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Meta-Analysis
. 2018 Jan 17;1(1):CD010947.
doi: 10.1002/14651858.CD010947.pub2.

Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults

Yun Yu  1 , Kaiying Zhang, Ling Zhang, Huantao Zong, Lingzhong Meng, Ruquan Han
Affiliations
Meta-Analysis

Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults

Yun Yu et al. Cochrane Database Syst Rev. .

Abstract

Background: Various techniques have been employed for the early detection of perioperative cerebral ischaemia and hypoxia. Cerebral near-infrared spectroscopy (NIRS) is increasingly used in this clinical scenario to monitor brain oxygenation. However, it is unknown whether perioperative cerebral NIRS monitoring and the subsequent treatment strategies are of benefit to patients.

Objectives: To assess the effects of perioperative cerebral NIRS monitoring and corresponding treatment strategies in adults and children, compared with blinded or no cerebral oxygenation monitoring, or cerebral oxygenation monitoring based on non-NIRS technologies, on the detection of cerebral oxygen desaturation events (CDEs), neurological outcomes, non-neurological outcomes and socioeconomic impact (including cost of hospitalization and length of hospital stay).

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 12), Embase (1974 to 20 December 2016) and MEDLINE (PubMed) (1975 to 20 December 2016). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing studies on 20 December 2016. We updated this search in November 2017, but these results have not yet been incorporated in the review. We imposed no language restriction.

Selection criteria: We included all relevant randomized controlled trials (RCTs) dealing with the use of cerebral NIRS in the perioperative setting (during the operation and within 72 hours after the operation), including the operating room, the postanaesthesia care unit and the intensive care unit.

Data collection and analysis: Two authors independently selected studies, assessed risk of bias and extracted data. For binary outcomes, we calculated the risk ratio (RR) and its 95% confidence interval (CI). For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. As we expected clinical and methodological heterogeneity between studies, we employed a random-effects model for analyses and we examined the data for heterogeneity (I2 statistic). We created a 'Summary of findings' table using GRADEpro.

Main results: We included 15 studies in the review, comprising a total of 1822 adult participants. There are 12 studies awaiting classification, and eight ongoing studies.None of the 15 included studies considered the paediatric population. Four studies were conducted in the abdominal and orthopaedic surgery setting (lumbar spine, or knee and hip replacement), one study in the carotid endarterectomy setting, and the remaining 10 studies in the aortic or cardiac surgery setting. The main sources of bias in the included studies related to potential conflict of interest from industry sponsorship, unclear blinding status or missing participant data.Two studies with 312 participants considered postoperative neurological injury, however no pooled effect estimate could be calculated due to discordant direction of effect between studies (low-quality evidence). One study (N = 126) in participants undergoing major abdominal surgery reported that 4/66 participants experienced neurological injury with blinded monitoring versus 0/56 in the active monitoring group. A second study (N = 195) in participants having coronary artery bypass surgery reported that 1/96 participants experienced neurological injury in the blinded monitoring group compared with 4/94 participants in the active monitoring group.We are uncertain whether active cerebral NIRS monitoring has an important effect on the risk of postoperative stroke because of the low number of events and wide confidence interval (RR 0.25, 95% CI 0.03 to 2.20; 2 studies, 240 participants; low-quality evidence).We are uncertain whether active cerebral NIRS monitoring has an important effect on postoperative delirium because of the wide confidence interval (RR 0.63, 95% CI 0.27 to 1.45; 1 study, 190 participants; low-quality evidence).Two studies with 126 participants showed that active cerebral NIRS monitoring may reduce the incidence of mild postoperative cognitive dysfunction (POCD) as defined by the original studies at one week after surgery (RR 0.53, 95% CI 0.30 to 0.95, I2 = 49%, low-quality evidence).Based on six studies with 962 participants, there was moderate-quality evidence that active cerebral oxygenation monitoring probably does not decrease the occurrence of POCD (decline in cognitive function) at one week after surgery (RR 0.62, 95% CI 0.37 to 1.04, I2 = 80%). The different type of monitoring equipment in one study could potentially be the cause of the heterogeneity.We are uncertain whether active cerebral NIRS monitoring has an important effect on intraoperative mortality or postoperative mortality because of the low number of events and wide confidence interval (RR 0.63, 95% CI 0.08 to 5.03, I2= 0%; 3 studies, 390 participants; low-quality evidence). There was no evidence to determine whether routine use of NIRS-based cerebral oxygenation monitoring causes adverse effects.

Authors' conclusions: The effects of perioperative active cerebral NIRS monitoring of brain oxygenation in adults for reducing the occurrence of short-term, mild POCD are uncertain due to the low quality of the evidence. There is uncertainty as to whether active cerebral NIRS monitoring has an important effect on postoperative stroke, delirium or death because of the low number of events and wide confidence intervals. The conclusions of this review may change when the eight ongoing studies are published and the 12 studies awaiting assessment are classified. More RCTs performed in the paediatric population and high-risk patients undergoing non-cardiac surgery (e.g. neurosurgery, carotid endarterectomy and other surgery) are needed.

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Conflict of interest statement

Yun Yu: none known.

Kaiying Zhang: none known.

Ling Zhang: none known.

