Regional cerebral oxygen saturation monitoring for predicting interventional outcomes in patients following out-of-hospital cardiac arrest of presumed cardiac cause: A prospective, observational, multicentre study

Nishiyama, Kei; Ito, Noritoshi; Orita, Tomohiko; Hayashida, Kei; Arimoto, Hideki; Beppu, Satoru; Abe, Mitsuru; Unoki, Takashi; Endo, Tomoyuki; Murai, Akira; Hatada, Takeshi; Yamada, Noriaki; Mizobuchi, Masahiro; Himeno, Hideo; Okuchi, Kazuo; Yasuda, Hideto; Mochizuki, Toshiaki; Shiga, Kazuhiro; Kikuchi, Masatoshi; Tsujimura, Yuka; Hatanaka, Tetsuo; Nagao, Ken

doi:10.1016/j.resuscitation.2015.07.049

Cited by 44 publications

(35 citation statements)

References 23 publications

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“…Despite this, HD patients frequently suffer from severe anemia caused by various hemorrhagic disorders [2]; therefore, intradialytic blood transfusion is sometimes performed to improve Hb levels in HD patients with severe anemia. Recently, near-infrared spectroscopy (NIRS) has been used to measure regional oxygen saturation (rSO 2 ), which is a real-time tissue oxygenation marker [3, 4, 5]. In particular, cerebral rSO 2 values were significantly lower in HD patients than in healthy controls [6, 7], and the Hb increase induced by ultrafiltration during HD did not lead to improvement of cerebral rSO 2 values [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Changes in Cerebral Oxygenation Associated with Intradialytic Blood Transfusion in Patients with Severe Anemia Undergoing Hemodialysis

Ookawara

Ueda

et al. 2017

Nephron Extra

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Background: Hemodialysis (HD) patients frequently suffer from severe anemia caused by various hemorrhagic disorders in addition to renal anemia. Intradialytic blood transfusion is sometimes performed; however, the cerebral oxygenation changes associated with this procedure remain unclear. Methods: Sixteen HD patients with severe anemia who required intradialytic blood transfusion were included (12 men and 4 women; mean age, 64.8 ± 9.8 years). Cerebral regional oxygen saturation (rSO₂) was monitored using near-infrared spectroscopy, and cerebral fractional oxygen extraction (FOE) was calculated before and after HD. Twenty-five HD patients with well-maintained hemoglobin (Hb) levels were included as a control group. Results: Cerebral rSO₂ values were significantly lower in HD patients with severe anemia than in the control group (42.4 ± 9.9 vs. 52.5 ± 8.5%, p = 0.001). Following intradialytic blood transfusion (385 ± 140 mL of concentrated red blood cells), Hb levels significantly increased (from 7.2 ± 0.9 to 9.1 ± 1.1 g/dL, p < 0.001), and cerebral rSO₂ values significantly improved after HD (from 42.4 ± 9.9 to 46.3 ± 9.0%, p < 0.001). Cerebral FOE values before HD in patients with severe anemia were significantly higher than those in the control group (severe anemia, 0.56 ± 0.10; controls, 0.45 ± 0.08; p < 0.001). After HD with intradialytic blood transfusion, these values significantly decreased (0.52 ± 0.09 after HD versus 0.56 ± 0.10 before HD, p = 0.002). Conclusion: HD patients with severe anemia represented cerebral oxygen metabolism deterioration, which could be significantly improved by intradialytic blood transfusion.

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Section: Introductionmentioning

confidence: 99%

Changes in Cerebral Oxygenation Associated with Intradialytic Blood Transfusion in Patients with Severe Anemia Undergoing Hemodialysis

Ookawara

Ueda

et al. 2017

Nephron Extra

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“…The measurement of cerebral rSO 2 by NIRS has recently been performed in various clinical settings, including cardiovascular surgery, pediatrics, and dialysis [3][4][5][6][7][8][16][17][18]. We therefore, reviewed the literature for reports of cerebral rSO 2 values in dialysis patients (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…In particular, cerebral rSO 2 was measured in patients in various clinical settings, including hemodialysis (HD) patients [3][4][5][6][7][8]. It would be considered important to maintain cerebral rSO 2 levels because that low cerebral rSO 2 has been associated with cognitive impairment in patients with chronic kidney disease (CKD) [5,8] and poor neurologic outcomes in post-cardiac arrest patients [7]. We aimed to examine the associations between changes in cerebral rSO 2 and those in systemic oxygenation using the measurement of peripheral arterial oxygen saturation (SpO 2 %) in a patient undergoing HD with SAS.…”

