PMID- 15799908
OWN - NLM
STAT- MEDLINE
DCOM- 20061213
LR  - 20220408
IS  - 1522-6662 (Electronic)
IS  - 1098-3511 (Linking)
VI  - 7
IP  - 5
DP  - 2004
TI  - Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral 
      oximetry decreases the incidence of stroke for cardiac surgical patients.
PG  - E376-81
AB  - BACKGROUND: A recent study demonstrated that almost 75% of strokes after coronary 
      artery revascularization surgery occur in patients classified preoperatively as 
      low to medium risk. Thus, despite the use of risk classification, most strokes 
      can occur when not expected. We hypothesized that optimization of cerebral oxygen 
      delivery variables by using noninvasive cerebral oximetry could reduce the 
      incidence of stroke. METHODS: Cerebral oximetry was used by all surgeons to 
      monitor cerebral oxygen saturation in all cardiac surgery patients from January 
      1, 2002, until June 30, 2003 (n = 1034; 18 months, treatment group). Cerebral 
      oxygen delivery was optimized during surgery by modifying oxygen delivery and 
      consumption variables to maintain oximetry values at or near the patient's 
      preinduction baseline. Stroke was defined according to guidelines of the Society 
      of Thoracic Surgeons. The incidence of stroke in the treatment group was compared 
      with that for patients who underwent cardiac surgery between July 1, 2000, and 
      December 31, 2001, (n = 1245; 18 months, control group) before cerebral oximetry 
      was incorporated. RESULTS: Age and sex distribution were similar in the 2 groups. 
      The study group had significantly more patients in New York Heart Association 
      (NYHA) classes III and IV than the control group, and patients in the study group 
      were sicker overall. Despite this difference, the study group overall had fewer 
      permanent strokes (10 [0.97%] versus 25 [2.5%]; P < .044). This difference 
      remained significant when the results were controlled for NYHA class and on-pump 
      or off-pump surgery. When the patients were examined by NYHA class, the 
      proportion of patients requiring prolonged ventilation was significantly smaller 
      in the study group (6.8% versus 10.6%; P < .0014), as was the length of hospital 
      stay (P < .046). CONCLUSIONS: The treatment group, which underwent all cardiac 
      surgeries with optimized cerebral oxygen delivery using cerebral oximetry 
      monitoring, demonstrated a significantly lower incidence of permanent stroke. 
      Because our study is retrospective, a prospective randomized trial is warranted.
FAU - Goldman, Scott
AU  - Goldman S
AD  - Division of Thoracic and Cardiovascular Surgery, Main Line Health Heart Center - 
      The Lankenau Hospital, and Institute for Medical Research, Wynnewood, 
      Pennsylvania 19026, USA. goldmans@mlhs.org
FAU - Sutter, Francis
AU  - Sutter F
FAU - Ferdinand, Francis
AU  - Ferdinand F
FAU - Trace, Candace
AU  - Trace C
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Aged
MH  - Brain/*blood supply/*metabolism
MH  - Cardiac Surgical Procedures/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Monitoring, Intraoperative/methods/statistics & numerical data
MH  - Oximetry/methods/*statistics & numerical data
MH  - Oxygen/*analysis
MH  - Pennsylvania/epidemiology
MH  - Quality Assurance, Health Care/methods
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Risk Factors
MH  - Stroke/*epidemiology
MH  - Treatment Outcome
EDAT- 2005/04/01 09:00
MHDA- 2006/12/14 09:00
CRDT- 2005/04/01 09:00
PHST- 2005/04/01 09:00 [pubmed]
PHST- 2006/12/14 09:00 [medline]
PHST- 2005/04/01 09:00 [entrez]
AID - X0FBPQXTULJ5Y0MD [pii]
AID - 10.1532/HSF98.20041062 [doi]
PST - ppublish
SO  - Heart Surg Forum. 2004;7(5):E376-81. doi: 10.1532/HSF98.20041062.