Ruquan Han: none known.

Huantao Zong: none known.

Lingzhong Meng: none known.

Figures

1
1
Study flow diagram.
2
2
Study flow diagram‐top up search on November 2017.
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score).
1.2
1.2. Analysis
Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 2 POCD defined by original studies ‐ 1 week.
1.3
1.3. Analysis
Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 3 POCD: decline in cognitive function ‐ 1 week.
1.4
1.4. Analysis
Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 4 Intraoperative mortality or postoperative mortality: Death.
1.5
1.5. Analysis
Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 5 The occurrence of abnormal rScO2 during or after surgery: Desaturation.
1.6
1.6. Analysis
Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 6 Any major non‐neurological complications as defined by individual study.
1.7
1.7. Analysis
Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 7 Length of ICU stay (days).
2.1
2.1. Analysis
Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 1 Postoperative stroke or other neurological injury: Neurological injury.
2.2
2.2. Analysis
Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 2 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 1 week.
2.3
2.3. Analysis
Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 3 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 12 weeks.
2.4
2.4. Analysis
Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 4 POCD defined by original studies ‐ 1 week ‐ mild.
2.5
2.5. Analysis
Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 5 POCD defined by original studies ‐ 1 week ‐ severe.
2.6
2.6. Analysis
Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 6 POCD: decline in cognitive function ‐ 1 week.
3.1
3.1. Analysis
Comparison 3 Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 1 week.
3.2
3.2. Analysis
Comparison 3 Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring, Outcome 2 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 12 weeks.
3.3
3.3. Analysis
Comparison 3 Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring, Outcome 3 POCD: decline in cognitive function ‐ 1 week.
4.1
4.1. Analysis
Comparison 4 Sensitivity analysis: detection bias, Outcome 1 Any major non‐neurological complications as defined by individual study: including studies with detection bias.
4.2
4.2. Analysis
Comparison 4 Sensitivity analysis: detection bias, Outcome 2 Any major non‐neurological complications as defined by individual study: including studies without detection bias.
5.1
5.1. Analysis
Comparison 5 Sensitivity analysis: missing data, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies with missing data.
5.2
5.2. Analysis
Comparison 5 Sensitivity analysis: missing data, Outcome 2 POCD: decline in cognitive function ‐ 1 week: including studies with missing data.
5.3
5.3. Analysis
Comparison 5 Sensitivity analysis: missing data, Outcome 3 Occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies with missing data.
5.4
5.4. Analysis
Comparison 5 Sensitivity analysis: missing data, Outcome 4 Any major non‐neurological complications as defined by individual study: including studies with missing data.
5.5
5.5. Analysis
Comparison 5 Sensitivity analysis: missing data, Outcome 5 POCD: decline in cognitive function ‐ 1 week: without missing data.
5.6
5.6. Analysis
Comparison 5 Sensitivity analysis: missing data, Outcome 6 Occurrence of abnormal rScO2 during or after surgery: Desaturation: without missing data.
5.7
5.7. Analysis
Comparison 5 Sensitivity analysis: missing data, Outcome 7 Any major non‐neurological complications as defined by individual study: without missing data.
6.1
6.1. Analysis
Comparison 6 Sensitivity analysis: reporting bias, Outcome 1 Any major non‐neurological complications as defined by individual study: including studies with reporting bias.
6.2
6.2. Analysis
Comparison 6 Sensitivity analysis: reporting bias, Outcome 2 Any major non‐neurological complications as defined by individual study: including studies without reporting bias.
7.1
7.1. Analysis
Comparison 7 Sensitivity analysis: other bias, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies with other bias.
7.2
7.2. Analysis
Comparison 7 Sensitivity analysis: other bias, Outcome 2 POCD defined by original studies ‐ 1 week: including studies with other bias.
7.3
7.3. Analysis
Comparison 7 Sensitivity analysis: other bias, Outcome 3 Intraoperative mortality or postoperative mortality: Death: including studies with other bias.
7.4
7.4. Analysis
Comparison 7 Sensitivity analysis: other bias, Outcome 4 The occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies with other bias.
7.5
7.5. Analysis
Comparison 7 Sensitivity analysis: other bias, Outcome 5 Any major non‐neurological complications as defined by individual study: including studies with other bias.
7.6
7.6. Analysis
Comparison 7 Sensitivity analysis: other bias, Outcome 6 Length of ICU stay (days): including studies with other bias.
7.7
7.7. Analysis
Comparison 7 Sensitivity analysis: other bias, Outcome 7 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies without other bias.
7.8
7.8. Analysis
Comparison 7 Sensitivity analysis: other bias, Outcome 8 The occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies without other bias.
7.9
7.9. Analysis
Comparison 7 Sensitivity analysis: other bias, Outcome 9 Any major non‐neurological complications as defined by individual study: including studies without other bias.
7.10
7.10. Analysis
Comparison 7 Sensitivity analysis: other bias, Outcome 10 Length of ICU stay (days): including studies without other bias.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD010947