Section: Introductionmentioning

confidence: 99%

Sleep apnea syndrome caused lowering of cerebral oxygenation in a hemodialysis patient: a case report and literature review

Ookawara

Fueki³

et al. 2018

Ren Replace Ther

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Background: Sleep apnea syndrome (SAS) is a sleep disturbance, which is frequently comorbid in dialysis patients. SAS induces hypoxia, and therefore, systemic and cerebral oxygenation would be low. Near-infrared spectroscopy (NIRS) has recently been used to measure regional saturation of oxygen (rSO 2), as a marker of tissue oxygenation. Although cerebral rSO 2 was measured in patients in various clinical settings, few reports have previously shown the associations of changes in cerebral rSO 2 and systemic oxygenation using measurement of peripheral arterial oxygen saturation (SpO 2) in patients undergoing hemodialysis (HD) with SAS. We herein report a first HD case with SASinduced reduction in cerebral oxygenation during sleep. Case presentation: A 74-year-old woman underwent HD therapy for 1 month, because of advanced CKD caused by hypertension and obesity. In addition, she was diagnosed with obstructive sleep apnea with polysomnography about 4 years prior. Her apnea-hypopnea index (AHI) was 77.5 per hour, and therefore, continuous positive airway pressure (CPAP) was started. Thereafter, her AHI was improved to 3 to 6 per hour. However, she discontinued CPAP therapy at HD initiation. Since her oxygenation without CPAP would deteriorate, we evaluated her SpO 2 and cerebral rSO 2 by NIRS monitoring during sleep. We confirmed the deterioration in cerebral rSO 2 according to the SpO 2 decrease, and furthermore, the improvement in cerebral rSO 2 was apparently delayed even after the improvement in her SpO 2. The patient's cerebral oxygenation under CPAP therapy could not be evaluated because she refused to receive CPAP therapy after HD initiation. Therefore, as a comparison, we evaluated a 69-year-old male HD patient without SAS and found that in contrast to a patient with SAS, his SpO 2 and cerebral rSO 2 were maintained throughout sleep. Conclusion: We observed deterioration in cerebral oxygenation during sleep in addition to a decrease in systemic oxygenation in a patient with SAS undergoing HD. Real-time cerebral NIRS monitoring during sleep might be a useful method for detection of SAS.

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“…On the other hand, it may increase SjO2 because good 90-day neurologic outcome with a sensitivity of 81% and specificity of 96% in patients with OHCA of presumed cardiac origin. 15 Another study reported that only 2 of 446 (0.4%) patients had a good 90-day outcome if their rSO2 was low (15%) on arrival at the hospital. 16 Prediction Models Consisting of Multiple Parameters Prediction models of neurologic recovery after OHCA have been developed combining several factors.…”

Section: Cbf and Metabolismmentioning

confidence: 98%

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

Nakashima

Hifumi

Kawakita

et al. 2017

Circ J

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The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia. We reviewed the literature and the latest research about the following issues and propose practical care recommendations. Issues are (1) prediction of TTM candidate on admission, (2) cerebral blood flow and metabolism and target value of them, (3) seizure management using continuous electroencephalography, (4) target value of hemodynamic stabilization and its method, (5) management and analysis of respiration, (6) sedation and its monitoring, (7) shivering control and its monitoring, and (8) glucose management. We hope to establish standards of neurocritical care to optimize brain function and produce a favorable neurologic outcome.

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Regional cerebral oxygen saturation monitoring for predicting interventional outcomes in patients following out-of-hospital cardiac arrest of presumed cardiac cause: A prospective, observational, multicentre study

Abstract: rSO2 is a good indicator of 90-day neurologic outcomes for post-cardiac arrest intervention patients.

Cited by 44 publications

References 23 publications

Changes in Cerebral Oxygenation Associated with Intradialytic Blood Transfusion in Patients with Severe Anemia Undergoing Hemodialysis

Changes in Cerebral Oxygenation Associated with Intradialytic Blood Transfusion in Patients with Severe Anemia Undergoing Hemodialysis

Sleep apnea syndrome caused lowering of cerebral oxygenation in a hemodialysis patient: a case report and literature review

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

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