorial or commentary papers, and policy statements or guidelines from national or international societies. The journal encourages debate on published papers and technology, including letters commenting on previous publications or technological concerns. The journal occasionally publishes special issues with technological or clinical themes, or reports and abstracts from scientificmeetings. Special issues proposals should be sent to the Editor-in-Chief. Specific details of types of papers, and the clinical and technological content of papers considered within scope can be found in instructions for authors.