References

References to studies included in this review

Ballard 2012 {published data only}
    1. Ballard C, Jones E, Gauge N, Aarsland D, Nilsen OB, Saxby BK, et al. Optimised anaesthesia to reduce post operative cognitive decline (POCD) in older patients undergoing elective surgery, a randomised controlled trial. PloS One 2012;7(6):e37410. [PUBMED: 22719840] - PMC - PubMed
Casati 2005 {published data only}
    1. Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Danelli G, et al. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesthesia and Analgesia 2005;101(3):740‐7, table of contents. [PUBMED: 16115985] - PubMed
Colak 2015 {published data only}
    1. Colak Z, Borojevic M, Bogovic A, Ivancan V, Biocina B, Majeric‐Kogler V. Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after coronary artery bypass surgery: a randomized, prospective study. European Journal of Cardio‐thoracic Surgery 2015;47(3):447‐54. [PUBMED: 24810757] - PubMed
Cowie 2014 {published data only}
    1. Cowie DA, Nazareth J, Story DA. Cerebral oximetry to reduce perioperative morbidity. Anaesthesia and Intensive Care 2014; Vol. 42, issue 3:310‐4. [PUBMED: 24794469] - PubMed
Deschamps 2013 {published data only}
    1. Deschamps A, Lambert J, Couture P, Rochon A, Lebon JS, Ayoub C, et al. Reversal of decreases in cerebral saturation in high‐risk cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 2013;27(6):1260‐6. [10.1053/j.jvca.2013.01.019. Epub 2013 Jun 18; PUBMED: 23791498] - PubMed
Deschamps 2016 {published data only}
    1. Deschamps A, Hall R, Grocott H, Mazer CD, Choi PT, Turgeon A, et al. Cerebral oximetry monitoring to maintain normal cerebral oxygen saturation during high‐risk cardiac surgery: a randomized controlled feasibility trial. Anesthesiology 2016;124(4):826‐36. [PUBMED: 26808629] - PubMed
Harilall 2014 {published data only}
    1. Harilall Y, Adam JK, Biccard BM, Reddi A. The effect of optimising cerebral tissue oxygen saturation on markers of neurological injury during coronary artery bypass graft surgery. Heart, Lung and Circulation 2014 Jan;23(1):68‐74. [PUBMED: 23911209] - PubMed
Kara 2015 {published data only}
    1. Kara I, Erkin A, Sacli H, Demirtas M, Percin B, Diler MS, et al. The effects of near‐infrared spectroscopy on the neurocognitive functions in the patients undergoing coronary artery bypass grafting with asymptomatic carotid artery disease: a randomized prospective study. Annals of Thoracic and Cardiovascular Surgery 2015;21(6):544‐50. [PUBMED: 26133933] - PMC - PubMed
Lau 2012 {published data only}
    1. Lau WC. Effect of regional cerebral oxygen saturation monitoring on neurological outcome In patients undergoing aortic arch surgery. https://clinicaltrials.gov/ct2/show/NCT01149148 (first received 23 June 2010). [NCT01149148]
Mohandas 2013 {published data only}
    1. Mohandas BS, Jagadeesh AM, Vikram SB. Impact of monitoring cerebral oxygen saturation on the outcome of patients undergoing open heart surgery. Annals of Cardiac Anaesthesia 2013;16(2):102‐6. [PUBMED: 23545864] - PubMed
Murkin 2007 {published data only}
    1. Murkin JM, Adams SJ, Novick RJ, Quantz M, Bainbridge D, Iglesias I, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesthesia and Analgesia 2007;104(1):51‐8. [PUBMED: 17179242] - PubMed
Slater 2009 {published data only}
    1. Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Annals of Thoracic Surgery 2009;87(1):36‐44; discussion 44‐5. [PUBMED: 19101265] - PubMed
Trafidlo 2015 {published data only}
    1. Trafidlo T, Gaszynski T, Gaszynski W, Nowakowska‐Domagala K. Intraoperative monitoring of cerebral NIRS oximetry leads to better postoperative cognitive performance: a pilot study. International Journal of Surgery 2015;16(Pt A):23‐30. [PUBMED: 25701620] - PubMed
Vretzakis 2013 {published data only}
    1. Vretzakis G, Georgopoulou S, Stamoulis K, Tassoudis V, Mikroulis D, Giannoukas A, et al. 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 2013;8:145. [PUBMED: 23758929] - PMC - PubMed
Zogogiannis 2011 {published data only}
    1. Zogogiannis ID, Iatrou CA, Lazarides MK, Vogiatzaki TD, Wachtel MS, Chatzigakis PK, et al. Evaluation of an intraoperative algorithm based on near‐infrared refracted spectroscopy monitoring, in the intraoperative decision for shunt placement, in patients undergoing carotid endarterectomy. Middle East Journal of Anesthesiology 2011;21(3):367‐73. [PUBMED: 22428491] - PubMed

