title: Factors associated with a low initial cerebral oxygen saturation value in patients undergoing cardiac surgery.
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.
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan. qzh01063@nifty.com.
authors.forename: Kensuke
authors.identifier: http://orcid.org/0000-0002-5928-4867
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Department of Medical Engineering, Kitasato University Hospital, Sagamihara, Kanagawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kohira
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Shinzo
authors.initials: S
authors.lastname: Torii
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Horai
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Hirata
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Mishima
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sughimoto
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Hirotoki
authors.initials: H
authors.lastname: Ohkubo
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Irisawa
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Matsushiro
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Yurie
authors.initials: Y
authors.lastname: Miyata
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Tsuchida
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohtomo
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Kagami
authors.initials: K
authors.lastname: Miyaji
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D010092:Oximetry; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared
chemical_list: D006454:Hemoglobins
keywords: Cardiopulmonary bypass; Near-infrared spectroscopy; Regional cerebral oxygen saturation