Cerebral perfusion monitoring in adult patients following cardiac surgery: an observational study^†

† This work was conducted at The Johns Hopkins Hospital, Cardiac Surgical Intensive Care Unit.

Abstract

Background: Following adult cardiac surgery, often difficult to detect fluctuations in regional cerebral perfusion can contribute to strokes. Optimal cerebral perfusion remains elusive and traditional monitoring strategies do not consistently identify acute changes. Non-invasive cerebral oximetry may detect perfusion variations.

Objective: To assess the feasibility of postoperative non-invasive cerebral oximetry monitoring.

Methods: Non-invasive cerebral oximetry was performed on adult aortic valve surgery patients in a cardiac surgical intensive care unit. Monitoring feasibility was assessed using an investigator-developed, data extraction tool.

Results: Non-invasive cerebral oximetry was completed in 94% of patients. Sixty percent had values that fell below pre-set ischemic threshold. Nurses reported monitoring was feasible, and they perceived identifying deleterious cerebral perfusion trends may improve patient care.

Conclusions: Prevalence of low cerebral oximetry values underscores the importance of increasing sensitivity of monitoring tools. Further evaluation is required to assess this modality and the role of nurses in optimizing neurocognitive outcomes.

Impact statement: Cerebral oximetry monitoring may help identify adult patients at risk of neurological complications after cardiac surgery, and as a consequence initiate definitive therapeutic strategies.

Keywords:

• aortic valve
• post-operative care
• stroke
• cardiac surgical procedures
• oximetry
• perioperative period
• hemodynamics
• critical care

Acknowledgements

We would like to thank the cardiac surgical anesthesia and intensive care unit staff. Without their assistance, this project could not have been possible.

Notes

† This work was conducted at The Johns Hopkins Hospital, Cardiac Surgical Intensive Care Unit.