References to studies excluded from this review

Kussman 2009 {published data only}
    1. Kussman BD, Wypij D, DiNardo JA, Newburger JW, Mayer JE, Nido PJ, et al. Cerebral oximetry during infant cardiac surgery: evaluation and relationship to early postoperative outcome. Anesthesia and Analgesia 2009;108(4):1122‐31. [PUBMED: 19299774] - PMC - PubMed
Kussman 2010 {published data only}
    1. Kussman BD, Wypij D, Laussen PC, Soul JS, Bellinger DC, DiNardo JA, et al. Relationship of intraoperative cerebral oxygen saturation to neurodevelopmental outcome and brain magnetic resonance imaging at 1 year of age in infants undergoing biventricular repair. Circulation 2010;122(3):245‐54. [PUBMED: 20606124] - PMC - PubMed
Murkin 2011 {published data only}
    1. Murkin JM, Adams SJ, Pardy E, Quantz M, McKenzie FN, Guo L. Monitoring brain oxygen saturation during coronary bypass surgery improves outcomes in diabetic patients: a post hoc analysis. Heart Surgery Forum 2011;14(1):E1‐6. [PUBMED: 21345770] - PubMed

References to studies awaiting assessment

Aguirre 2016 {published data only}
    1. Aguirre JA, Brada M, Guzzella S, Buehler P, Borgeat A. Shoulder surgery in the beach chair position for high risk patients: the impact of regional anaesthesia compared TOA near‐infrared spectroscopy‐based general anaesthesia protocol. Regional Anesthesia and Pain Medicine 2016;41(5):e40. [DOI: 10.1097/AAP.0000000000000469] - DOI
Baker 2006 {published data only}
    1. Baker RA, Knight JL. The OXICAB trial: cerebral oximetry in adult cardiac surgical patients. Journal of Extra‐corporeal Technology 2006;38(1):77. [PUBMED: 16637536] - PMC - PubMed
Ellis 2015 {published data only}
    1. Ellis L, Murphy GJ, Culliford L, Dreyer L, Clayton G, Downes R, et al. The effect of patient‐specific cerebral oxygenation monitoring on postoperative cognitive function: a multicenter randomized controlled trial. JMIR Research Protocols 2015;4(4):e137. [PUBMED: 26685289] - PMC - PubMed
Gauge 2014 {published data only}
    1. Gauge N, Salaunkey K, Zhu J, Ferreira N, Aron J, Araujo H, et al. Optimization of intra‐operative depth of anaesthesia and cerebral oxygenation significantly reduces postoperative delirium after coronary artery bypass graft surgery. Applied Cardiopulmonary Pathophysiology 2014;18:68.
Girgin 2012 {published data only}
    1. Girgin S, Aksun M, Karahan N, Golboyu BE, Sencan A, Yurekli I, et al. Effects of intraoperative monitoring of cerebral oximetry on postoperative neurocognitive functions of patients after CABG surgery. Applied Cardiopulmonary Pathophysiology 2012;16:268‐9.
Hosang 2017 {published data only}
    1. Hosang S, Bartels C, Hansen M, Herr M, Schilling T, Baraki H, et al. Short‐term cognitive function following coronary artery bypass grafting in patients at high risk of cerebrovascular events ‐ preliminary results from a prospective study. Internist 2017;58(Suppl 1):S36. [DOI: 10.1007/s00108-017-0235-y] - DOI
Iglesias 2003 {published data only}
    1. Iglesias I, Murkin JM, Bainbridge D, Adams S. Monitoring cerebral oxygen saturation significantly decreases postoperative length of stay: a prospective randomized blinded study. Heart Surgery Forum 2003;6(4):204.
Lei 2017 {published data only}
    1. Lei L, Katznelson R, Fedorko L, Carroll J, Poonawala H, Machina M, et al. Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial. Anaesthesia 2017;72(12):1456‐66. [PUBMED: 28940368] - PubMed
Rogers 2017 {published data only}
    1. Rogers CA, Stoica S, Ellis L, Stokes E A, Wordsworth S, Dabner L, et al. Randomized trial of near‐infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery. British Journal of Anaesthesia 2017;119(3):384‐93. [PUBMED: 28969313] - PubMed
Sahan 2014 {published data only}
    1. Sahan C, Sivrikoz N, Sungur Z, Gurvit H, Senturk M, Camci E. Effects of near‐infrared spectroscopy on cognitive dysfunction for patients undergoing elective coronary surgery. Applied Cardiopulmonary Pathophysiology 2014;18:99.
Trinh 2016 {published data only}
    1. Trinh M, Uysal S, Fischer G, Lin H, Reich D. Optimizing cerebral saturation in cardiac surgical patients. Anesthesia and Analgesia 2016;122(5):S79.
Verborgh 2009 {published data only}
    1. Verborgh C, Pregardien C, Oubaha D, Beckers S, Poelaert J. Continuous monitoring of regional cerebral oxygen saturation during and outcome after OPCAB surgery. European Journal of Anaesthesiology 2009;26:59‐60.

