Monitoring of brain oxygen saturation (INVOS) in a protocol to direct blood transfusions during cardiac surgery: a prospective randomized clinical trial

Journal of Cardiothoracic Surgery

Menelaos Karanikolas³  Nikolaos Tsilimingas¹  Athanasios Giannoukas⁵  Dimitrios Mikroulis⁴  Vassilios Tassoudis²  Konstantinos Stamoulis²  Stavroula Georgopoulou²  George Vretzakis² 

[1] Cardiac Surgery Clinic, University of Thessaly, Biopolis, Larissa, Greece;Cardiac Anesthesia Unit, Anesthesiology Clinic, University of Thessaly, Biopolis, Larissa, Greece;Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA;Department of Cardiac Surgery, Democritus University, Alexandroupolis, Greece;Vascular Department, University of Thessaly, Biopolis, Larissa, Greece

关键词: Near-infrared spectroscopy;    Fluid restriction;    Transfusion;    Anesthesia;    Cardiac surgery;    INVOS;   

Others  :  824528
DOI  :  10.1186/1749-8090-8-145

 received in 2012-07-17, accepted in 2013-05-30,  发布年份 2013

【 摘 要 】

Background

Blood transfusions are common in cardiac surgery, but have been associated with increased morbidity and long-term mortality. Efforts to reduce blood product use during cardiac surgery include fluid restriction to minimize hemodilution, and protocols to guide transfusion decisions. INVOS is a modality that monitors brain tissue oxygen saturation, and could be useful in guiding decisions to transfuse. However, the role of INVOS (brain tissue oxygen saturation) as part of an algorithm to direct blood transfusions during cardiac surgery has not been evaluated. This study was conducted to investigate the value of INVOS as part of a protocol for blood transfusions during cardiac surgery.

Methods

Prospective, randomized, blinded clinical trial, on 150 (75 per group) elective cardiac surgery patients. The study was approved by the Institution Ethics committee and all patients gave written informed consent. Data were initially analyzed based on “intention to treat”, but subsequently were also analyzed “per protocol”.

Results

When protocol was strictly followed (“per protocol analysis”), compared to the control group, significantly fewer patients monitored with INVOS received any blood transfusions (46 of 70 patients in INVOS group vs. 55 of 67 patients in the control group, p = 0.029). Similarly, patients monitored with INVOS received significantly fewer units of red blood cell transfusions intraoperatively (0.20 ± 0.50 vs. 0.52 ± 0.88, p = 0.008) and overall during hospital stay (1.31 ± 1.20 vs. 1.82 ± 1.46, p = 0.024). When data from all patients (including patient with protocol violation) were analyzed together (“intention to treat analysis”), the observed reduction of blood transfusions in the INVOS group was still significant (51 of 75 patients transfused in the INVOS group vs. 63 of 75 patients transfused in the control group, p = 0.021), but the overall number of units transfused per patient did not differ significantly between the groups (1.55 ± 1.97 vs. 1.84 ± 1.41, p = 0.288).

Conclusions

Our data suggest that INVOS could be a useful tool as part of an algorithm to guide decisions for blood transfusion in cardiac surgery. Additional data from rigorous, well designed studies are needed to further evaluate the role of INVOS in guiding blood transfusions in cardiac surgery, and circumvent the limitations of this study.

Trial registration

ClinicalTrials.gov: NCT00879463

【 授权许可】

   
2013 Vretzakis et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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