Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany.
Can J Anaesth. 2018 Jul;65(7):766-775. doi: 10.1007/s12630-018-1093-3. Epub 2018 Feb 26.
The present study aimed to test the hypothesis that cerebral oxygen saturation (ScO) measurements with the INVOS-5100-C and the ForeSight-Elite cerebral oximeters vary in their correlation with mixed venous oxygen saturation (SvO) upon changes in systemic oxygenation in extubated cardiac surgical patients. Additionally, we aimed to elucidate whether the ScO measurements of both devices can be used interchangeably to detect reduced SvO.
Forty-eight spontaneously breathing patients extubated after cardiac surgery were included in this prospective observational study. The patients were exposed to both high (10 oxygen L·min via face mask) and low (room air) inspiratory oxygen concentrations. Bi-hemispherical ScO was determined with the INVOS and ForeSight Elite cerebral oximeters. The SvO was measured with a pulmonary artery catheter.
Significant changes in oxygen delivery, ScO (by both cerebral oximeters), and SvO were observed upon variation of oxygenation. The minimum mean (standard deviation) ScO (ScO) using the INVOS and ForeSight did not differ significantly during high oxygen delivery [63.1 (8.6) % vs 65.8 (4.7) %, respectively; P = 0.07], but during low oxygen delivery, the INVOS value was significantly lower than that of the ForeSight oximeter [56.7 (8.9) % vs 61.3 (4.4) %, respectively; P = 0.003]. Both devices differed in the correlation between ScO and SvO for the combined oxygenation data (0.59, INVOS vs 0.28, ForeSight; correlation difference, 0.31; Bonferroni-adjusted 95% confidence interval [CI], 0.08 to 0.54; P = 0.008). The receiver-operating curve analysis revealed an area under the curve of 0.83 (95% CI, 0.74 to 0.9; P = 0.005) for detecting an SvO below 50% by ScO with the INVOS and 0.51 (95% CI, 0.41 to 0.62; P = 0.92), respectively, with the ForeSight.
These findings suggest that the cerebral oximeters tested react differently to variations in systemic oxygenation and in their relationship with SvO and thus give different information on cardiopulmonary function. These findings raise doubt about whether these devices should be used interchangeably.
本研究旨在验证假设，即在拔除气管导管的心脏手术患者中，INVOS-5100-C 和 ForeSight-Elite 脑氧饱和度测量仪的脑氧饱和度（ScO）与混合静脉氧饱和度（SvO）在全身氧合变化时的相关性不同。此外，我们旨在阐明这两种设备的 ScO 测量值是否可以互换使用，以检测 SvO 降低。
本前瞻性观察研究纳入了 48 例心脏手术后拔管的自主呼吸患者。患者暴露于高（通过面罩给予 10 升/分钟氧气）和低（室内空气）吸入氧气浓度。使用 INVOS 和 ForeSight Elite 脑氧饱和度测量仪测量双半球 ScO。使用肺动脉导管测量 SvO。
在氧合变化时，观察到氧输送、ScO（两种脑氧饱和度测量仪）和 SvO 有显著变化。在高氧输送时，INVOS 和 ForeSight 的平均（标准差）ScO（ScO）无显著差异[分别为 63.1（8.6）%和 65.8（4.7）%；P=0.07]，但在低氧输送时，INVOS 值明显低于 ForeSight 血氧仪[分别为 56.7（8.9）%和 61.3（4.4）%；P=0.003]。对于综合氧合数据，两种设备的 ScO 与 SvO 之间的相关性不同（0.59，INVOS 与 0.28，ForeSight；相关性差异，0.31；Bonferroni 调整的 95%置信区间[CI]，0.08 至 0.54；P=0.008）。受试者工作特征曲线分析显示，INVOS 检测 ScO 下 SvO 低于 50%的曲线下面积为 0.83（95%CI，0.74 至 0.9；P=0.005），ForeSight 为 0.51（95%CI，0.41 至 0.62；P=0.92）。
这些发现表明，测试的脑氧饱和度测量仪对全身氧合变化及其与 SvO 的关系反应不同，因此对心肺功能提供不同的信息。这些发现使人怀疑这些设备是否可以互换使用。