References to ongoing studies

Bal 2016 {unpublished data only}
    1. Bal GK. Prospective evaluation of cognitive outcomes after anesthesia on patients in the beach chair position (BCP). https://clinicaltrials.gov/ct2/show/NCT02674334 (first received 4 February 2016). [NCT02674334] - PubMed
Djaiani 2012 {unpublished data only}
    1. Djaiani G. Role of cerebral oximetry in reducing delirium after complex cardiac surgery. https://clinicaltrials.gov/ct2/show/NCT01707446 (first received 16 October 2012). [NCT01707446]
Fischer 2009 {unpublished data only}
    1. Fischer G. Role of absolute cerebral oximetry to prevent neurocognitive injury in elderly patients undergoing cardiac surgery. https://clinicaltrials.gov/ct2/show/NCT00991328 (first received 8 October 2009). [NCT00991328]
Fominskiy 2014 {unpublished data only}
    1. Lomivorotov VV. Role of cerebral oximetry in reducing postoperative morbidity following cardiac surgery. https://clinicaltrials.gov/ct2/show/NCT02155868 (first received 4 June 2014). [NCT02155868]
Grocott 2013 {unpublished data only}
    1. Grocott HP. Reversing cerebral oxygen desaturations greater that 10% of baseline values using NIRS in the ICU (NIRS ICU). https://clinicaltrials.gov/ct2/show/NCT01875055 (first received 11 June 2013). [NCT01875055]
Shi 2013 {unpublished data only}
    1. Shi X. Cerebral oxygen directed perioperative anesthesia management and postoperative delirium in elder patients having esophageal cancer surgery. http://www.chictr.org.cn/hvshowproject.aspx?id=7860 (first received 27 September 2013). [ChiCTR‐TRC‐13003800]
Teurnier 2011 {unpublished data only}
    1. Teurnier Y. Medico‐economic evaluation of preoperative cerebral oximetry monitoring during carotid endarterectomy (EMOCAR). https://clinicaltrials.gov/ct2/show/NCT01415648 (first received 12 August 2011). [NCT01415648]
Trinh 2012 {unpublished data only}
    1. Trinh M. Measuring and treating brain oxygen levels in open heart surgery. https://clinicaltrials.gov/ct2/show/NCT01539382 (first received 27 February 2012). [NCT01539382]

