Kelly Monthé-Sagan1, Marc-Olivier Fischer1, Vladimir Saplacan2, Jean-louis Gerard1, Jean-Luc Hanouz1, Jean-Luc Fellahi3. 1. Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, Caen, France. 2. Service de Chirurgie Cardiaque, CHU de Caen, Avenue de la Côte de Nacre, Caen, France. 3. Service d'Anesthésie-Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, Lyon, France. Electronic address: jean-luc.fellahi@chu-lyon.fr.
Abstract
PURPOSE: The diagnosis of microvascular dysfunction remains challenging after cardiac surgery. We hypothesized that peripheral near-infrared spectroscopy (NIRS) monitoring in combination with a vascular occlusion test could reliably assess postoperative microvascular dysfunction in that setting. MATERIALS AND METHODS: Twenty-two patients undergoing cardiac surgery with cardiopulmonary bypass and 10 healthy volunteers were prospectively investigated. Relevant NIRS parameters (regional tissue oxygen saturation, desaturation, and resaturation rates) were recorded the day before surgery (D-1), at the arrival in the intensive care unit (postoperative day [POD] 0) and on POD 1 and POD 2. RESULTS: No difference in NIRS parameters was found at baseline between healthy volunteers and cardiac surgical patients. Absolute values of regional tissue oxygen saturation significantly increased at POD 0 and POD 1 when compared with D-1: 78% (75%-81%) and 75% (73%-78%) vs 68% (64%-72%), P < .001. No statistical difference was evidenced within the postoperative period in desaturation and resaturation rates compared with D-1: desaturation rate, 0.11% · s(-1) (0.08-0.14) and 0.15% · s(-1) (0.08-0.22) vs 0.14% · s(-1) (0.10-0.17), P = .233, and resaturation rate, 0.76% · s(-1) (0.41-1.11) and 0.77% · s(-1) (0.53-1.02) vs 0.79% · s(-1) (0.61-0.97), P = .453. The use of postoperative norepinephrine infusion did not change the results. CONCLUSIONS: Peripheral NIRS monitoring in combination with a vascular occlusion test failed to assess cardiopulmonary bypass-induced microvascular dysfunction.
PURPOSE: The diagnosis of microvascular dysfunction remains challenging after cardiac surgery. We hypothesized that peripheral near-infrared spectroscopy (NIRS) monitoring in combination with a vascular occlusion test could reliably assess postoperative microvascular dysfunction in that setting. MATERIALS AND METHODS: Twenty-two patients undergoing cardiac surgery with cardiopulmonary bypass and 10 healthy volunteers were prospectively investigated. Relevant NIRS parameters (regional tissue oxygen saturation, desaturation, and resaturation rates) were recorded the day before surgery (D-1), at the arrival in the intensive care unit (postoperative day [POD] 0) and on POD 1 and POD 2. RESULTS: No difference in NIRS parameters was found at baseline between healthy volunteers and cardiac surgical patients. Absolute values of regional tissue oxygen saturation significantly increased at POD 0 and POD 1 when compared with D-1: 78% (75%-81%) and 75% (73%-78%) vs 68% (64%-72%), P < .001. No statistical difference was evidenced within the postoperative period in desaturation and resaturation rates compared with D-1: desaturation rate, 0.11% · s(-1) (0.08-0.14) and 0.15% · s(-1) (0.08-0.22) vs 0.14% · s(-1) (0.10-0.17), P = .233, and resaturation rate, 0.76% · s(-1) (0.41-1.11) and 0.77% · s(-1) (0.53-1.02) vs 0.79% · s(-1) (0.61-0.97), P = .453. The use of postoperative norepinephrine infusion did not change the results. CONCLUSIONS: Peripheral NIRS monitoring in combination with a vascular occlusion test failed to assess cardiopulmonary bypass-induced microvascular dysfunction.
Authors: William Fornier; Matthias Jacquet-Lagrèze; Thomas Collenot; Priscilla Teixeira; Philippe Portran; Rémi Schweizer; Michel Ovize; Jean-Luc Fellahi Journal: Crit Care Date: 2017-12-12 Impact factor: 9.097