A randomised trial of near infra-red spectroscopy for the personalised optimisation of cerebral tissue oxygenation during cardiac surgery
<h4>Background</h4> <p>We assessed whether a Near Infra-Red Spectroscopy (NIRS) based algorithm for the personalised optimisation of cerebral oxygenation during cardiopulmonary bypass (CPB) combined with a restrictive red cell transfusion threshold would reduce perioperative injur...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Journal article |
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Oxford University Press
2017
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| _version_ | 1797099038796939264 |
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| author | Rogers, C Stoica, S Ellis, L Stokes, E Wordsworth, S Dabner, L Clayton, G Downes, R Nicholson, E Bennett, S Angelini, G Reeves, B Murphy, G |
| author_facet | Rogers, C Stoica, S Ellis, L Stokes, E Wordsworth, S Dabner, L Clayton, G Downes, R Nicholson, E Bennett, S Angelini, G Reeves, B Murphy, G |
| author_sort | Rogers, C |
| collection | OXFORD |
| description | <h4>Background</h4> <p>We assessed whether a Near Infra-Red Spectroscopy (NIRS) based algorithm for the personalised optimisation of cerebral oxygenation during cardiopulmonary bypass (CPB) combined with a restrictive red cell transfusion threshold would reduce perioperative injury to the brain, heart and kidneys.</p> <h4>Methods</h4> <p>In a randomised controlled trial participants in 3 UK centres were randomised with concealed allocation to a NIRS (INVOS 5100, Medtronic Inc, 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, >70% of baseline values. The primary outcome for the trial was cognitive function measured up to 3 months post-surgery. </p> <h4>Results</h4> <p>The analysis population comprised eligible randomised patients that underwent valve or combined valve surgery and coronary artery bypass grafts (CABG) 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 3 core cognitive domains; attention, verbal memory, and motor coordination, or for the non-core domains psychometer speed and visuo-spatial skills. The NIRS group had higher scores for verbal fluency; Mean Difference 3.73, 95% CI (1.50, 5.96). Red cell transfusions, biomarkers of brain, kidney and myocardial injury, adverse events and healthcare costs were similar between the groups. </p> <h4>Conclusions</h4> <p>These results do not support the use of NIRS based algorithms for the personalised optimisation of cerebral oxygenation in adult cardiac surgery. </p> |
| first_indexed | 2024-03-07T05:18:00Z |
| format | Journal article |
| id | oxford-uuid:dde73a84-8928-4073-8b49-abbbbc3f2354 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T05:18:00Z |
| publishDate | 2017 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:dde73a84-8928-4073-8b49-abbbbc3f23542022-03-27T09:28:18ZA randomised trial of near infra-red spectroscopy for the personalised optimisation of cerebral tissue oxygenation during cardiac surgeryJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:dde73a84-8928-4073-8b49-abbbbc3f2354Symplectic Elements at OxfordOxford University Press2017Rogers, CStoica, SEllis, LStokes, EWordsworth, SDabner, LClayton, GDownes, RNicholson, EBennett, SAngelini, GReeves, BMurphy, G <h4>Background</h4> <p>We assessed whether a Near Infra-Red Spectroscopy (NIRS) based algorithm for the personalised optimisation of cerebral oxygenation during cardiopulmonary bypass (CPB) combined with a restrictive red cell transfusion threshold would reduce perioperative injury to the brain, heart and kidneys.</p> <h4>Methods</h4> <p>In a randomised controlled trial participants in 3 UK centres were randomised with concealed allocation to a NIRS (INVOS 5100, Medtronic Inc, 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, >70% of baseline values. The primary outcome for the trial was cognitive function measured up to 3 months post-surgery. </p> <h4>Results</h4> <p>The analysis population comprised eligible randomised patients that underwent valve or combined valve surgery and coronary artery bypass grafts (CABG) 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 3 core cognitive domains; attention, verbal memory, and motor coordination, or for the non-core domains psychometer speed and visuo-spatial skills. The NIRS group had higher scores for verbal fluency; Mean Difference 3.73, 95% CI (1.50, 5.96). Red cell transfusions, biomarkers of brain, kidney and myocardial injury, adverse events and healthcare costs were similar between the groups. </p> <h4>Conclusions</h4> <p>These results do not support the use of NIRS based algorithms for the personalised optimisation of cerebral oxygenation in adult cardiac surgery. </p> |
| spellingShingle | Rogers, C Stoica, S Ellis, L Stokes, E Wordsworth, S Dabner, L Clayton, G Downes, R Nicholson, E Bennett, S Angelini, G Reeves, B Murphy, G A randomised trial of near infra-red spectroscopy for the personalised optimisation of cerebral tissue oxygenation during cardiac surgery |
| title | A randomised trial of near infra-red spectroscopy for the personalised optimisation of cerebral tissue oxygenation during cardiac surgery |
| title_full | A randomised trial of near infra-red spectroscopy for the personalised optimisation of cerebral tissue oxygenation during cardiac surgery |
| title_fullStr | A randomised trial of near infra-red spectroscopy for the personalised optimisation of cerebral tissue oxygenation during cardiac surgery |
| title_full_unstemmed | A randomised trial of near infra-red spectroscopy for the personalised optimisation of cerebral tissue oxygenation during cardiac surgery |
| title_short | A randomised trial of near infra-red spectroscopy for the personalised optimisation of cerebral tissue oxygenation during cardiac surgery |
| title_sort | randomised trial of near infra red spectroscopy for the personalised optimisation of cerebral tissue oxygenation during cardiac surgery |
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