The response of a standardized fluid challenge during cardiac surgery on cerebral oxygen saturation measured with near-infrared spectroscopy

Frederik Holmgaard, Simon T Vistisen, Hanne B Ravn, Thomas W L Scheeren, Frederik Holmgaard, Simon T Vistisen, Hanne B Ravn, Thomas W L Scheeren

Abstract

Near infrared spectroscopy (NIRS) has been used to evaluate regional cerebral tissue oxygen saturation (ScO2) during the last decades. Perioperative management algorithms advocate to maintain ScO2, by maintaining or increasing cardiac output (CO), e.g. with fluid infusion. We hypothesized that ScO2 would increase in responders to a standardized fluid challenge (FC) and that the relative changes in CO and ScO2 would correlate. This study is a retrospective substudy of the FLuid Responsiveness Prediction Using Extra Systoles (FLEX) trial. In the FLEX trial, patients were administered two standardized FCs (5 mL/kg ideal body weight each) during cardiac surgery. NIRS monitoring was used during the intraoperative period and CO was monitored continuously. Patients were considered responders if stroke volume increased more than 10% following FC. Datasets from 29 non-responders and 27 responders to FC were available for analysis. Relative changes of ScO2 did not change significantly in non-responders (mean difference - 0.3% ± 2.3%, p = 0.534) or in fluid responders (mean difference 1.6% ± 4.6%, p = 0.088). Relative changes in CO and ScO2 correlated significantly, p = 0.027. Increasing CO by fluid did not change cerebral oxygenation. Despite this, relative changes in CO correlated to relative changes in ScO2. However, the clinical impact of the present observations is unclear, and the results must be interpreted with caution.Trial registration:http://ClinicalTrial.gov identifier for main study (FLuid Responsiveness Prediction Using Extra Systoles-FLEX): NCT03002129.

Keywords: Cardiac anaesthesia; Cardiac output; Cerebral oximetry; Fluid challenge; Monitoring; Near infrared spectroscopy.

Conflict of interest statement

TWLS received Research Grants and Honoraria from Edwards Lifesciences (Irvine, CA, USA) and Masimo, Inc. (Irvine, CA, USA) for consulting and lecturing and from Pulsion Medical Systems SE (Feldkirchen, Germany) for lecturing in the past. TWLS is Associate Editor of the Journal of Clinical Monitoring and Computing but had no role in the handling of this paper.

Figures

Fig. 1
Fig. 1
Scatterplot illustrating ScO2 and CO at the end of fluid challenge expressed as the relative change to the value before fluid challenge. Illustrated with trendline and confidence interval
Fig. 2
Fig. 2
Graph illustrating the relative changes and the correlation between ScO2 and CO minute by minute into the fluid challenge for fluid challenge non-responders
Fig. 3
Fig. 3
Graph illustrating the relative changes and the correlation between ScO2 and CO minute by minute into the fluid challenge for fluid challenge responders

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