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Journal of Artificial Organs

, Volume 20, Issue 2, pp 110–116 | Cite as

Factors associated with a low initial cerebral oxygen saturation value in patients undergoing cardiac surgery

  • Kensuke Kobayashi
  • Tadashi Kitamura
  • Satoshi Kohira
  • Shinzo Torii
  • Tetsuya Horai
  • Mitsuhiro Hirata
  • Toshiaki Mishima
  • Koichi Sughimoto
  • Hirotoki Ohkubo
  • Yusuke Irisawa
  • Takuya Matsushiro
  • Hidenori Hayashi
  • Yurie Miyata
  • Yuta Tsuchida
  • Naoki Ohtomo
  • Kagami Miyaji
Original Article Cardiopulmonary Bypass

Abstract

Regional cerebral oximetry using near-infrared spectroscopy device, an INVOS 5100 C (Medtronic, Minneapolis, MN, USA), during cardiac surgery aims to avoid perioperative neurological impairment, especially during cardiopulmonary bypass. However, it is not uncommon to encounter critically low initial cerebral regional oxygen saturation or a low value unresponsive to intervention. Therefore, it is important to identify factors associated with low saturation value other than true cerebral hypoxia. We investigated the relationship between preoperative regional cerebral oxygen saturation and clinical variables during cardiac surgery. From January 2013 to May 2016, 462 patients underwent elective cardiac surgery. Patient’s ≤12 years of age, with acute cerebral infarction, with previous intracranial hemorrhage or neurosurgery, with concomitant aortic surgery, and having off-pump coronary artery bypass surgery were excluded. The remaining 223 patients were monitored by intraoperative regional cerebral oximetry. Univariate analysis found that scalp-cortex distance, cerebrospinal fluid thickness, left ventricular ejection fraction, hemoglobin concentration, estimated glomerular filtration rate, and hemodialysis were significantly correlated with the initial regional oxygen saturation value. Multiple regression analysis revealed that scalp-cortex distance, left ventricular ejection fraction, hemoglobin, and hemodialysis remained as significant variables. A receiver operating characteristic analysis found that for a low initial regional oxygen saturation value of 40%, the thresholds of scalp-cortex distance, left ventricular ejection fraction, and hemoglobin concentration were 17.6 mm, 45.2%, and 7.5 g/dl, respectively. In conclusion, brain atrophy, poor left ventricular function, anemia, and hemodialysis were associated with low initial cerebral regional oxygen saturation values in adult cardiac surgery patients.

Keywords

Regional cerebral oxygen saturation Near-infrared spectroscopy Cardiopulmonary bypass 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

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Copyright information

© The Japanese Society for Artificial Organs 2017

Authors and Affiliations

  • Kensuke Kobayashi
    • 1
  • Tadashi Kitamura
    • 1
  • Satoshi Kohira
    • 2
  • Shinzo Torii
    • 1
  • Tetsuya Horai
    • 1
  • Mitsuhiro Hirata
    • 1
  • Toshiaki Mishima
    • 1
  • Koichi Sughimoto
    • 1
  • Hirotoki Ohkubo
    • 1
  • Yusuke Irisawa
    • 1
  • Takuya Matsushiro
    • 1
  • Hidenori Hayashi
    • 1
  • Yurie Miyata
    • 1
  • Yuta Tsuchida
    • 1
  • Naoki Ohtomo
    • 1
  • Kagami Miyaji
    • 1
  1. 1.Department of Cardiovascular SurgeryKitasato University School of MedicineSagamiharaJapan
  2. 2.Department of Medical EngineeringKitasato University HospitalSagamiharaJapan

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