Iranian Heart Journal

Iranian Heart Journal

Relationship Between Cerebral Oximetry Monitoring and Mixed Venous Oxygen Saturation During Cardiopulmonary Bypass and Postoperative Cognitive Impairment

Document Type : Original Article

Authors
Samira Orouji Omid 1
Hamid Pairovi 2
Rasoul Azarfarin 3
Mohsen Ziyaeifard 3
Maryam Abedzadeh 1
Parvin Vahid 1
Seyed Salaheddin Nabavi 4
1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
2 Nursing Care Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
3 Congenital Heart Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
4 Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran.
Abstract
Background: We assessed the relationship between postoperative cognitive impairment and cerebral oximetry (INVOS) and mixed venous oxygen saturation (SvO2) during cardiopulmonary bypass (CPB).
 
Methods: This observational cohort study enrolled 110 patients and divided them into 2 groups of 55 subjects. After the exclusion of 5 patients in the SvO2 group and 3 in the INVOS group, the final analysis was conducted on 50 and 52 patients in the former and latter groups, respectively. The Mini-Mental State ‎Examination (MMSE) score was used to assess cognitive impairment in the patients on the second and third postoperative days. SPSS software, version 24, was used for statistical analysis. ‎
 
Results: On the second postoperative day, the frequency of cognitive dysfunction was 4% in the SvO2 group and 3.8% in the INVOS group ‎‎ (P = 0.73). Three days after surgery, the incidence of cognitive ‎dysfunction in the SvO2 and INVOS groups was 2% and 1.9% (P = 0.49), respectively. No statistically significant difference was observed between the 2 groups concerning the incidence of cognitive dysfunction after surgery with CPB.
 
