Monitoring brain oxygen saturation during coronary bypass surgery: A randomized, prospective study

BACKGROUND: Cerebral deoxygenation. is associated with various adverse systemic outcomes. We hypothesized, by using the brain as an index organ, that interventions. to improve cerebral oxygenation would have systemic benefits in cardiac surgical patients. METHODS: Two-hundred coronary artery bypass patients were randomized to either intraoperative cerebral regional oxygen saturation (rSO(2),) monitoring with active display and treatment intervention protocol (intervention, n = 100), or underwent blinded rSO(2) monitoring (control, n = 100). Predefined clinical outcomes were assessed by a blinded observer. RESULTS: Significantly more patients in the control group demonstrated prolonged cerebral desaturation (P = 0.014) and longer duration in the intensive care unit (P = 0.029) versus intervention patients. There was no difference in overall incidence of adverse complications, but significantly more control patients had major organ morbidity or mortality (death, ventilation > 48 h, stroke, myocardial infarction, return for re-exploration) versus intervention group patients (P = 0.048). Patients experiencmg major organ morbidity or mortality had lower baseline and mean rSO(2), more cerebral desaturations and longer lengths of stay in the intensive care it and postoperative hospitalization, than patients without such complications. There was a significant (r(2) = 0.29) inverse correlation between intraoperative rSO(2), and duration of postoperative hospitalization in patients requiring >= 10 days postoperative length of stay. CONCLUSION: Monitoring cerebral rSO(2) in coronary artery bypass patients avoids profound cerebral desaturation and is associated with significantly fewer incidences of major organ dysfunction.