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Near-infrared spectroscopy monitoring tissue oxygen saturation after cardiac surgery

Introduction

The aim of this study was to compare near-infrared spectroscopy with global parameters of tissue oxygenation after cardiac surgery, such as cardiac output (CI), mixed venous oxygen saturation (SvO2) or lactate concentration. After cardiac surgery, the circulating blood volume and cardiac function is regularly reduced on the ICU [1]. This results in reduced microperfusion and peripheral vasoconstriction. The noninvasive InSpectra StO2 monitor (Hutchinson Technology Inc., Hutchinson, MN, USA) measures the oxygen saturation in the microcirculation of the thenar muscle [2].

Methods

Forty patients after cardiac surgery were monitored with a StO2 monitor and a Swan–Ganz catheter measuring CI and SvO2 on the ICU. Additionally intermittent lactate and blood gas analysis was performed. ANOVA was used for statistics of results.

Results

The mean Euro-Score of the patients was 6.5 ± 3.7 including 24 aortocoronary bypass, five heart valve, three ascending aorta and eight combined cardiac operations. After admission were significantly reduced (Figure 1). The StO2, CI and SvO2 lactate concentration and noradrenaline dose were increased (P < 0.05). On day 1 the noradrenaline dose dropped after fluid substitution, but only the StO2 value recovered.

Figure 1
figure1

Course of StO 2 , cardiac output, SvO 2 and lactate concentration.

Conclusion

After heart surgery StO2 indicated the reduction as well as the recovery of microcirculation early, whereas the lactate concentration and SvO2 seemed to demonstrate a delayed response especially of recovery. Management of postoperative fluid and catecholamine therapy by StO2 to optimize microcirculation should be the subject of further studies.

References

  1. 1.

    Tschaikowsky K, et al.: Changes in circulating blood volume after cardiac surgery measured by a novel method using hydroxyethyl starch. Crit Care Med 2000, 28: 336-334. 10.1097/00003246-200002000-00008

  2. 2.

    Myers DE, et al.: Noninvasive method for measuring local hemoglobin oxygen saturation in tissue using wide gap second derivative near-infrared spectroscopy. J Biomed Opt 2005, 10: 034017. 10.1117/1.1925250

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Kopp, R., Rex, S., Dommann, K. et al. Near-infrared spectroscopy monitoring tissue oxygen saturation after cardiac surgery. Crit Care 13, P239 (2009). https://doi.org/10.1186/cc7403

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Keywords

  • Oxygen Saturation
  • Lactate Concentration
  • Global Parameter
  • Circulate Blood Volume
  • Peripheral Vasoconstriction