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Monitoring Cardiac Surgical Patients with the INVOS™ Cerebral Oximetry System

Guiding cardiac patients care with INVOS™ cerebral oximetry system

Intraoperative cerebral oxygen desaturation in cardiac surgical patients is surprisingly common and associated with worsened postoperative outcome.2,3  Multiple controlled trials have demonstrated that INVOS™ cerebral oximetry-guided care can reverse cerebral desaturation and improve postoperative outcome.1,2

The burden of cerebral desaturation in cardiac surgical patients

 The incidence of cerebral desaturation ranges from 69.9-76% in high-risk cardiac surgery patients.3 The implication of these desaturation events is significant, as multiple clinical trials have demonstrated the adverse influence of these events on postoperative patient outcome. 

  • de Tournay-Jetté et al.  determined that CABG patients who suffered cerebral desaturation is associated with early and late post-operative cognitive dysfunction4
  • Murkin et al. found that among CABG patients suffering postoperative major organ morbidity and mortality had lower cerebral oximetry values.2
  • Schoen et al. found that elective cardiac surgery patients with intraoperative cerebral desaturation were at greater risk for worsened early postoperative cognitive function scores5
  • Slater et al. determined that CABG patients with prolonged desaturation are more than 2.5 times more likely to stay in the hospital > 6 days6

Reversing cerebral desaturation

In 2007, Denault and Murkin et al. published an interventional algorithm to assist clinicians in reversing cerebral desaturation events.2,7 The interventions in the algorithm target factors that regularly influence cerebral oxygen supply and demand such as perfusion pressure, cardiac output, arterial oxygen content, partial pressure of carbon dioxide (PaCO2), and cerebral metabolic rate.  Studies have demonstrated that an interventional algorithm coupled with cerebral oximetry monitoring can reverse 88% of all desaturation events, resulting in a 78% reduction in burden of intraoperative cerebral desaturation.3

Denault and Murkin et al. interventional algorithm to assist clinicians in reversing cerebral desaturation event

Improving outcome with INVOS™ cerebral oximetry guided care

In controlled trials, interventions delivered based on cerebral oximetry resulted in improved outcome in cardiac surgical patients.

1. Colak Z, Borojevic M, Bogovic A, Ivancan V, Biocina B, Majeric-Kogler V. Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after coronary artery bypass surgery: a randomized, prospective study. Eur J Cardiothorac Surg. 2015;47(3):447-454.
2. Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg. 2007;104(1):51-58.
3. Deschamps A, Lambert J, Couture P, et al. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. J Cardiothorac Vasc Anesth. 2013;27(6):1260-1266.
4. de Tournay-Jette E, Dupuis G, Bherer L, Deschamps A, Cartier R, Denault A. The relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction in elderly patients after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2011;25(1):95-104.
5. Schoen J, Husemann L, Tiemeyer C, et al. Cognitive function after sevoflurane- vs propofol-based anaesthesia for on-pump cardiac surgery: a randomized controlled trial. Br J Anaesth. 2011;106(6):840-850.
6. Slater JP, Guarino T, Stack J, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009;87(1):36-44; discussion 44-35.
7. Denault A, Deschamps A, Murkin JM. A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth. 2007;11(4):274-281.
8. Vretzakis G, Georgopoulou S, Stamoulis K, et al. Monitoring of brain oxygen saturation (INVOS) in a protocol to direct blood transfusions during cardiac surgery: a prospective randomized clinical trial. J Cardiothorac Surg. 2013;8:145.
9. Anastasiadis K, Antonitsis P, Deliopoulos A, Argiriadou H. A multidisciplinary perioperative strategy for attaining "more physiologic" cardiac surgery. Perfusion. 2017;32(6):446-453.

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TOPIC: INVOS™ Cerebral/Somatic OximetryOperating Room

About the Author

Scott Stoneburner is a Principle Medical Affairs Specialist who focuses on disseminating evidence-based information for Medtronic’s Respiratory and Monitoring Solutions franchise.

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