Additional references

Aguirre 2014
    1. Aguirre J, Borgeat A, Trachsel T, Cobo Del Prado I, Andres J, Buhler P. Cerebral oxygenation in patients undergoing shoulder surgery in beach chair position: comparing general to regional anesthesia and the impact on neurobehavioral outcome. Revista Española De Anestesiología Y Reanimación 2014;61(2):64‐72. [PUBMED: 24119783] - PubMed
Akpek 2008
    1. Akpek EA. Cerebral monitoring in cardiac surgery. Anestezi Dergisi 2008;16(3):117‐24.
Andropoulos 2004
    1. Andropoulos DB, Stayer SA, Diaz LK, Ramamoorthy C. Neurological monitoring for congenital heart surgery. Anesthesia and Analgesia 2004;99(5):1365‐75. [PUBMED: 15502032] - PubMed
Anttila 2005
    1. Anttila V, Hagino I, Zurakowski D, Iwata Y, Duebener L, Lidov HG, et al. Specific bypass conditions determine safe minimum flow rate. Annals of Thoracic Surgery 2005;80(4):1460‐7. [PUBMED: 16181887] - PubMed
Bhatia 2007
    1. Bhatia R, Hampton T, Malde S, Kandala NB, Muammar M, Deasy N, et al. The application of near‐infrared oximetry to cerebral monitoring during aneurysm embolization: a comparison with intraprocedural angiography. Journal of Neurosurgical Anesthesiology 2007;19(2):97‐104. [PUBMED: 17413995] - PubMed
Bickler 2013
    1. Bickler PE, Feiner JR, Rollins MD. Factors affecting the performance of 5 cerebral oximeters during hypoxia in healthy volunteers. Anesthesia and Analgesia 2013;117(4):813‐23. [PUBMED: 24023027] - PubMed
Calderon‐Arnulphi 2007
    1. Calderon‐Arnulphi M, Alaraj A, Amin‐Hanjani S, Mantulin WW, Polzonetti CM, Gratton E, et al. Detection of cerebral ischemia in neurovascular surgery using quantitative frequency‐domain near‐infrared spectroscopy. Journal of Neurosurgery 2007;106(2):283‐90. [PUBMED: 17410713] - PubMed
Closhen 2013
    1. Closhen D, Berres M, Werner C, Engelhard K, Schramm P. Influence of beach chair position on cerebral oxygen saturation: a comparison of INVOS and FORE‐SIGHT cerebral oximeter. Journal of Neurosurgical Anesthesiology 2013;25(4):414‐9. [PUBMED: 24004981] - PubMed
Colak 2012
    1. Colak Z, Borojevic M, Ivancan V, Gabelica R, Biocina B, Majeric‐Kogler V. The relationship between prolonged cerebral oxygen desaturation and postoperative outcome in patients undergoing coronary artery bypass grafting. Collegium Antropologicum 2012;36(2):381‐8. [PUBMED: 22856219] - PubMed
Denault 2007
    1. Denault A, Deschamps A, Murkin JM. A proposed algorithm for the intraoperative use of cerebral near‐infrared spectroscopy. Seminars in Cardiothoracic and Vascular Anesthesia 2007;11(4):274‐81. [PUBMED: 18270192] - PubMed
Egawa 2009
    1. Egawa J, Kawaguchi M, Inoue S, Nishiwada T, Furuya H. Cerebral oxygen balance and postoperative cognitive function in patients undergoing lung surgery with one lung ventilation under propofol or sevoflurane anesthesia. Journal of Neurosurgical Anesthesiology 2009;21(4):408‐9. [DOI: 10.1097/01.ana.0000358102.35410.08] - DOI
Ferrari 2012
    1. Ferrari M, Quaresima V. Review: Near infrared brain and muscle oximetry: from the discovery to current applications. Journal of Near Infrared Spectroscopy 2012;20(1):1‐14. [DOI: 10.1255/jnirs.973] - DOI
Fischer 2008
    1. Fischer GW. Recent advances in application of cerebral oximetry in adult cardiovascular surgery. Seminars in Cardiothoracic and Vascular Anesthesia 2008;12(1):60‐9. [PUBMED: 18397905] - PubMed
Fischer 2011
    1. Fischer GW, Lin HM, Krol M, Galati MF, Luozzo G, Griepp RB, et al. Noninvasive cerebral oxygenation may predict outcome in patients undergoing aortic arch surgery. Journal of Thoracic and Cardiovascular Surgery 2011;141(3):815–21. [PUBMED: 20579669] - PubMed
Gale 2004
    1. Gale SD, Hopkins RO. Effects of hypoxia on the brain: neuroimaging and neuropsychological findings following carbon monoxide poisoning and obstructive sleep apnea. Journal of the International Neuropsychological Society 2004;10(1):60‐71. [PUBMED: 14751008] - PubMed
Ghanayem 2016
    1. Ghanayem NS, Hoffman GM. Near infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatric Critical Care Medicine 2016;17(8 Suppl 1):S201‐6. [PUBMED: 27490600] - PubMed
Ghosh 2012
    1. Ghosh A, Elwell C, Smith M. Review article: Cerebral near‐infrared spectroscopy in adults: a work in progress. Anesthesia and Analgesia 2012;115(6):1373‐83. [PUBMED: 23144435] - PubMed
Goldman 2004
    1. Goldman S, Sutter F, Ferdinand F, Trace C. Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. Heart Surgery Forum 2004;7(5):E376‐81. [PUBMED: 15799908] - PubMed
Greenberg 2013
    1. Greenberg SB, Murphy G, Alexander J, Fasanella R, Garcia A, Vender J. Cerebral desaturation events in the intensive care unit following cardiac surgery. Journal of Critical Care 2013;28(3):270‐6. [PUBMED: 23159132] - PubMed
Grinspan 2014
    1. Grinspan ZM, Pon S, Greenfield JP, Malhotra S, Kosofsky BE. Multimodal monitoring in the pediatric intensive care unit: new modalities and informatics challenges. Seminars in Pediatric Neurology 2014;21(4):291‐8. [PUBMED: 25727511] - PubMed
Guo 2011
    1. Guo L, Gelb AW. The use of motor evoked potential monitoring during cerebral aneurysm surgery to predict pure motor deficits due to subcortical ischemia. Clinical Neurophysiology 2011;122(4):648‐55. [PUBMED: 20869304] - PubMed
