Dataset Information

Differences between Hepatic and Cerebral Regional Tissue Oxygen Saturation at the Onset of Intradialytic Hypotension.

ABSTRACT:

Background

Intradialytic hypotension (IDH) is a critical pathological condition associated with all-cause mortality in patients undergoing hemodialysis (HD). However, few studies have investigated IDH-related changes in hepatic and cerebral regional tissue oxygen saturation (rSO₂). This study investigated IDH-induced changes in hepatic and cerebral rSO₂.

Methods

Hepatic and cerebral rSO₂ during HD were measured using an INVOS 5100C oxygen saturation monitor, and their percentage (%) changes during the development of IDH were analyzed. Ninety-one patients undergoing HD were investigated, including twenty with IDH.

Results

In patients with IDH, % changes in hepatic and cerebral rSO₂ decreased at the onset of IDH. Additionally, the % change in hepatic rSO₂ was significantly larger than that in cerebral rSO₂ (p < 0.001). In patients without IDH, no significant differences were found between the % changes in hepatic and cerebral rSO₂ at the time of the lowest systolic blood pressure during HD. Multivariable linear regression analysis showed that the difference between the % changes in cerebral and hepatic rSO₂ was significantly associated with the development of IDH (p < 0.001) and the ultrafiltration rate (p = 0.010).

Conclusions

Hepatic and cerebral rSO₂ significantly decreased during the development of IDH, and hepatic rSO₂ was more significantly decreased than cerebral rSO₂ at the onset of IDH.

SUBMITTER: Kaneko S

PROVIDER: S-EPMC10419901 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Publications

Differences between Hepatic and Cerebral Regional Tissue Oxygen Saturation at the Onset of Intradialytic Hypotension.

Kaneko Shohei S Ookawara Susumu S Ito Kiyonori K Minato Saori S Mutsuyoshi Yuko Y Ueda Yuichiro Y Hirai Keiji K Morishita Yoshiyuki Y

Journal of clinical medicine 20230726 15

<h4>Background</h4>Intradialytic hypotension (IDH) is a critical pathological condition associated with all-cause mortality in patients undergoing hemodialysis (HD). However, few studies have investigated IDH-related changes in hepatic and cerebral regional tissue oxygen saturation (rSO<sub>2</sub>). This study investigated IDH-induced changes in hepatic and cerebral rSO<sub>2</sub>.<h4>Methods</h4>Hepatic and cerebral rSO<sub>2</sub> during HD were measured using an INVOS 5100C oxygen saturatio ...[more]

PMID: 37568305

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Project description:One of the main concerns of intraoperative hypotension is adequacy of cerebral perfusion, as cerebral blood flow decreases passively when mean arterial pressure falls below the lower limit of cerebral autoregulation. Treatment of intraoperative hypotension includes administration of drugs, such as inotropes and vasopressors, which have different pharmacological effects on cerebral hemodynamics; there is no consensus on the preferred drug to use. We performed a network meta-analysis (NMA) to pool and analyze data comparing the effect on cerebral oxygen saturation (ScO2) measured by cerebral oximetry of various inotropes/vasopressors used to treat intraoperative hypotension. We searched randomized control trials in Embase, Ovid Medline, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. We included studies that enrolled adult patients undergoing surgery under general/spinal anesthesia that compared at least 2 inotropes/vasopressors to treat hypotension. We reviewed 51 full-text manuscripts and included 9 randomized controlled trials in our study. The primary outcome was change in ScO2. Our results showed the likelihood that dopamine, ephedrine, and norepinephrine had the lowest probability of decreasing ScO2. The suggested rank order to maintain ScO2, from higher to lower, was dopamine <ephedrine <norepinephrine <phenylephrine. Drugs in the lower rank order, like phenylephrine, produce higher reductions in ScO2. Compared with dopamine, the mean difference (95% credible interval) of ScO2 reduction was: ephedrine -3.19 (-15.74, 8.82), norepinephrine -4.44 (-18.23, 9.63) and phenylephrine -6.93 (-18.31, 4.47). The results of our NMA suggest that dopamine and ephedrine are more likely to preserve ScO2, followed by norepinephrine. Compared with the other inotropes/vasopressors, phenylephrine decreased ScO2. Because of the inherent imprecision of direct/indirect comparisons, the rank orders are possibilities, not absolute ranks. Therefore the results of this NMA should be interpreted with caution.

Project description:ObjectiveTo investigate whether monitoring of cerebral tissue oxygen saturation using near infrared spectroscopy in addition to routine monitoring combined with defined treatment guidelines during immediate transition and resuscitation increases survival without cerebral injury of premature infants compared with standard care alone.DesignMulticentre, multinational, randomised controlled phase 3 trial.Setting11 tertiary neonatal intensive care units in six countries in Europe and in Canada.Participants1121 pregnant women (<32 weeks' gestation) were screened prenatally. The primary outcome was analysed in 607 of 655 randomised preterm neonates: 304 neonates in the near infrared spectroscopy group and 303 in the control group.InterventionPreterm neonates were randomly assigned to either standard care (control group) or standard care plus monitoring of cerebral oxygen saturation with a dedicated treatment guideline (near infrared spectroscopy group) during immediate transition (first 15 minutes after birth) and resuscitation.Main outcome measureThe primary outcome, assessed using all cause mortality and serial cerebral ultrasonography, was a composite of survival without cerebral injury. Cerebral injury was defined as any intraventricular haemorrhage or cystic periventricular leukomalacia, or both, at term equivalent age or before discharge.ResultsCerebral tissue oxygen saturation was similar in both groups. 252 (82.9%) out of 304 neonates (median gestational age 28.9 (interquartile range 26.9-30.6) weeks) in the near infrared spectroscopy group survived without cerebral injury compared with 238 (78.5%) out of 303 neonates (28.6 (26.6-30.6) weeks) in the control group (relative risk 1.06, 95% confidence interval 0.98 to 1.14). 28 neonates died (near infrared spectroscopy group 12 (4.0%) v control group 16 (5.3%): relative risk 0.75 (0.33 to 1.70).ConclusionMonitoring of cerebral tissue oxygen saturation in combination with dedicated interventions in preterm neonates (<32 weeks' gestation) during immediate transition and resuscitation after birth did not result in substantially higher survival without cerebral injury compared with standard care alone. Survival without cerebral injury increased by 4.3% but was not statistically significant.Trial registrationClinicalTrials.gov NCT03166722.

Dataset Information

Differences between Hepatic and Cerebral Regional Tissue Oxygen Saturation at the Onset of Intradialytic Hypotension.

Background

Methods

Results

Conclusions

Publications

Differences between Hepatic and Cerebral Regional Tissue Oxygen Saturation at the Onset of Intradialytic Hypotension.

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