• Matthew J Chan, Tricia Chung, Neil J Glassford, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Hospital, Heidelberg, Australia; The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University Alfred Hospital, Melbourne, Australia.
• J. Cardiothorac. Vasc. Anesth. 2017 Aug 1; 31 (4): 1155-1165.

ObjectivesTo identify the normal baseline preoperative range of cerebral tissue oxygen saturation (SctO2) derived using near-infrared spectroscopy (NIRS) and the efficacy of perioperative interventions designed to modulate SctO2 in cardiac surgical patients.DesignSystematic review and meta-analysis of relevant randomized controlled trials (RCTs) extracted from the Medline, Embase, and Cochrane Central Register of Controlled Trials databases.SettingHospitals performing cardiac surgery.ParticipantsThe study comprised 953 participants from 11 RCTs.InterventionsInterventions included the following: (1) SctO2 monitoring protocol compared with no monitoring; (2) use of cardiopulmonary bypass (CPB) compared with no CPB; (3) normothermic CPB compared with hypothermic CPB; (4) glyceryl trinitrate during surgery compared with placebo; (5) midazolam during induction of anesthesia compared with propofol; (6) sevoflurane anesthesia compared with total intravenous anesthesia; (7) sevoflurane anesthesia compared with propofol-based anesthesia; and (8) norepinephrine during CPB compared with phenylephrine.Measurements And Main ResultsEleven RCTs with 953 participants measured baseline preoperative SctO2 using NIRS. The pooled mean baseline SctO2 was 66.4% (95% CI 65.0-67.7), generating a reference range of 51.0% to 81.8%. Four interventions (1, 3, 4, and 6 described in the Interventions section above) increased intraoperative SctO2 across the majority of reported time points. Postoperative follow-up of SctO2 occurred in only 1 study, and postoperative cognitive assessment correlating SctO2 with cognitive function was applied in only 4 studies using variable methodology.ConclusionsThe authors have established that reference values for baseline NIRS-derived SctO2 in cardiac surgery patients are varied and have identified interventions that modulate SctO2. This information opens the door to standardized research and interventional studies in this field.Copyright © 2017. Published by Elsevier Inc.

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