Guyatt 2008
    1. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck‐Ytter Y, Schunemann HJ. What is "quality of evidence" and why is it important to clinicians?. BMJ (Clinical research ed.) 2008;336(7651):995‐8. [PUBMED: 18456631] - PMC - PubMed
Hagino 2005
    1. Hagino I, Anttila V, Zurakowski D, Duebener LF, Lidov HG, Jonas RA. Tissue oxygenation index is a useful monitor of histologic and neurologic outcome after cardiopulmonary bypass in piglets. Journal of Thoracic and Cardiovascular Surgery 2005;130(2):384‐92. [PUBMED: 16077403] - PubMed
Harilall 2013
    1. Harilall Y, Adam JK, Biccard BM, Reddi A. The effect of optimising cerebral tissue oxygen saturation on markers of neurological injury during coronary artery bypass graft surgery. Heart, Lung and Circulation 2014;23(1):68‐74. [PUBMED: 23911209] - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hirsch 2009
    1. Hirsch JC, Charpie JR, Ohye RG, Gurney JG. Near‐infrared spectroscopy: what we know and what we need to know—a systematic review of the congenital heart disease literature. Journal of Thoracic and Cardiovascular Surgery 2009;137(1):154‐9, 159e1‐12. [PUBMED: 19154918] - PubMed
Hirsch 2010
    1. Hirsch JC, Charpie JR, Ohye RG, Gurney JG. Near infrared spectroscopy (NIRS) should not be standard of care for postoperative management. Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual 2010;13(1):51‐4. [PUBMED: 20307861] - PubMed
Hoffman 2004
    1. Hoffman GM, Stuth EA, Jaquiss RD, Vanderwal PL, Staudt SR, Troshynski TJ, et al. Changes in cerebral and somatic oxygenation during stage 1 palliation of hypoplastic left heart syndrome using continuous regional cerebral perfusion. Journal of Thoracic and Cardiovascular Surgery 2004;127(1):223‐33. [PUBMED: 14752434] - PubMed
Hyttel‐Sorensen 2017
    1. Hyttel‐Sorensen S, Greisen G, Als‐Nielsen B, Gluud C. Cerebral near‐infrared spectroscopy monitoring for prevention of brain injury in very preterm infants. Cochrane Database of Systematic Reviews 2017, Issue 9. [DOI: 10.1002/14651858.CD011506.pub2] - DOI - PMC - PubMed
Inoue 2013
    1. Inoue T, Ohwaki K, Tamura A, Tsutsumi K, Saito I, Saito N. Subclinical ischemia verified by somatosensory evoked potential amplitude reduction during carotid endarterectomy: negative effects on cognitive performance. Journal of Neurosurgery 2013;118(5):1023‐9. [PUBMED: 23451902] - PubMed
Jöbsis 1977
    1. Jöbsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science 1977;198(4323):1264‐7. [PUBMED: 929199] - PubMed
Kurth 1999
    1. Kurth CD, Thayer WS. A multiwavelength frequency‐domain near‐infrared cerebral oximeter. Physics in Medicine and Biology 1999;44(3):727‐40. [PUBMED: 10211806] - PubMed
Lovell 1999
    1. Lovell AT, Owen‐Reece H, Elwell CE, Smith M, Goldstone JC. Continuous measurement of cerebral oxygenation by near infrared spectroscopy during induction of anesthesia. Anesthesia and Analgesia 1999;88(3):554‐8. [PUBMED: 10072005] - PubMed
Mazzeo 2012
    1. Mazzeo AT, Pasquale R, Settineri N, Bottari G, Granata F, Farago G, et al. Usefulness and limits of near infrared spectroscopy monitoring during endovascular neuroradiologic procedures. Minerva Anestesiologica 2012;78(1):34‐45. [PUBMED: 21617599] - PubMed
McCormick 1991
    1. McCormick PW, Stewart M, Goetting MG, Dujovny M, Lewis G, Ausman JI. Noninvasive cerebral optical spectroscopy for monitoring cerebral oxygen delivery and hemodynamics. Critical Care Medicine 1991;19(1):89‐97. [PUBMED: 1986896] - PubMed
Meng 2012
    1. Meng L, Mantulin WW, Alexander BS, Cerussi AE, Tromberg BJ, Yu Z, et al. Head‐up tilt and hyperventilation produce similar changes in cerebral oxygenation and blood volume: an observational comparison study using frequency‐domain near‐infrared spectroscopy. Canadian Journal of Anaesthesia 2012;59(4):357‐65. [PUBMED: 22234820] - PMC - PubMed
Menke 2014
    1. Menke J, Moller G. Cerebral near‐infrared spectroscopy correlates to vital parameters during cardiopulmonary bypass surgery in children. Pediatric Cardiology 2014;35(1):155‐63. [PUBMED: 23852460] - PubMed
Moerman 2012b
    1. Moerman AT, Hert SG, Jacobs TF, Wilde LF, Wouters PF. Cerebral oxygen desaturation during beach chair position. European Journal of Anaesthesiology 2012;29(2):82‐7. [PUBMED: 21730865] - PubMed
Monk 2008
    1. Monk TG, Weldon BC, Garvan CW, Dede DE, Aa MT, Heilman KM, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 2008;108(1):18‐30. [PUBMED: 18156878] - PubMed
Moreno 2013
    1. Moreno GE, Pilan ML, Manara C, Magliola R, Vassallo JC, Balestrini M, et al. Regional venous oxygen saturation versus mixed venous saturation after paediatric cardiac surgery. Acta Anaesthesiologica Scandinavica 2013;57(3):373‐9. [PUBMED: 23210461] - PubMed
Morimoto 2003
    1. Morimoto Y, Niida Y, Hisano K, Hua Y, Kemmotsu O, Murashita T, et al. Changes in cerebral oxygenation in children undergoing surgical repair of ventricular septal defects. Anaesthesia 2003;58(1):77‐83. [PUBMED: 12523330] - PubMed
Murkin 2009
    1. Murkin JM, Arango M. Near‐infrared spectroscopy as an index of brain and tissue oxygenation. British Journal of Anaesthesia 2009;103 Suppl 1:i3‐13. [PUBMED: 20007987] - PubMed
Ng 2011
    1. Ng JL, Chan MT, Gelb AW. Perioperative stroke in noncardiac, nonneurosurgical surgery. Anesthesiology 2011;115(4):879‐90. [PUBMED: 21862923] - PubMed
