Abstract
Background: Patients who undergo cardiac surgery are at increased risk
of stroke, postoperative cognitive decline, and delirium. These
neurocognitive complications have led to increased costs, intensive care
unit stays, morbidity, and mortality. As a result, there is a
significant push to mitigate any neurological complications in cardiac
surgery patients. Near-infrared spectroscopy to measure regional
cerebral oxygen saturations has gained consideration due to its
non-invasive, user-friendly, and relatively inexpensive nature. Aim of
Study: To provide a comprehensive summary of cerebral oximetry in
cardiac surgery. The review interrogates multiple systematic reviews
assessing different outcomes in cardiac surgery to assess if cerebral
oximetry is effective. Further, the review analyzes all available
interventions for an acute desaturation to determine the efficacy of
individual interventions. Methods: A narrative review of randomized
controlled trials, observational studies, and systematic reviews with
metanalyses were performed through August 2021. Results: There is
significant heterogeneity amongst studies regarding the definition of a
clinically significant cerebral desaturation. In addition, the
assessment of neurocognitive outcomes has large variability, making
metanalysis challenging. To date, cerebral oximetry use during cardiac
surgery has not been associated with improvements in neurocognitive
outcomes, morbidity, or mortality. The evidence to support particular
interventions for an acute desaturation is equivocal. Conclusions:
Future research is needed to quantify a clinically significant cerebral
desaturation and to determine which interventions for an acute
desaturation effectively improve clinical outcomes.