Silaschi Miriam, Kruse Jacqueline, Wittmann Maria, Osawa Itsuki, Goto Tadahiro, Velten Markus, Thudium Marcus, Rohner Marc, Hamiko Marwan, Rowlands David, Kreyer Stefan, Coburn Marc, Bakhtiary Farhad
Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
Department of Anesthesiology and Intensvie Care Medicine, University Hospital Bonn, Bonn, Germany.
J Clin Monit Comput. 2025 Sep 13. doi: 10.1007/s10877-025-01359-y.
While cerebral near infrared spectroscopy (NIRS) is a valuable diagnostic tool to monitor brain oxygenation during cardiac surgery, its value in low cardiac output syndrome (LCOS) in adults has not been evaluated. This study was prospective and observational. Patients undergoing coronary artery bypass grafting (CABG) with reduced ejection fraction (LVEF < 35%) were included and received NIRS monitoring for up to 48 h after surgery with simultaneous continuous cardiac index (CI) monitoring. The primary endpoint was LCOS by a standard definition. From 2020 to 2023, 82 Patients with severely reduced LVEF undergoing CABG were included. Of these, 44 patients had sufficient NIRS and CI data for further analyses. Median age was 68 years (Interquartile range (IQR) 60-73), 91% (40/44) were male and median EuroSCORE II was 3.2% (1.7-5.4). Median LVEF was 30% (26.5-30.1) and baseline CI was 2.15 L/min/m² (2.05-2.60). CABG was combined with other procedures in 23% (10/44). LCOS rate was 11% (5/44) and in-hospital mortality was 2.2% (1/44). The performance of Lasso-regularized models increased if NIRS was included in LCOS prediction models (AUROC 0.99 [95%CI, 0.98-1.00]) showing that both relative NIRS drop rate and absolute NIRS value were significant predictors of LCOS. Risk of LCOS was high if NIRS drops by > 20% or absolute NIRS drops below < 50. In patients with LCOS, NIRS drop occurred before CI values decreased. NIRS drop was not associated with other adverse events. NIRS is an early and valid indicator of LCOS in patients after cardiac surgery. In selected patients, NIRS may be a substitute for invasive continuous CI measurements. However, we could not show an association of NIRS drop with adverse events. Future studies should compare blinded and non-blinded NIRS monitoring to investigate possible impact on clinical outcomes further.
虽然脑近红外光谱技术（NIRS）是心脏手术期间监测脑氧合的一种有价值的诊断工具，但其在成人低心排血量综合征（LCOS）中的价值尚未得到评估。本研究为前瞻性观察性研究。纳入接受冠状动脉旁路移植术（CABG）且射血分数降低（左心室射血分数[LVEF]<35%）的患者，并在术后长达48小时接受NIRS监测，同时持续监测心脏指数（CI）。主要终点为根据标准定义的LCOS。2020年至2023年，纳入82例LVEF严重降低且接受CABG的患者。其中，44例患者有足够的NIRS和CI数据用于进一步分析。中位年龄为68岁（四分位间距[IQR]60 - 73岁），91%（40/44）为男性，中位欧洲心脏手术风险评估系统（EuroSCORE）II为3.2%（1.7 - 5.4）。中位LVEF为30%（26.5 - 30.1），基线CI为2.15L/min/m²（2.05 - 2.60）。23%（10/44）的CABG联合了其他手术。LCOS发生率为11%（5/44），住院死亡率为2.2%（1/44）。如果将NIRS纳入LCOS预测模型，套索正则化模型的性能会提高（曲线下面积[AUC]0.99[95%可信区间，0.98 - 1.00]），表明相对NIRS下降率和绝对NIRS值都是LCOS的重要预测指标。如果NIRS下降>20%或绝对NIRS降至<50以下，LCOS风险较高。在发生LCOS的患者中，NIRS下降发生在CI值降低之前。NIRS下降与其他不良事件无关。NIRS是心脏手术后患者LCOS的早期有效指标。在选定患者中，NIRS可能替代有创连续CI测量。然而，我们未能证明NIRS下降与不良事件之间的关联。未来研究应比较盲法和非盲法NIRS监测，以进一步研究其对临床结局的可能影响。
