КОРРЕКЦИЯ ЦЕРЕБРАЛЬНОЙ ОКСИГЕНАЦИИ С ЦЕЛЬЮ СНИЖЕНИЯ РАЗВИТИЯ ПОСЛЕОПЕРАЦИОННЫХ ОСЛОЖНЕНИЙ У КАРДИОХИРУРГИЧЕСКИХ ПАЦИЕНТОВ ВЫСОКОГО РИСКА

The imbalance between oxygen delivery and consumption in the brain can lead to unfavorable post-operative outcomes of cardiac surgery. The authors evaluated the effect of the protocol on management of cerebral oxygenation episodes during the post-operative period in the patients undergoing cardiac surgery and facing a high risk of complications. Subjects: Patients who underwent coronary bypass surgery and/or cardiac valve surgery with cardiopulmonary bypass, were randomly divided into two groups: the interventional group (n = 60), where a special protocol was used to manage desaturation episodes, and the control group (n = 60) where only blinded monitoring of cerebral oximetry was used. Within 30 days after surgery, the development of desaturation episodes during surgery was assessed as well as the occurrence of complications (myocardial infarction, brain damage of the 1st and 2nd types, infectious complications, prolonged artificial ventilation of the lungs, arrhythmia, repeated thoracotomy, acute renal damage) in both groups. Results. The duration and intensity of desaturation did not significantly differ between the groups. The composite outcome was observed in 41 (68.3%) patients in the intervention group and in 38 (63.3%) of them in the control group (p = 0.70), and no significant difference was found in the frequency of individual components of the composite outcome. It was found out that desaturation significantly affected the development of delirium (odds ratio 1.03, 95% confidence interval 1.01–1.05, p = 0.03, to reduce % of the area under saturation curve for the less than 60% of the absolute value per every 5 minutes). Conclusion. The cerebral oximetry correction protocol provided no effect on prevention of complications in high-risk patients undergoing cardiac surgery. However, the reduction of cerebral oximetry turned out to be significant to predict the development of post-operative delirium, and it noted the need to search for ways to manage oxygen imbalance during surgery.Нарушение баланса между доставкой и потреблением кислорода в головном мозге может привести к неблагоприятным послеоперационным исходам в кардиохирургической практике. Авторы оценили влияние протокола по устранению эпизодов снижения церебральной оксигенации на течение послеоперационного периода у кардиохирургических пациентов с высоким риском развития осложнений. Методы. Пациенты, которым выполняли операции коронарного шунтирования и/или коррекции клапанного аппарата сердца в условиях искусственного кровообращения, рандомизированы на две группы: интервенционную (n = 60), где для коррекции эпизодов десатурации использовали специальный протокол, и контрольную группу (n = 60), где осуществляли только ослепленный мониторинг церебральной оксиметрии. Выполнена оценка развития эпизодов десатурации во время операции и возникновения осложнений (инфаркт миокарда, повреждения головного мозга 1-го и 2-го типов, инфекционные осложнения, продленная искусственная вентиляция легких, аритмия, реторакотомия, острое почечное повреждение) в течение 30 дней после операции в обеих группах. Результаты. Продолжительность и выраженность десатурации достоверно не различались между группами. Композитный исход возник у 41 (68,3%) пациента в интервенционной группе и у 38 (63,3%) – в контрольной (p = 0,70), также не обнаружено достоверных различий в частоте развития отдельных компонентов композитного исхода. Выявлено, что десатурация значительно влияет на развитие делирия (отношение шансов 1,03, 95%-ный доверительный интервал 1,01–1,05, p = 0,03 для снижения на каждые 5 мин∙% площади под кривой сатурации менее абсолютного значения 60%). Заключение. Протокол коррекции церебральной оксиметрии не оказывал влияния на предотвращение развития осложнений у кардиохирургических пациентов высокого риска. Однако снижение церебральной оксиметрии оказалось прогностически значимым в развитии послеоперационного делирия, что указывает на необходимость поиска подходов к устранению нарушения кислородного баланса во время операции

MANAGEMENT OF CEREBRAL OXYGENATION IN ORDER TO REDUCE THE DEVELOPMENT OF POST-OPERATIVE COMPLICATIONS IN HIGH-RISK PATIENTS UNDERGOING CARDIAC SURGERY

The imbalance between oxygen delivery and consumption in the brain can lead to unfavorable post-operative outcomes of cardiac surgery. The authors evaluated the effect of the protocol on management of cerebral oxygenation episodes during the post-operative period in the patients undergoing cardiac surgery and facing a high risk of complications. Subjects: Patients who underwent coronary bypass surgery and/or cardiac valve surgery with cardiopulmonary bypass, were randomly divided into two groups: the interventional group (n = 60), where a special protocol was used to manage desaturation episodes, and the control group (n = 60) where only blinded monitoring of cerebral oximetry was used. Within 30 days after surgery, the development of desaturation episodes during surgery was assessed as well as the occurrence of complications (myocardial infarction, brain damage of the 1st and 2nd types, infectious complications, prolonged artificial ventilation of the lungs, arrhythmia, repeated thoracotomy, acute renal damage) in both groups. Results. The duration and intensity of desaturation did not significantly differ between the groups. The composite outcome was observed in 41 (68.3%) patients in the intervention group and in 38 (63.3%) of them in the control group (p = 0.70), and no significant difference was found in the frequency of individual components of the composite outcome. It was found out that desaturation significantly affected the development of delirium (odds ratio 1.03, 95% confidence interval 1.01–1.05, p = 0.03, to reduce % of the area under saturation curve for the less than 60% of the absolute value per every 5 minutes). Conclusion. The cerebral oximetry correction protocol provided no effect on prevention of complications in high-risk patients undergoing cardiac surgery. However, the reduction of cerebral oximetry turned out to be significant to predict the development of post-operative delirium, and it noted the need to search for ways to manage oxygen imbalance during surgery