High-Target Versus Low-Target Blood Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral Injury in Cardiac Surgery Patients

Vedel, A; Holmgaard, Frederik; Rasmussen, Lars S.; Langkilde, Annika Reynberg; Paulson, Olaf B.; Lange, Theis; Thomsen, Carsten; Olsen, Peter Skov; Ravn, Hanne Berg; Nilssøn, Jens

doi:10.1161/circulationaha.117.030308

Cited by 158 publications

(124 citation statements)

References 34 publications

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“…Indeed, as long as CO is fixed, MAP may be less important with regard to the incidence of silent strokes and cognitive function after cardiac surgery. 11 Chaix et al 6 demonstrate some limitations of TCD, including when only able to obtain velocities intermittently and not in all patients. Furthermore, it is assumed that the diameter of the ultrasound-interrogated vessel is unchanging over time and in different conditions.…”

Section: Is Cerebral Monitoring Useful? Focus Must Shift From Mere Obmentioning

confidence: 99%

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Is cerebral monitoring useful? Focus must shift from mere observation to testing interventions

Sørensen

2020

Acta Anaesthesiol Scand

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Section: Is Cerebral Monitoring Useful? Focus Must Shift From Mere Obmentioning

confidence: 99%

“…The reduction in CO during induction of anaesthesia was twice as large in high‐risk patients compared to low‐risk patients, underlining that CO is an important determinant of cerebral blood flow. Indeed, as long as CO is fixed, MAP may be less important with regard to the incidence of silent strokes and cognitive function after cardiac surgery …”

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confidence: 99%

Is cerebral monitoring useful? Focus must shift from mere observation to testing interventions

Sørensen

2020

Acta Anaesthesiol Scand

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“…The study protocol and primary outcome result has been published previously. 3,8 The PPCI trial was a single-centre, parallel group, 1:1 randomised trial investigating the effect of different MAP levels during CPB on cerebral complications after cardiac surgery.…”

Section: Trial Designmentioning

confidence: 99%

“…Detailed protocols for interventions, anaesthesia, and CPB procedures, and the primary outcome from the PPCI trial have been published previously. 3,8 DWI evaluated lesions and NIRS measurements were both prespecified outcomes in the PPCI trial and the data analysis exploring the association between NIRS readings and DWI measures was specified before initiation of analysis.…”

Section: Study Settingmentioning

confidence: 99%

“…1,2 Diffusion weighted magnetic resonance imaging (DWI) has revealed that new cerebral ischaemic lesions can occur in more than 50% of patients undergoing cardiac surgery with the use of cardiopulmonary bypass (CPB). 3 To identify patients at risk of cerebral complications, near infrared spectroscopy (NIRS) has gained increasing popularity to monitor regional cerebral tissue oxygenation (rScO 2 ) noninvasively, 4 thereby enabling the physician to counteract a potential ominous effect of cerebral desaturation. Despite this logical approach, intervention algorithms to alleviate cerebral desaturation have in previous randomised studies reported conflicting results, not only in the individual studies, but also in recent meta-analyses.…”

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Differences in regional cerebral oximetry during cardiac surgery for patients with or without postoperative cerebral ischaemic lesions evaluated by magnetic resonance imaging

Holmgaard

Vedel

Langkilde

et al. 2018

British Journal of Anaesthesia

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Background: Near infrared spectroscopy (NIRS) is widely used to monitor regional cerebral tissue oxygenation (rScO 2 ). We compared rScO 2 values during cardiac surgery in patients with or without new cerebral ischaemic lesions on diffusion weighted magnetic resonance imaging (DWI). We hypothesised patients with new cerebral lesions would have impaired tissue oxygenation reflected in their rScO 2 values. Methods: NIRS and DWI data were collected in 152 elective cardiac surgery patients. Absolute rScO 2 values, duration of desaturation below thresholds (baseline, 10%, and 20%), and accumulated cerebral desaturation load were compared between patients with or without new cerebral lesions on DWI. Primary outcome was time below 10% from rScO 2 baseline. Results: The time below 10% from rScO 2 baseline was significantly longer for patients with new cerebral lesions than for patients without [median (inter-quartile range): 11.0 (0.4; 37.5) min vs 1.8 inter-quartile range: (0.05; 20.9) min, P¼0.02]. Furthermore, they had a higher accumulated desaturation load below baseline (P¼0.02) and 10% below baseline (P¼0.02). Finally, their absolute minimum rScO 2 value was significantly lower (P¼0.01). However, the frequency of patients with desaturation below 10% and 20% was comparable between patients with and without new cerebral lesions. Receiveroperating characteristic curve analysis did not identify a clear-cut critical threshold among the investigated rScO 2 variables. Conclusions: Use of NIRS identified significant group differences in rScO 2 values between patients with or without new ischaemic lesions. However, a critical threshold could not be identified because of a high variation in NIRS values across both groups.

