Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study.
BACKGROUND
Cerebral deoxygenation is associated with various adverse systemic outcomes. We hypothesized, by using the brain as an index organ, that interventions to improve cerebral oxygenation would have systemic benefits in cardiac surgical patients.


METHODS
Two-hundred coronary artery bypass patients were randomized to either intraoperative cerebral regional oxygen saturation (rSO2) monitoring with active display and treatment intervention protocol (intervention, n = 100), or underwent blinded rSO2 monitoring (control, n = 100). Predefined clinical outcomes were assessed by a blinded observer.


RESULTS
Significantly more patients in the control group demonstrated prolonged cerebral desaturation (P = 0.014) and longer duration in the intensive care unit (P = 0.029) versus intervention patients. There was no difference in overall incidence of adverse complications, but significantly more control patients had major organ morbidity or mortality (death, ventilation >48 h, stroke, myocardial infarction, return for re-exploration) versus intervention group patients (P = 0.048). Patients experiencing major organ morbidity or mortality had lower baseline and mean rSO2, more cerebral desaturations and longer lengths of stay in the intensive care unit and postoperative hospitalization, than patients without such complications. There was a significant (r(2) = 0.29) inverse correlation between intraoperative rSO2 and duration of postoperative hospitalization in patients requiring > or =10 days postoperative length of stay.


CONCLUSIONS
Monitoring cerebral rSO2 in coronary artery bypass patients avoids profound cerebral desaturation and is associated with significantly fewer incidences of major organ dysfunction.
Murkin
John M
JM
Department of Anesthesiology and Perioperative Medicine, University Hospital-LHSC, University of Western Ontario, London, Ontario, Canada. jmurkin@uwo.ca
Adams
Sandra J
SJ
Novick
Richard J
RJ
Quantz
Mackenzie
M
Bainbridge
Daniel
D
Iglesias
Ivan
I
Cleland
Andrew
A
Schaefer
Betsy
B
Irwin
Beverly
B
Fox
Stephanie
S
D000328:Adult; D001921:Brain / Q000378:metabolism*; D002315:Cardiopulmonary Bypass; D002340:Carotid Artery Diseases / Q000453:epidemiology; D001026:Coronary Artery Bypass; D006801:Humans; D007258:Informed Consent; D007430:Intraoperative Care; D016343:Monitoring, Intraoperative; D008991:Monitoring, Physiologic; D009203:Myocardial Infarction / Q000601:surgery; D010101:Oxygen Consumption; D011446:Prospective Studies