title: Reversal of decreases in cerebral saturation in high-risk cardiac surgery.
abstract: OBJECTIVE
  To measure the incidence of cerebral desaturation during high-risk cardiac surgery and to evaluate strategies to reverse cerebral desaturation.
  
  
  METHODS
  Prospective observational study followed by a randomized controlled study with 1 intervention group and 1 control group.
  
  
  METHODS
  Tertiary care center specialized in cardiac surgery.
  
  
  METHODS
  All patients were scheduled for high-risk cardiac surgery, 279 consecutive patients in the prospective study and 48 patients in the randomized study.
  
  
  METHODS
  An algorithmic approach of strategies to reverse cerebral desaturation. In the control group, no attempts were made to reverse cerebral desaturation.
  
  
  RESULTS
  Cerebral saturation was measured using near-infrared reflectance spectroscopy. A decrease of 20% from baseline for 15 seconds defined cerebral desaturation. The success or failure of the interventions was noted. Demographic data were collected. Models for predicting the probability and the reversal of cerebral desaturation were based on multiple logistic regressions. In the randomized study, 12 hours of measurements were continued in the intensive care unit without interventions. Differences in desaturation load (% desaturation × time) were compared between groups. Half of the high-risk patients had cerebral desaturation that could be reversed 88% of the time. Interventions resulted in smaller desaturation loads in the operating room and in the intensive care unit.
  
  
  CONCLUSIONS
  Cerebral desaturation in high-risk cardiac surgery is frequent but can be reversed most of the time resulting in a smaller desaturation load. A large randomized study will be needed to measure the impact of reversing cerebral desaturation on patient's outcome.
authors.affiliation: Anesthesiology, Montreal Heart Institute. Electronic address: a.deschamps@umontreal.ca.
authors.forename: Alain
authors.initials: A
authors.lastname: Deschamps
authors.forename: Jean
authors.initials: J
authors.lastname: Lambert
authors.forename: Pierre
authors.initials: P
authors.lastname: Couture
authors.forename: Antoine
authors.initials: A
authors.lastname: Rochon
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Lebon
authors.forename: Christian
authors.initials: C
authors.lastname: Ayoub
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cogan
authors.forename: André
authors.initials: A
authors.lastname: Denault
mesh_terms: D000368:Aged; D000465:Algorithms; D001923:Brain Chemistry / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003422:Critical Care; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: NIRS; algorithm; cardiac surgery; cerebral desaturation; cerebral oxygen saturation; high-risk patients; intervention to reverse cerebral desaturation; near-infrared spectroscopy; prospective study; randomized study