Conclusions: Our results indicated that cerebral tissue perfusion monitoring by INVOS could be replaced with the SvO2 approach ‏without increasing the incidence of cognitive dysfunction ‏compared with INVOS in adult cardiac surgery using CPB. (Iranian Heart Journal 2024; 25(1): 66-73)
Keywords
Cardiopulmonary bypass
Cognitive disorders
Tissue perfusion
Cerebral oxygen saturation
Mixed venous oxygen saturation
  1. K. Bernstein, J. Wyrobek, J. Tang, D.M. Lindenmuth, R. Stahl, B. Ayers, I. Gosev. An Anesthetic Approach to Off Pump Complete Sternal-Sparing Implantation of a Fully Magnetically Levitated LVAD.The Journal of Heart and Lung Transplantation 39(4), Supplement 2020, S392-S393.
  2. A. Bermudez, M.A. Daneshmand, 6 - The Role of Extracorporeal Membrane Oxygenation in Cardiac Support, in: J.K. Kirklin, J.G. Rogers (Eds.). Mechanical Circulatory Support: a Companion to Braunwald's Heart Disease (Second Edition), Content Repository Only!, Philadelphia, 2020, pp. 53-70.
  3. Hori, Y. Nomura, M. Ono, B. Joshi, K. Mandal, D. Cameron, M. Kocherginsky, C.W. Hogue. Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring, The Journal of Thoracic and Cardiovascular Surgery 154(5) 2017, 1590-1598.e2.
  4. H. Adam, V. Haas, S. Lindau, K. Zacharowski, B. Scheller. Cholinesterase alterations in delirium after cardiosurgery: a German monocentric prospective study, BMJ Open 10(1) 2020, e031212.
  5. Hinckley, J. Jones. Extracorporeal membrane oxygenation improves outcomes of accidental hypothermia without vital signs: A nationwide observational study. Resuscitation. 2019;144:27-32
  6. Fang, K.Y. Allen, B.S. Marino, K.M. Brady, Neurologic outcomes after heart surgery, Pediatric Anesthesia 29(11) 2019 1086-1093.
  7. Bazli, A.M. Chahardehi, H. Arsad, N. Azizabadi, M.A. Jazi. Factors influencing the failure of dental implants: A Systematic Review, Journal of Composites and Compounds 2(2) 2020, 18-25.
  8. V. Eryomina, M.M. Petrova, S.V. Prokopenko, E.Y. Mozheyko, D.S. Kaskaeva, O.A. Gavrilyuk. The effectiveness of the correction of cognitive impairment using computer-based stimulation programs for patients with coronary heart disease after coronary bypass surgery, Journal of the Neurological Sciences 358(1) 2015, 188-192.
  9. K.M. Ellis, A.M. Brambrink. Neurotoxicity of General Anesthetics, in: A.M. Brambrink, J.R. Kirsch (Eds.). Essentials of Neurosurgical Anesthesia & Critical Care: Strategies for Prevention, Early Detection, and Successful Management of Perioperative Complications, Springer International Publishing, Cham, 2020, pp. 91-104.
  10. Szwed, A. Słomka, W. Pawliszak, M. Szwed, L. Anisimowicz, E. Żekanowska, A. Borkowska, Novel Markers for Predicting Type 2 Neurologic Complications of Coronary Artery Bypass Grafting, The Annals of Thoracic Surgery 2020 110(2): 599-607.
  11. R. Rouhani, A.H. Esmaeil-Khanian, F. Davar, S. Hasani, The effect of agarose content on the morphology, phase evolution, and magnetic properties of CoFe2O4 nanoparticles prepared by sol-gel autocombustion method, International Journal of Applied Ceramic Technology 2018 15(3) 758-765.
  12. Rahimi, F. SharifianJazi, A. Esmaeilkhanian, M. Moradi, A.H. Safi Samghabadi, Effect of SiO2 content on Y-TZP/Al2O3 ceramic-nanocomposite properties as potential dental applications, Ceramics International 2020 46(8) Part A: 10910-10916.
  13. Vahid Tavakoli, O. Hamid, H. Seyed Mohammad Mehdi, S. Fariborz, Microstructure and hot corrosion behavior of hot dip siliconized coating on Ni-base superalloy IN738LC, Materials Research Express 2020: 7 056527DOI 10.1088/2053-1591/ab6dab.
  14. Esmaeilkhanian, F. Sharifianjazi, A. Abouchenari, A. Rouhani, N. Parvin, M. Irani, Synthesis and Characterization of Natural Nano-hydroxyapatite Derived from Turkey Femur-Bone Waste, Applied Biochemistry and Biotechnology 2019 189(3): 919-932.
  15. -H. Xu, T.-Z. Zhang, X.-F. Peng, C.-J. Jin, J. Zhou, Y.-N. Zhang, Effects of sevoflurane before cardiopulmonary bypass on cerebral oxygen balance and early postoperative cognitive dysfunction, Neurological Sciences 2013 34(12): 2123-2129.
  16. Zhou, Y. Lyu, Y. Zhu, T. Jiang, C. Wu, J. Yang, L. Wang, Effect of Ulinastatin Combined With Dexmedetomidine on Postoperative Cognitive Dysfunction in Patients Who Underwent Cardiac Surgery, Frontiers in Neurology 2019 10(1293): doi.10.3389/fneur.2019.01293
  17. Teng, W. Chen, C. Yin, H. Zhang, Q. Zhao, Dexmedetomidine Improves Cerebral Ischemia-Reperfusion Injury in Rats via Extracellular Signal-Regulated Kinase/Cyclic Adenosine Monophosphate Response Element Binding Protein Signaling Pathway, World Neurosurgery 2019 127: e624-e630.
  18. Kannan, S. Kannan, P. Stalin, Prevalence and Risk Factors of Neuropsychological Issues Following Acute Mild Traumatic Brain Injury, Journal of Evolution of Medical and Dental Sciences 2019 8(46): 3469-3474.
  19. Thies, D. Mücke, A. Lowit, E. Kalbe, J. Steffen, M.T. Barbe, Prominence marking in parkinsonian speech and its correlation with motor performance and cognitive abilities, Neuropsychologia 2020 137: 107306.
  20. AbdelKarim Elsayed, W. Angerstein, M. Bielsa Corrochano, D. Deuster, A.J. Embacher, U. Hanning, et al. Diagnosis and Differential Diagnosis of Developmental Disorders of Speech and Language, in: A. am Zehnhoff-Dinnesen, B. Wiskirska-Woznica, K. Neumann, T. Nawka (Eds.), Phoniatrics I: Fundamentals – Voice Disorders – Disorders of Language and Hearing Development, Springer Berlin Heidelberg, Berlin, Heidelberg, 2020, pp. 619-712.
