AUTHOR=Tian Li-Juan , Yuan Su , Zhou Cheng-Hui , Yan Fu-Xia 

TITLE=The Effect of Intraoperative Cerebral Oximetry Monitoring on Postoperative Cognitive Dysfunction and ICU Stay in Adult Patients Undergoing Cardiac Surgery: An Updated Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.814313

DOI=10.3389/fcvm.2021.814313

ISSN=2297-055X

ABSTRACT=Aim: The objective of this study was to conduct an up-to-date meta-analysis to comprehensively assess the effects of intervention guiding by regional cerebral oxygen saturation (rSO2) monitoring on cognitive outcomes after cardiac surgery.
Methods: The PubMed, EMBASE, Ovid, and Cochrane Library databases were systematically searched using the related keywords for randomized-controlled trials (RCTs) published from their inception to July 31, 2021. The primary outcome was POD. Secondary outcomes were postoperative cognitive decline (POCD) and other major postoperative outcomes. The odds ratio (OR) or weighted mean differences (WMD) with 95% confidence interval (CI) were used to pool the data. We performed meta-regression and subgroup analyses to assess the possible influence of intervention guiding by rSO2 monitoring on clinical outcomes.
Results: Twelve RCTs with 1868 cardiac surgical patients were included. Compared with controls, intervention guiding by rSO2 monitoring reduced the incidence of POD (OR, 0.28; 95 % CI, 0.09 to 0.84; P = 0.02; I2 = 81%) and POCD (OR, 0.38; 95 % CI, 0.16 to 0.93; P = 0.03; I2 = 78%). Cerebral oximetry desaturation also showed a positive association with the incidence of POD ( OR, 2.02; 95 % CI, 1.25 to 3.24; P = 0.004; I2 = 81%). A statistically significant reduction in the length of intensive care unit (ICU) stay by intervention group was indicated (WMD, −0.22 days; 95% CI, −0.44 to −0.00; P = 0.05; I2 = 74%). Univariate meta-regression analyses showed that the major sources of heterogeneity were age (P = 0.03), BMI (P = 0.05), and proportion of CHD (P = 0.02) for POD, age (P = 0.04) for POCD, DM (P = 0.07), CVA (P = 0.02), and COPD (P = 0.09) for ICU stay. Subsequent subgroup analyses also confirmed these results. 
Conclusion: Available evidence from the present study suggest that intraoperative cerebral oximetry desaturation is associated with increased POD risk, and the intervention guiding by rSO2 monitoring correlated with a lower risk of POD and POCD, and shorter ICU stay after cardiac surgery. These clinical benefits may be limited in patients with aging, diabetes status, high BMI, non-CHD, non-COPD, or previous cardiovascular accident.