Obrig 2014
    1. Obrig H. NIRS in clinical neurology ‐ a 'promising' tool?. Neuroimage 2014;85 Pt 1:535‐46. [PUBMED: 23558099] - PubMed
Olsson 2006
    1. Olsson C, Thelin S. Regional cerebral saturation monitoring with near‐infrared spectroscopy during selective antegrade cerebral perfusion: diagnostic performance and relationship to postoperative stroke. Journal of Thoracic and Cardiovascular Surgery 2006;131(2):371‐9. [PUBMED: 16434267] - PubMed
Orihashi 2004
    1. Orihashi K, Sueda T, Okada K, Imai K. Near‐infrared spectroscopy for monitoring cerebral ischemia during selective cerebral perfusion. European Journal of Cardio‐Thoracic Surgery 2004;26(5):907‐11. [PUBMED: 15519181] - PubMed
RevMan 5.3 [Computer program]
    1. Copenhagen. Review Manager (RevMan). Version 5.3. The Nordic Cochrane Centre, The Cochrane Collaboration: Copenhagen, 2014.
Salazar 2001
    1. Salazar JD, Wityk RJ, Grega MA, Borowicz LM, Doty JR, Petrofski JA, et al. Stroke after cardiac surgery: short‐ and long‐term outcomes. Annals of Thoracic Surgery 2001;72(4):1195‐201; discussion 1201‐2. [PUBMED: 11603436] - PubMed
Sanchez‐Pena 2012
    1. Sanchez‐Pena P, Nouet A, Clarencon F, Colonne C, Jean B, Jean L, et al. Atorvastatin decreases computed tomography and S100‐assessed brain ischemia after subarachnoid aneurysmal hemorrhage: a comparative study. Critical Care Medicine 2012;40(2):594‐602. [PUBMED: 21926584] - PubMed
Scheeren 2012
    1. Scheeren TW, Schober P, Schwarte LA. Monitoring tissue oxygenation by near infrared spectroscopy (NIRS): background and current applications. Journal of Clinical Monitoring and Computing 2012;26(4):279‐87. [PUBMED: 22467064] - PMC - PubMed
Schön 2009
    1. Schön J, Serien V, Heinze H, Hanke T. Association between cerebral desaturation and an increased risk of stroke in patients undergoing deep hypothermic circulatory arrest for cardiothoracic surgery. Applied Cardiopulmonary Pathophysiology 2009;13(3):201–7. [EMBASE: 2009479966]
Sood 2013
    1. Sood ED, Benzaquen JS, Davies RR, Woodford E, Pizarro C. Predictive value of perioperative near‐infrared spectroscopy for neurodevelopmental outcomes after cardiac surgery in infancy. Journal of Thoracic and Cardiovascular Surgery 2013;145(2):438‐445 e1; discussion 444‐5. [PUBMED: 23219333] - PubMed
Stys 1998
    1. Stys PK. Anoxic and ischemic injury of myelinated axons in CNS white matter: from mechanistic concepts to therapeutics. Journal of Cerebral Blood Flow and Metabolism 1998;18(1):2‐25. [PUBMED: 9428302] - PubMed
Subramanian 2016
    1. Subramanian B, Nyman C, Fritock M, Klinger RY, Sniecinski R, Roman P, et al. A multicenter pilot study assessing regional cerebral oxygen desaturation frequency during cardiopulmonary bypass and responsiveness to an intervention algorithm. Anesthesia and Analgesia 2016;122(6):1786‐93. [PUBMED: 27028775] - PMC - PubMed
Taillefer 2005
    1. Taillefer MC, Denault AY. Cerebral near‐infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy. Canadian Journal of Anesthesia 2005;52(1):79‐87. [PUBMED: 15625262] - PubMed
Tsai 2016
    1. Tsai HI, Chung PC, Lee CW, Yu HP. Cerebral perfusion monitoring in acute care surgery: current and perspective use. Expert Review of Medical Devices 2016;13(9):865‐75. [PUBMED: 27552801] - PubMed
Vohra 2009
    1. Vohra HA, Modi A, Ohri SK. Does use of intra‐operative cerebral regional oxygen saturation monitoring during cardiac surgery lead to improved clinical outcomes?. Interactive Cardiovascular and Thoracic Surgery 2009;9(2):318‐22. [PUBMED: 19447799] - PubMed
Watzman 2000
    1. Watzman HM, Kurth CD, Montenegro LM, Rome J, Steven JM, Nicolson SC. Arterial and venous contributions to near‐infrared cerebral oximetry. Anesthesiology 2000;93(4):947‐53. [PUBMED: 11020744] - PubMed
Williams 1994
    1. Williams IM, Picton A, Farrell A, Mead GE, Mortimer AJ, McCollum CN. Light‐reflective cerebral oximetry and jugular bulb venous oxygen saturation during carotid endarterectomy. British Journal of Surgery 1994;81(9):1291‐5. [PUBMED: 7953390] - PubMed
Yao 2004
    1. Yao FS, Tseng CC, Ho CY, Levin SK, Illner P. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 2004;18(5):552‐8. [PUBMED: 15578464] - PubMed
Yoshitani 2005
    1. Yoshitani K, Kawaguchi M, Iwata M, Sasaoka N, Inoue S, Kurumatani N, et al. Comparison of changes in jugular venous bulb oxygen saturation and cerebral oxygen saturation during variations of haemoglobin concentration under propofol and sevoflurane anaesthesia. British Journal of Anaesthesia 2005;94(3):341‐6. [PUBMED: 15591331] - PubMed
Zheng 2013
    1. Zheng F, Sheinberg R, Yee MS, Ono M, Zheng Y, Hogue CW. Cerebral near‐infrared spectroscopy monitoring and neurologic outcomes in adult cardiac surgery patients: a systematic review. Anesthesia and Analgesia 2013; Vol. 116, issue 3:663‐76. [PUBMED: 23267000] - PMC - PubMed

References to other published versions of this review

Yu 2014
    1. Yu Y, Zhang K, Zhang L, Zong H, Meng L, Han R. Cerebral near‐infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Cochrane Database of Systematic Reviews 2014, Issue 1. [DOI: 10.1002/14651858.CD010947] - DOI - PMC - PubMed

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