Understanding and Preventing Cerebral Oxygen Desaturation

Understanding the Risks of Cerebral Oxygen Desaturation During Surgical Procedures

Cerebral oxygen desaturation — compromised perfusion and oxygen delivery to the brain — is a common and serious event during cardiac surgery. It affects up to 25-37% of all cardiac surgery patients and up to 69-76% of high-risk cardiac surgery patients.1,2

This blog post discusses the risks, potential complications, and costs of cerebral oxygen desaturation. It also explains how regional oximetry and early detection of changes in a patient’s cerebral oxygenation and end organ perfusion allows you to intervene faster. And earlier intervention may reduce postoperative complications, improve patient outcomes, and lower the economic impact on your hospital.3-7

Postoperative Complications of Cerebral Desaturation

Numerous clinical studies have shown that cerebral oxygen desaturation can lead to significant postoperative complications. These include:

  • Higher rates of major operative morbidity and mortality (MOMM)4
  • Increased risk of postoperative cognitive decline3
  • More time on mechanical ventilation5
  • Longer hospital and ICU stays4-7

Further negative outcomes of cerebral desaturation during cardiac surgery can include neurologic injury3,6,7 and renal failure.4

The risks are real — understanding and preventing cerebral desaturation can help minimize postop complications.

Cost Considerations for Patients, Clinicians, and Hospitals

Surgical and postoperative complications from cerebral oxygen desaturation are costly in many ways. They can lead to additional procedures, longer ICU and hospital stays, and readmissions — and increase the cost of care:

  • Low mean intraoperative cerebral saturation during CABG procedures is associated with longer hospital stays, which can contribute up to $3,300 of additional cost per day4,8
  • CABG patients who experience prolonged desaturation have a threefold greater risk for hospital stays longer than 6 days.6

So what can you do to lessen the impact and reduce the costs of these potential adverse outcomes? Implement patient monitoring with regional oximetry, along with appropriate intervention.

Related: Get the facts about cerebral oxygen desaturation, which is common, costly, and debilitating.

Regional Oximetry and “First Alert” Indicators

Regional oximetry (or cerebral oximetry monitoring) solutions use near-infrared spectroscopy (NIRS) technology to provide a continuous noninvasive measure of hemoglobin oxygen saturation in the tissue beneath the sensor. Beyond providing this insight, NIRS cerebral oximetry allows clinicians to use the brain as an index organ to assess tissue perfusion and oxygenation of other vital organs.9

Regional oximetry solutions are highly responsive to changes in cerebral blood oxygen saturation — and can provide early alerts to indications of cerebral desaturation. The Society of Thoracic Surgeons (STS) National Database analyzed the intraoperative use of NIRS cerebral oximetry in cardiac surgical patients. The data strongly suggests that this monitoring frequently (23%) served as a “first alert” indicator of an intraoperative event that could lead to a potential adverse clinical outcome.9

Related: Read a paper about cerebral oximetry that explains NIRS and its clinical use, validation, and clinical outcomes.

Clinical Evidence Conclusions

Independent research has shown that 88% of cerebral desaturation events are reversible with standard clinical interventions.1 One study concludes that continual perfusion monitoring and immediate action to maintain optimal perfusion throughout the perioperative period can protect end-organ function. This strategy also improves patient outcomes after cardiac surgery.10 Other researchers have found that patients had a lower incidence of permanent stroke, less need for prolonged ventilation, and a shorter hospital stay — although patients in this cerebral oximetry intervention group were sicker and had more comorbidity.11

In a high-risk cardiac surgery population, cerebral desaturation as measured by cerebral oximetry was common. And it was successfully reversed in the majority of patients with an interventional protocol. Monitoring and intervention were associated with a reduction in the total cerebral desaturation load during surgery.1

The important takeaway? Monitoring cerebral oxygenation helps you detect ischemic events earlier — so you can intervene sooner and minimize postoperative complications.

Related: Read clinical study summaries that describe the study objectives, populations, results, and more. 

References:
1. 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.
2. 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.
3. 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.
4. 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.
5. Schon J, V S, Hanke T, et al. Cerebral oxygen saturation monitoring in on-pump cardiac surgery – A 1 year experience. Vol 132009.
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. Yao FS, Tseng CC, Ho CY, Levin SK, Illner P. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18(5):552-558.
8. Weiss AJ, Elixhauser A, Andrews RM. Characteristics of Operating Room Procedures in U.S. Hospitals, 2011: Statistical Brief #170. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014.
9. Based on internal Medtronic white paper #11-PM-0232(1), Cerebral oximetry is frequently a “first alert” indicator of adverse outcomes. April 2016.
10. Anastasiadis K, Antonitsis P, Deliopoulos A, Argiriadou H. A multidisciplinary perioperative strategy for attaining "more physiologic" cardiac surgery. Perfusion. 2017;32(6):446-453.
11. Goldman S, Sutter F, Ferdinand F, Trace C. Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. Heart Surg Forum. 2004;7(5):E376-381.

© 2019 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. 04/2019 —19-PM-00092

TOPIC: INVOS™ Cerebral/Somatic OximetryOperating Room

About the Author

Connor Fox

Connor Fox is a Product Specialist for BIS™ brain monitoring technology and INVOS™ regional oximeter at Medtronic.

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