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Treatment algorithm for regional cerebral oxygen desaturation during cardiopulmonary bypass*

Treatment algorithm for regional cerebral oxygen desaturation during cardiopulmonary bypass*

rSO2: regional oxygen saturation index; CVP: central venous pressure; CPB: cardiopulmonary bypass; MAP: mean arterial pressure; SaO2: oxygen saturation of arterial blood; FiO2: fraction of inspired oxygen; PaCO2: partial pressure of carbon dioxide; Hgb: hemoglobin; RBC: red blood cells; O2: oxygen.

* When using this algorithm to treat cerebral oxygen desaturation, it is important to verify the accuracy of the monitoring equipment, particularly if unexpected values are encountered or sensor signal levels are inconsistent (suggesting a technical measurement problem).

¶ If rSO2 has not returned to baseline, continue assessments and treat abnormalities, as noted in the algorithm.

Δ When low MAP is identified, always verify adequate CPB pump flow before administering pharmacologic treatment (ie, vasopressors).

◊ Administering 100% O2, even if the SaO2 is within normal limits, may improve O2 delivery by increasing the O2 content dissolved in arterial blood.
Adapted from:
  1. Subramanian B, Nyman C, Fritock M, et al. A multicenter pilot study assessing regional cerebral oxygen desaturation frequency during cardiopulmonary bypass and responsiveness to an intervention algorithm. Anesth Analg 2016; 122:1786.
  2. Denault A, Deschamps A, Murkin JM. A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth 2007; 11:274.
  3. Kara I, Erkin A, Sach H, et al. The effects of near-infrared spectroscopy on the neurocognitive functions in patients undergoing coronary artery bypass grafting with asymptomatic carotic artery disease: A randomized prospective study. Ann Thorac Cardiovasc Surg 2015; 21:544.
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