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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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01-05-2018 | Reports of Original Investigations

Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials

Authors: Andres Zorrilla-Vaca, BSc, Ryan Healy, BSc, Michael C. Grant, MD, Brijen Joshi, MD, Lucia Rivera-Lara, MD, Charles Brown, MD, Marek A. Mirski, MD, PhD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 5/2018

Abstract

Purpose

Although evidence from observational studies in a variety of clinical settings supports the utility of cerebral oximetry as a predictor of outcomes, prospective clinical trials thus far have reported conflicting results. This systematic review and meta-analysis was designed to evaluate the influence of management associated with intraoperative cerebral oximetry on postoperative outcomes. The primary outcome was postoperative cognitive dysfunction (POCD), with secondary outcomes that included postoperative delirium, length of intensive care unit (ICU) stay, and hospital length of stay (LOS).

Source

After searching the PubMed, EMBASE, Cochrane Library, Scopus, and Google Scholar databases, all randomized controlled trials (RCTs) assessing the impact of intraoperative cerebral oximetry-guided management on clinical outcomes following surgery were identified.

Principal findings

Fifteen RCTs comprising 2,057 patients (1,018 in the intervention group and 1,039 in control group) were included. Intraoperative management guided by the use of cerebral oximetry was associated with a reduction in the incidence of POCD (risk ratio [RR] 0.54; 95% confidence interval [CI], 0.33 to 0.90; P = 0.02; I² = 85%) and a significantly shorter length of ICU stay (standardized mean difference [SMD], −0.21 hr; 95% CI, −0.37 to −0.05; P = 0.009; I² = 48%). In addition, overall hospital LOS (SMD, −0.06 days; 95% CI, −0.18 to 0.06; P = 0.29; I² = 0%) and incidence of postoperative delirium (RR, 0.69; 95% CI, 0.36 to 1.32; P = 0.27; I² = 0%) were not impacted by the use of intraoperative cerebral oximetry.

Conclusions

Intraoperative cerebral oximetry appears to be associated with a reduction in POCD, although this result should be interpreted with caution given the significant heterogeneity in the studies examined. Further large (ideally multicentre) RCTs are needed to clarify whether POCD can be favourably impacted by the use of cerebral oximetry-guided management.

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Title: Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials
Authors: Andres Zorrilla-Vaca, BSc
Ryan Healy, BSc
Michael C. Grant, MD
Brijen Joshi, MD
Lucia Rivera-Lara, MD
Charles Brown, MD
Marek A. Mirski, MD, PhD
Publication date: 01-05-2018
Publisher: Springer US
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 5/2018
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-018-1065-7

At a glance: The STEP trials

Springer Medicine

Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials

Abstract

Purpose

Source

Principal findings

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Source

Principal findings

Conclusions

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