title: Survey of the clinical assessment and utility of near-infrared cerebral oximetry in cardiac surgery.
abstract: OBJECTIVE
  Near-infrared cerebral oximetry increasingly is used for monitoring during cardiac surgery. Nonetheless, the scientific basis for incorporating this technology into clinical practice, the indications for when to do so, and standard diagnostic and treatment algorithms for defining abnormal values are yet to be rigorously defined. The authors hypothesized that there would be (1) variation in clinical use and practices for near-infrared spectroscopy (NIRS), and (2) variation in management of patients when clinicians are provided with NIRS information. In order to test this hypothesis, they sought to assess the nature and strength of response heterogeneity among anesthesiologists and cardiac perfusionists when provided with cardiac surgery patient scenarios and cerebral oximetry data.
  
  
  METHODS
  A prospectively collected survey.
  
  
  METHODS
  A hospital-based, multi-institutional, multinational study.
  
  
  METHODS
  By e-mail, the authors surveyed the membership of the Society of Cardiovascular Anesthesiologists and the online Cardiovascular Perfusion Forum.
  
  
  METHODS
  This survey was focused on ascertaining what actions clinicians would take in each scenario, given case information and cerebral oximetry tracings. Questions were based on 11 patient scenarios selected to represent small, large, symmetric, or asymmetric decreases in measured regional cerebral oxygen saturation (rScO2) encountered during cardiac surgery. Information on the respondents' (n = 796; 73% anesthesiologists) clinical practice, demography, and cerebral oximetry utilization was collected. An index of dispersion was used to assess response heterogeneity overall and within demographic subgroups.
  
  
  RESULTS
  The majority of respondents indicated that cerebral oximetry monitoring was either useful or an essential monitor, especially perfusionists and clinicians who used cerebral oximetry most frequently. There were marked differences in responses between perfusionists and anesthesiologists for 4 of the 6 scenarios (p<0.005 for each of these 4 scenarios) occurring during cardiopulmonary bypass. Scenarios having greatest rScO2 reduction or asymmetry in rScO2 were associated with the highest dispersion, indicating least agreement in management. Scenarios with mild or moderate rScO2 reduction were associated with the lowest dispersion, indicating greater agreement in management.
  
  
  CONCLUSIONS
  Although experimental data gradually are accumulating to support the role for cerebral oximetry monitoring during cardiac surgery, the results of the present survey support the view that its role remains poorly defined, and consensus for its appropriate use is lacking. Importantly, the authors observed marked variation in the use, perceived utility, and management of patients for 4 of the 6 CPB scenarios between perfusionists and anesthesiologists who share the management of CPB. These findings support the need for well-designed, adequately-powered clinical trials examining the value of this technology.
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: David G
authors.initials: DG
authors.lastname: Zacharias
authors.affiliation: Cape Cod Hospital, Hyannis, MA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Lilly
authors.affiliation: Cape Cod Hospital, Hyannis, MA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Shaw
authors.affiliation: Cape Cod Hospital, Hyannis, MA.
authors.forename: Paul
authors.initials: P
authors.lastname: Pirundini
authors.affiliation: Cape Cod Hospital, Hyannis, MA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Rizzo
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: body@zeus.bwh.harvard.edu.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Body
authors.affiliation: SNTL Statistics Research and Consulting, Barcelona, Spain.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Longford
mesh_terms: D000328:Adult; D001011:Aorta / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D019538:Health Care Surveys; D006324:Heart Arrest, Induced; D006801:Humans; D010092:Oximetry / Q000379:methods / Q000706:statistics & numerical data*; D010100:Oxygen / Q000097:blood; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D019265:Spectroscopy, Near-Infrared / Q000379:methods / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery / Q000193:education / Q000706:statistics & numerical data*
chemical_list: D010100:Oxygen
keywords: NIRS; cardiac surgery; cardiopulmonary bypass; cerebral oximetry; complications