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Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery

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posted on 31.01.2019, 12:29 by CA Rogers, S Stoica, L Ellis, EA Stokes, S Wordsworth, L Dabner, G Clayton, R Downes, E Nicholson, S Bennett, GD Angelini, BC Reeves, GJ Murphy
Background We assessed whether a near-infrared spectroscopy (NIRS)-based algorithm for the personalized optimization of cerebral oxygenation during cardiopulmonary bypass combined with a restrictive red cell transfusion threshold would reduce perioperative injury to the brain, heart, and kidneys. Methods In a randomized controlled trial, participants in three UK centres were randomized with concealed allocation to a NIRS (INVOS 5100; Medtronic Inc., Minneapolis, MN, USA)-based ‘patient-specific’ algorithm that included a restrictive red cell transfusion threshold (haematocrit 18%) or to a ‘generic’ non-NIRS-based algorithm (standard care). The NIRS algorithm aimed to maintain cerebral oxygenation at an absolute value of > 50% or at > 70% of baseline values. The primary outcome for the trial was cognitive function measured up to 3 months postsurgery. Results The analysis population comprised eligible randomized patients who underwent valve or combined valve surgery and coronary artery bypass grafts using cardiopulmonary bypass between December 2009 and January 2014 (n=98 patient-specific algorithm; n=106 generic algorithm). There was no difference between the groups for the three core cognitive domains (attention, verbal memory, and motor coordination) or for the non-core domains psychomotor speed and visuo-spatial skills. The NIRS group had higher scores for verbal fluency; mean difference 3.73 (95% confidence interval 1.50, 5.96). Red cell transfusions, biomarkers of brain, kidney, and myocardial injury, adverse events, and health-care costs were similar between the groups. Conclusions These results do not support the use of NIRS-based algorithms for the personalized optimization of cerebral oxygenation in adult cardiac surgery.

Funding

National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant HTA: RP-PG-0407-10384 for The PASPORT Trial); Leicester and Bristol NIHR Cardiovascular Biomedical Research Units (The PASPORT Trial); British Heart Foundation (RG/13/6/29947 and CH/12/1/29419 to G.J.M.).

History

Citation

BRITISH JOURNAL OF ANAESTHESIA, 2017, 119 (3), pp. 384-393 (10)

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

AM (Accepted Manuscript)

Published in

BRITISH JOURNAL OF ANAESTHESIA

Publisher

Elsevier

issn

0007-0912

eissn

1471-6771

Copyright date

2017

Available date

31/01/2019

Publisher version

https://www.sciencedirect.com/science/article/pii/S0007091217537514?via=ihub

Language

en