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Limitations of Current Near‐Infrared Spectroscopy Configuration in Detecting Focal Cerebral Ischemia During Cardiac Surgery: An Observational Case‐Series Study
Author(s) -
Erdoes Gabor,
Rummel Christian,
Basciani Reto M.,
Verma Rajeev,
Carrel Thierry,
Banz Yara,
Eberle Balthasar,
Schroth Gerhard
Publication year - 2018
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.13150
Subject(s) - medicine , cerebral blood flow , stroke (engine) , ischemia , cardiac surgery , cerebral perfusion pressure , cardiopulmonary bypass , magnetic resonance imaging , neuroimaging , middle cerebral artery , radiology , anesthesia , cardiology , mechanical engineering , psychiatry , engineering
Abstract Cerebral oximetry using near‐infrared spectroscopy (NIRS) allows for continuous monitoring of cerebral perfusion and immediate treatment of hemodynamic perturbations. In configurations used in current clinical practice, NIRS optodes are placed on the patient`s forehead and cerebral oxygen saturation (ScO 2 ) is determined in bilateral frontal cortical samples. However, focal cerebral ischemic lesions outside of the NIRS field of view may remain undetected. The objective of this observational case‐series study was to investigate ScO 2 measurements in patients with acute iatrogenic stroke not located in the frontal cortical region. Adult patients undergoing cardiac surgery with cardiopulmonary bypass or interventional cardiology procedures and suffering stroke in the early postoperative period were identified from the Bernese Stroke Registry and analyzed for their intraoperative ScO 2 values and brain imaging data. Main outcome measures were the ScO 2 values, computed tomography and magnetic resonance imaging findings. In six patients, the infarct areas were localized in the vascular territories of the posterior and/or dorsal middle cerebral arteries. One patient had watershed stroke and another one excellent collaterals resulting in normal cerebral blood volume and only subtle decrease of cerebral blood flow in initially critically perfused watershed brain areas. Intraoperative ScO 2 values were entirely unremarkable or nonindicative for brain damage. Our results indicate that uneventful intraoperative NIRS monitoring does not exclude severe cerebral ischemia due to the limited field of view of commercially available NIRS devices. False negative NIRS may occur as a consequence of stroke localized outside the frontal cortex.