| Autor: |
Slater, James P., Guarino, Theresa, Stack, Jessica, Vinod, Kateki, Bustami, Rami T., Brown, John M., Rodriguez, Alejandro L., Magovern, Christopher J., Zaubler, Thomas, Freundlich, Kenneth, Parr, Grant V.S. |
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| Zdroj: |
Annals of Thoracic Surgery; Jan2009, Vol. 87 Issue 1, p36-45, 10p |
| Abstrakt: |
Background: Previous studies have reported an 11% to 75% incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSo 2) saturation. The purpose of this study is to examine whether decreased rSo 2 predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG). Methods: The rSo 2 was monitored intraoperatively in a cohort of primary CABG patients. Patients were prospectively randomized to a blinded control group or an unblinded intervention group. Cognitive function was assessed preoperatively, postoperatively, and at 3 months using a battery of standardized neurocognitive tests. Cognitive decline was defined as a decrease of one standard deviation or more in performance on at least one neurocognitive measure. The rSo 2 desaturation score was calculated by multiplying rSo 2 below 50% by time (seconds). Multivariate logistic regression models were used to assess cognitive decline and hospital stay. The change in cognitive performance was also assessed using a multivariate linear regression model. Results: Patients with rSo 2 desaturation score greater than 3,000%-second had a significantly higher risk of early postoperative cognitive decline [p = 0.024]. Patients with rSo 2 desaturation score greater than 3,000%-second also had a near threefold increased risk of prolonged hospital stay (>6 days) [p = 0.007]. Conclusions: Intraoperative cerebral oxygen desaturation is significantly associated with an increased risk of cognitive decline and prolonged hospital stay after CABG. [Copyright &y& Elsevier] |
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