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IMPROVING NEUROLOGIC OUTCOME IN CARDIAC SURGERY PATIENTS\ud\udWITH A GOAL-ORIENTED THERAPY PROTOCOL BASED ON CEREBRAL\ud\udREGIONAL OXYGEN SATURATION\ud\udF. Franchi, B. Biagioli, A. Tabucchi, S. Scolletta\ud\udUniversity of Siena, Siena, Italy\ud\udINTRODUCTION. NIRS (near infrared spectroscopy) is a neuro-monitoring tool that\ud\udprovides cerebral regional oxygen saturation (rSO2).\ud\udOBJECTIVES. We hypothesized that a goal-directed therapy (GDT) protocol based on\ud\udrSO2 values would be associated with reduced incidence of postoperative neurologic\ud\udcomplications (PNC) in high-risk cardiac surgery (CS) patients.\ud\udMETHODS. 85 high-risk CS patients (mean age 71 ± 9) were monitored during CS with\ud\udNIRS (cNIRS group). Intraoperative interventions were based on a GDT protocol aimed at\ud\udimproving cerebral rSO2 and blood flow (i.e., increasing arterial oxygen content with red blood cell transfusions and FiO2; increasing systemic blood flow and cerebral perfusion\ud\udpressure with fluids, inotropic, and vasoactive drugs and increasing pump-flow during\ud\udcardiopulmonary bypass). cNIRS group was compared with 100 patients (mean age 73 ± 6)\ud\ud(not monitored with cerebral NIRS, N-cNIRS group) who were selected from a historical\ud\uddatabase using a propensity-matching analysis. Neuron-specific enolase (NSE) and S-100B\ud\udprotein were collected at different times in the cNIRS group.\ud\udRESULTS. PNC resulted 21 % in the cNIRS group and 35 % in N-cNIRS group\ud\ud(p\0.05). N-cNIRS group showed longer times of mechanical ventilation (MV)\ud\ud(150.3 ± 274.9 vs 29.9 ± 65 h, p = 0.02) and ICU stay (13.3 ± 14.7 vs 3.4 ± 3.9 days,\ud\udp = 0.01) than cNIRS group. In the cNIRS group, preoperative rSO2 values were signifi-\ud\udcantly lower in the patients who exhibited PNC than those who had good neurologic\ud\udoutcome (59.6 ± 7.6 vs 63.4 ± 7.8 %, p = 0.04). An inverse correlation was found\ud\udbetween the lowest values of intraoperative cerebral rSO2 and the length of MV (r = -0.31,\ud\udp = 0.04) and ICU stay (r = -0.43, p = 0.003). Only the peak of NSE, measured 6 h after\ud\udCS, showed significant difference between patients who developed PNC and those who did\ud\udnot (p = 0.02).\ud\udCONCLUSIONS. In our cohort of CS patients, NSE and S-100B protein were poor pre-\uddictors of PNC. Conversely, the lower the preoperative cerebral rSO2, the poorer the\ud\udneurologic outcome. A GDT protocol based on NIRS values, aimed at improving cerebral\ud\udrSO2 and blood flow, might reduce PNC in high-risk CS patients.\ud\udREFERENCE(S). Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen\ud\udsaturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg.\ud\ud2007;104(1):51-8

IMPROVING NEUROLOGIC OUTCOME IN CARDIAC SURGERY PATIENTS WITH A GOAL-ORIENTED THERAPY PROTOCOL BASED ON CEREBRAL REGIONAL OXYGEN SATURATION