Abstract
Purpose
Near infrared spectroscopy (NIRS) is a promising noninvasive method for continuous monitoring of cerebral oxygenation during cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to study the agreement between tissue oxygen index (TOI) measured by spatially resolved spectroscopy (NIRO- 300) and jugular bulb oxygen saturation (SjO2) in patients undergoing warm coronary bypass surgery.
Methods
Seventeen patients undergoing warm coronary artery bypass surgery were studied. NIRS was continuously monitored and was averaged before CPB, five, 20, 40, 60 min on CPB, five minutes before end of CPB and ten minutes after CPB to coincide with SjO2 measurements. Bypass temperature was maintained at 34–37°C.
Results
Bland and Altman analysis showed a bias (TOI-SjO2) of- 6.7%, and wide limits of agreement (from 16% to –28%) between the two methods. In addition, mean TOI was lower than mean SjO2 during and after CPB. We observed a statistically significant correlation between arterial carbon dioxide and SjO2 measurements (r2=0.33;P=0.0003), but the former did not correlate with TOI values (r2=0.001;P=0.7).
Conclusion
Our results demonstrate a lack of agreement between SjO2 and TOI for monitoring cerebral oxygenation during cardiac surgery. We conclude that the two methods are not interchangeable.
Résumé
Objectif
La spectroscope proche infrarouge (SPIR) est une méthode non effractive et prometteuse de monitorage continu de l’oxygénation cérébraie utilisée en chirurgie cardiaque sous circulation extracorporelle (CEC). L’étude actuelle voulait tester la concordance entre l’index d’oxygène tissuiaire (I0T) mesuré par spectroscope à résoiution spatiaie (NIRO- 300) et la saturation en oxygène du golfe de la jugulaire (SjO2) pendant une cardioplégie chaude.
Méthode
Dix sept patients subissant un pontage coronarien sous cardiopiégie chaude ont été étudiés. La SPIR a été surveillée continûment et ajustée avant la CEC, à cinq, 20, 40, 60 min pendant la CEC, cinq minutes avant la fin de la CEC et dix minutes après pour coïncider avec les mesures moyennes de SjO2. La température a été maintenue à 34– 37°C pendant la CEC.
Résultats
L’analyse de Bland et Altman a montré un biais (IOT- SjO2) de − 6,7 % et de larges limites de concordance (de 16% à − 28 %) entre les deux méthodes. De plus, l’IOT moyen était plus bas que la SjO2 moyenne pendant et après la CEC. Il existait une corrélation statistiquement significative entre le gaz carbonique artériel et les mesures de SjO2(r2 = 0,33; P = 0,0003), mais non entre le CO2 et les valeurs de l’IOT (r2 = 0,001; P = 0,7).
Conclusion
Nos résultats démontrent un manque de concordance entre la SjO2 et l’IOT lors du monitorage de l’oxygénation cérébrale pendant une intervention cardiaque. Les deux méthodes ne sont donc pas interchangeables.
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Ali, M.S., Harmer, M., Vaughan, R.S. et al. Spatially resolved spectroscopy (NIRO-300) does not agree with jugular bulb oxygen saturation in patients undergoing warm bypass surgery. Can J Anesth 48, 497–501 (2001). https://doi.org/10.1007/BF03028317
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DOI: https://doi.org/10.1007/BF03028317