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J Clin Monit Comput. 2019 May 28. doi: 10.1007/s10877-019-00324-w. [Epub ahead of print]

The response of a standardized fluid challenge during cardiac surgery on cerebral oxygen saturation measured with near-infrared spectroscopy.

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Department of Cardiothoracic Anesthesiology, Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Clinical Medicine, Aarhus University, Århus, Denmark.
Department of Anesthesiology & Intensive Care, Aarhus University Hospital, Århus, Denmark.
Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.


Near infrared spectroscopy (NIRS) has been used to evaluate regional cerebral tissue oxygen saturation (ScO2) during the last decades. Perioperative management algorithms advocate to maintain ScO2, by maintaining or increasing cardiac output (CO), e.g. with fluid infusion. We hypothesized that ScO2 would increase in responders to a standardized fluid challenge (FC) and that the relative changes in CO and ScO2 would correlate. This study is a retrospective substudy of the FLuid Responsiveness Prediction Using Extra Systoles (FLEX) trial. In the FLEX trial, patients were administered two standardized FCs (5 mL/kg ideal body weight each) during cardiac surgery. NIRS monitoring was used during the intraoperative period and CO was monitored continuously. Patients were considered responders if stroke volume increased more than 10% following FC. Datasets from 29 non-responders and 27 responders to FC were available for analysis. Relative changes of ScO2 did not change significantly in non-responders (mean difference - 0.3% ± 2.3%, p = 0.534) or in fluid responders (mean difference 1.6% ± 4.6%, p = 0.088). Relative changes in CO and ScO2 correlated significantly, p = 0.027. Increasing CO by fluid did not change cerebral oxygenation. Despite this, relative changes in CO correlated to relative changes in ScO2. However, the clinical impact of the present observations is unclear, and the results must be interpreted with caution.Trial registration: identifier for main study (FLuid Responsiveness Prediction Using Extra Systoles-FLEX): NCT03002129.


Cardiac anaesthesia; Cardiac output; Cerebral oximetry; Fluid challenge; Monitoring; Near infrared spectroscopy


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