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Comparison of Machine Learning Models Including Preoperative, Intraoperative, and Postoperative Data and Mortality After Cardiac Surgery

et al. 2022

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ImportanceA variety of perioperative risk factors are associated with postoperative mortality risk. However, the relative contribution of routinely collected intraoperative clinical parameters to short-term and long-term mortality remains understudied.ObjectiveTo examine the performance of multiple machine learning models with data from different perioperative periods to predict 30-day, 1-year, and 5-year mortality and investigate factors that contribute to these predictions.Design, Setting, and ParticipantsIn this prognostic study using prospectively collected data, risk prediction models were developed for short-term and long-term mortality after cardiac surgery. Included participants were adult patients undergoing a first-time valve operation, coronary artery bypass grafting, or a combination of both between 1997 and 2017 in a single center, the University Medical Centre Groningen in the Netherlands. Mortality data were obtained in November 2017. Data analysis took place between February 2020 and August 2021.ExposureCardiac surgery.Main Outcomes and MeasuresPostoperative mortality rates at 30 days, 1 year, and 5 years were the primary outcomes. The area under the receiver operating characteristic curve (AUROC) was used to assess discrimination. The contribution of all preoperative, intraoperative hemodynamic and temperature, and postoperative factors to mortality was investigated using Shapley additive explanations (SHAP) values.ResultsData from 9415 patients who underwent cardiac surgery (median [IQR] age, 68 [60-74] years; 2554 [27.1%] women) were included. Overall mortality rates at 30 days, 1 year, and 5 years were 268 patients (2.8%), 420 patients (4.5%), and 612 patients (6.5%), respectively. Models including preoperative, intraoperative, and postoperative data achieved AUROC values of 0.82 (95% CI, 0.78-0.86), 0.81 (95% CI, 0.77-0.85), and 0.80 (95% CI, 0.75-0.84) for 30-day, 1-year, and 5-year mortality, respectively. Models including only postoperative data performed similarly (30 days: 0.78 [95% CI, 0.73-0.82]; 1 year: 0.79 [95% CI, 0.74-0.83]; 5 years: 0.77 [95% CI, 0.73-0.82]). However, models based on all perioperative data provided less clinically usable predictions, with lower detection rates; for example, postoperative models identified a high-risk group with a 2.8-fold increase in risk for 5-year mortality (4.1 [95% CI, 3.3-5.1]) vs an increase of 11.3 (95% CI, 6.8-18.7) for the high-risk group identified by the full perioperative model. Postoperative markers associated with metabolic dysfunction and decreased kidney function were the main factors contributing to mortality risk.Conclusions and RelevanceThis study found that the addition of continuous intraoperative hemodynamic and temperature data to postoperative data was not associated with improved machine learning–based identification of patients at increased risk of short-term and long-term mortality after cardiac operations.

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High-Target Versus Low-Target Blood Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral Injury in Cardiac Surgery Patients

Abstract: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02185885.

Cited by 158 publications

References 34 publications

Is cerebral monitoring useful? Focus must shift from mere observation to testing interventions

Is cerebral monitoring useful? Focus must shift from mere observation to testing interventions

Differences in regional cerebral oximetry during cardiac surgery for patients with or without postoperative cerebral ischaemic lesions evaluated by magnetic resonance imaging

Comparison of Machine Learning Models Including Preoperative, Intraoperative, and Postoperative Data and Mortality After Cardiac Surgery

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