  21. Ziyaeifard M, Alizadehasl A, Amiri A, Rezaei H, Faiz S H, Babaee T et al. Prevalence and Predisposing Factors for Cognitive Dysfunction Following Adult Cardiac Surgery. Res Cardiovasc Med. 2017 March; 6(2):e37284.
  22. Su, S. Ban, M. Wang, F. Hua, L. Wang, X. Cheng, Y. Tang, H. Zhou, Y. Zhai, X. Du, J. Liu, Reduced resting-state brain functional network connectivity and poor regional homogeneity in patients with CADASIL, The Journal of Headache and Pain 2019 20(1): 103.
  23. I. Tröster, A. Abbott, Movement Disorders with Dementia in Older Adults, in: L.D. Ravdin, H.L. Katzen (Eds.), Handbook on the Neuropsychology of Aging and Dementia, Springer International Publishing, Cham, 2019, pp. 543-575.
  24. L. McGoohan, Exploration of the outcomes and experiences of people living with cognitive impairment and intracerebral haemorrhage: a mixed methods approach, 2019 https://hdl.handle.net/1842/36527.
  25. Song, P. Fu, M. Chen, Q. Bi, Association of CT perfusion and postoperative cognitive dysfunction after off-pump coronary artery bypass grafting, Neurological Research 2016 38(6): 533-537.
  26. I. Tröster, S.J. Pulaski, S.P. Woods, Neuropsychology of Movement Disorders and Motor Neuron Disease: Parkinson’s Disease, Progressive Supranuclear Palsy, Essential Tremor, Huntington’s Disease, and Amyotrophic Lateral Sclerosis, in: C.L. Armstrong, L.A. Morrow (Eds.), Handbook of Medical Neuropsychology: Applications of Cognitive Neuroscience, Springer International Publishing, Cham, 2019, pp. 415-440.
  27. Ziyaeifard M, Gholami Beh Khoo F, Lotfian S, Azarfarin R, Aminnejad R, *, Alikhani R et al. Effects of Early Mobilization Protocol on Cognitive Outcome after Cardiac Surgery. Ann Anesth Crit Care. 2018 April; 3(1):e63594.
  28. Azarfarin, R., Sheikhzadeh, D., Mirinazhad, M., Bilehjani, E., Alizadehasl, A. Do nondiabetic patients undergoing coronary artery bypass grafting surgery require intraoperative management of hyperglycemia? Acta Anaesthesiologica Taiwanica, 2011, 49(2), pp. 41–45.
  29. Kurniawan, A. Arch, S.-R. Smith, Ageing and Older Adults, in: Y. Yesilada, S. Harper (Eds.), Web Accessibility: A Foundation for Research, Springer London, London, 2019, pp. 93-119.
  30. Ekrami, J. Shahbazi Karami, A. Araee, F. Sharifianjazi, E. Sadeghi, A. Moghanian, Fabrication of copper/stainless steel bimetallic couple, by diffusion bonding using silver and nickel foils as interlayers, Inorganic and Nano-Metal Chemistry 2019 49(5):152-162.
  31. Hasanin, A. Mukhtar, H. Nassar, Perfusion indices revisited, Journal of Intensive Care 2017 5(1): 24.
  32. Fowler, I. Dady, A pilot feasibility study to assess and validate the use of cerebral saturation monitoring during the transport of critically ill neonates, F1000Research 2018 7. publication/330542536.
  33. -H. Lee, Y.-H. Park, H.-S. Kim, J.-T. Kim, Comparison of two devices using near-infrared spectroscopy for the measurement of tissue oxygenation during a vascular occlusion test in healthy volunteers (INVOS® vs. InSpectra™), Journal of Clinical Monitoring and Computing 2015 29(2): 271-278.
  34. G. Iodice, Z. Ricci, R. Haiberger, I. Favia, P. Cogo, Fiberoptic monitoring of central venous oxygen saturation (PediaSat) in small children undergoing cardiac surgery: continuous is not continuous, F1000Research. 2014; 3: 23.
  35. Moerman, G. Vandenplas, T. Bové, P.F. Wouters, S.G. De Hert, Relation between mixed venous oxygen saturation and cerebral oxygen saturation measured by absolute and relative near-infrared spectroscopy during off-pump coronary artery bypass grafting, BJA: British Journal of Anaesthesia 2012 110(2): 258-265.
  36. Deschamps, R. Hall, H. Grocott, C.D. Mazer, P.T. Choi, A.F. Turgeon, E. de Medicis, J.S. Bussières, C. Hudson, S. Syed, Cerebral Oximetry Monitoring to Maintain Normal Cerebral Oxygen Saturation during High-risk Cardiac SurgeryA Randomized Controlled Feasibility Trial, Anesthesiology: The Journal of the American Society of Anesthesiologists 2016 124(4): 826-836.
  37. Schmidt, M. Heringlake, P. Kellner, A.E. Berggreen, H. Maurer, S. Brandt, B. Bucsky, M. Petersen, E.I. Charitos, The effects of systemic oxygenation on cerebral oxygen saturation and its relationship to mixed venous oxygen saturation: A prospective observational study comparison of the INVOS and ForeSight Elite cerebral oximeters, Canadian Journal of Anesthesia/Journal canadien d'anesthésie 2018 65(7): 766-775.
  38. Carmona García, E. Mateo, I. Zarragoikoetxea, M. López Cantero, J.J. Peña Borrás, R. Vicente, Can regional cerebral oxygen saturation guide red blood cell transfusion in high risk cardiac surgery?, Revista Española de Anestesiología y Reanimación (English Edition) 2019 66(7): 355-361.
  39. Colak, M. Borojevic, A. Bogovic, V. Ivancan, B. Biocina, V. Majeric-Kogler, Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after coronary artery bypass surgery: a randomized, prospective study†‡, European Journal of Cardio-Thoracic Surgery 2014 47(3): 447-454.
  40. Harilall, J.K. Adam, B.M. Biccard, A. Reddi, Correlation between cerebral tissue and central venous oxygen saturation during off-pump coronary bypass graft surgery, Perfusion 2010 26(2): 83-90.
  41. Schön, M. Heringlake, K. Berger, H. Volker Groesdonk, B. Sedemund-Adib, H. Paarmann, Relationship between mixed venous oxygen saturation and regional cerebral oxygenation in awake, spontaneously breathing cardiac surgery patients, Minerva anestesiologica 2011 77(10): 952.
Iranian Heart Journal
Volume 25, Issue 1
Winter 2024
Pages 66-73