IMPROVING NEUROLOGIC OUTCOME IN CARDIAC SURGERY PATIENTS
WITH A GOAL-ORIENTED THERAPY PROTOCOL BASED ON CEREBRAL
REGIONAL OXYGEN SATURATION
F. Franchi, B. Biagioli, A. Tabucchi, S. Scolletta
University of Siena, Siena, Italy
INTRODUCTION. NIRS (near infrared spectroscopy) is a neuro-monitoring tool that
provides cerebral regional oxygen saturation (rSO2).
OBJECTIVES. We hypothesized that a goal-directed therapy (GDT) protocol based on
rSO2 values would be associated with reduced incidence of postoperative neurologic
complications (PNC) in high-risk cardiac surgery (CS) patients.
METHODS. 85 high-risk CS patients (mean age 71 ± 9) were monitored during CS with
NIRS (cNIRS group). Intraoperative interventions were based on a GDT protocol aimed at
improving cerebral rSO2 and blood flow (i.e., increasing arterial oxygen content with red blood cell transfusions and FiO2; increasing systemic blood flow and cerebral perfusion
pressure with fluids, inotropic, and vasoactive drugs and increasing pump-flow during
cardiopulmonary bypass). cNIRS group was compared with 100 patients (mean age 73 ± 6)
(not monitored with cerebral NIRS, N-cNIRS group) who were selected from a historical
database using a propensity-matching analysis. Neuron-specific enolase (NSE) and S-100B
protein were collected at different times in the cNIRS group.
RESULTS. PNC resulted 21 % in the cNIRS group and 35 % in N-cNIRS group
(p\0.05). N-cNIRS group showed longer times of mechanical ventilation (MV)
(150.3 ± 274.9 vs 29.9 ± 65 h, p = 0.02) and ICU stay (13.3 ± 14.7 vs 3.4 ± 3.9 days,
p = 0.01) than cNIRS group. In the cNIRS group, preoperative rSO2 values were signifi-
cantly lower in the patients who exhibited PNC than those who had good neurologic
outcome (59.6 ± 7.6 vs 63.4 ± 7.8 %, p = 0.04). An inverse correlation was found
between the lowest values of intraoperative cerebral rSO2 and the length of MV (r = -0.31,
p = 0.04) and ICU stay (r = -0.43, p = 0.003). Only the peak of NSE, measured 6 h after
CS, showed significant difference between patients who developed PNC and those who did
not (p = 0.02).
CONCLUSIONS. In our cohort of CS patients, NSE and S-100B protein were poor pre-
dictors of PNC. Conversely, the lower the preoperative cerebral rSO2, the poorer the
neurologic outcome. A GDT protocol based on NIRS values, aimed at improving cerebral
rSO2 and blood flow, might reduce PNC in high-risk CS patients.
REFERENCE(S). Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen
saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg.
2007;104(1):51-8