Spatially resolved spectroscopy (NIRO-300) does not agree with jugular bulb oxygen saturation in patients undergoing warm bypass surgery

Abstract

Spatially troscopy does not resolved spec-(NIRO-300) agree with jugular bulb oxygen saturation in patients undergoing warm bypass surgery Purpose: Near infrared spectroscopy (NIRS) is a promising noninvasive method for continuous monitoring of cerebral oxygenation during cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to study the agreement between tissue oxygen index (TO o measured by spatially resolved spectroscopy (NIRO-300) and jugular bulb oxygen saturation (SjO2) in patients undergoing warm coronary bypass surgery.Methods: Seventeen patients undergoing warm coronary artery bypass surgery were studied. NIRS was continuously monitored and was averaged before CPB, five, 20, 40, 60 min on CPB, five minutes before end of CPB and ten minutes after CPB to coincide with SjO 2 measurements. Bypass temperature was maintained at 34-37°C.Results: Bland and Altman analysis showed a bias (TOI-SjO2) of-6.7%, and wide limits of agreement (from 16% to -28%) between the two methods. In addition, mean TOI was lower than mean SjO~ during and after CPB. We observed a statistically significant correlation between arterial carbon dioxide and SjO 2 measurements (r 2 0.33; P 0.0003), but the former did not correlate with TOI values (r 2 0.001; P 0.7).Conclusion: Our results demonstrate a lack of agreement between SjO 2 and TOI for monitoring cerebral oxygenation during cardiac surgery. We conclude that the two methods are not interchangeable. Objectif : La spectroscopie proche infrarouge (SPIR) est une m&hode non effractive et prometteuse de monitorage continu de I'oxyg4nation c&4brale utilis& en chirurgie cardiaque sous circulation extracorporelle (CEC). L'&ude actuelle voulait tester la concordance entre I'in

Transcutaneously measured near-infrared spectroscopic liver tissue oxygenation does not correlate with hepatic venous oxygenation in children

“…This seems to be an important issue, when NIRS tissue oxygenation is compared with oxygen saturation in the venous outflow of a specific organ or vascular region. 26 Third, it should be kept in mind that, in cyanotic cardiac patients, adaptive mechanisms regarding splanchnic blood flow and oxygen extraction may affect distribution of blood in the liver and may, therefore, be a contributing factor. Fourth, the fact that TOI was greatly influenced by systemic variables, such as arterial oxygen saturation, vascular resistances and, to a lesser extent, by inferior caval SO 2 and cardiac output, implies that the NIRS method used reflects global tissue oxygenation rather than tissue oxygenation in the liver.…”

Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy

“…While Kadoi et al 34 found that NIRS was more effective in detecting brain desaturation than SjVO 2 at certain stages of normothermic and hypothermic CABG and suggested that one should not rely solely on SjVO 2 during cardiopulmonary bypass (CPB), others 24,27,48 considered NIRS less sensitive than SjVO 2 . The sole randomized controlled trial 63 performed did not ascertain any difference in the number of neurological complications between patients who underwent NIRS monitoring and those who did not.…”

Validity of near‐infrared cerebral spectroscopy

“…However, it does have obvious limitations [2][3][4]; it detects regional cerebral oxygenation (small area under the optodes), the optical path length is difficult to quantify, and arterial and venous changes are not distinguished. The previous limitations were very clear in adult studies [2,4,5]. Indeed, our group [5] reported a significant bias with wide limits of agreement between jugular bulb oxygen saturation and tissue oxygen index monitored by NIRO 300 in adult patients undergoing coronary bypass surgery.…”

“…There is no doubt that more work is needed in this field and we thank the correspondents for their suggestions. .............................................................................................................................................................................................................. [4] and jugular venous [5] saturations in individuals, but the relationship is variable and inconsistent between subjects. In addition a number of methodological problems have been identified with NIRS including attenuation of the infrared signal by extracerebral tissues [6], and variability between devices [7].…”