Patient Outcomes Improve by Managing rSo2 with INVOS
Feb. 14, 2007 — Results have been released from a study examining the use of cerebral regional oxygen saturation (rSO2) monitoring to decrease the number of adverse outcomes of coronary artery bypass surgery patients.
John Murkin, M.D., professor of Anesthesiology at the University of Western Ontario, conducted from the randomized, prospective, blinded 200-patient study, titled, “Monitoring Brain Oxygen Saturation During Coronary Bypass Surgery: A Randomized, Prospective Study;” it was published in the January edition of the peer-reviewed publication, “Anesthesia & Analgesia.”
Dr. Murkin’s key findings included:
1.) The intervention group, whose cerebral rSO2 was managed via the INVOS System, experienced zero severe oxygen desaturations compared to six severe desaturations in the control group, where cerebral rSO2 was not managed.
2.) Actively managing cerebral rSO2 decreased major organ morbidity and mortality (MOMM) by 73 percent. MOMM includes permanent stroke, greater than 48 hours ventilation, re-operation for any reason, deep sternal infection and renal failure requiring dialysis.
3.) Interventions to rectify dropping rSO2 values were successful in rapidly reversing the ischemia 80 percent of the time. Dr. Murkin states, “While none of the interventions undertaken are outside the range of good clinical practice, it is clear that in the absence of feedback from a specific indicator of end-organ compromise (e.g., cerebral desaturations), the ability of the clinician to detect and optimize otherwise silent but potentially adverse perturbations in clinical variables remains limited.”?
4.) Patients whose cerebral rSO2 was actively managed had shorter ICU length of stay (1.25 0.8 days compared to 1.87 2.7 days).
An additional prospective presentation by James P. Slater, M.D., Cardiothoracic Surgeon at Atlantic Health System, Morristown , N.J.,
was given at STS, which showed that the INVOS System (In Vivo Optical Spectroscopy)by Somanetics is tied to better outcomes and may elevate cerebral oximetry to a neuro-monitoring standard of care.
Dr. Slater conducted a separate prospective, randomized, blinded trial of 240 coronary artery bypass surgery patients, and confirmed that a significantly increased risk of neuro-cognitive decline is associated with cerebral desaturation.
The INVOS System identifies hemoglobin and red-colored oxygenated hemoglobin molecules within red blood cells, measuring the relative amounts of each to determine whether or not there is adequate oxygenation. Since brain cells and organ tissues die within minutes without proper oxygenation, measurement of this color provides potentially life-saving or life-changing information. When its "regional oxygen saturation" (rSO2) value shows a change in blood oxygenation toward or beyond threshold levels, the care team can intervene to potentially lessen or prevent complications.
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