Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration

Klaus U Koch; Xu Zhao; Irene K Mikkelsen; Ulrick S Espelund; Joel Aanerud; Mads Rasmussen; Lingzhong Meng

doi:10.1097/ANA.0000000000000822

Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration

Klaus U Koch, Xu Zhao, Irene K Mikkelsen, Ulrick S Espelund, Joel Aanerud, Mads Rasmussen, Lingzhong Meng

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

8 Citations (Scopus)

Abstract

BACKGROUND: The speculation that cerebral tissue oxygen saturation (SctO2) measured using tissue near-infrared spectroscopy reflects the balance between cerebral metabolic rate of oxygen and cerebral oxygen delivery has not been validated. Our objective was to correlate SctO2 with cerebral oxygen extraction fraction (OEF) measured using positron emission tomography; OEF is the ratio between cerebral metabolic rate of oxygen and cerebral oxygen delivery and reflects the balance between these 2 variables.

MATERIALS AND METHODS: This cohort study was based on data collected in a previously published trial assessing phenylephrine versus ephedrine treatment in anesthetized patients undergoing brain tumor surgery. The variables of interest were measured twice over the healthy hemisphere before surgery: the first measurement performed after anesthesia induction and the second measurement performed after induction of a ∼20% increase in blood pressure using either phenylephrine or ephedrine.

RESULTS: Data from 24 patients were analyzed. The overall vasopressor-induced relative changes in SctO2 (ΔSctO2) and OEF (ΔOEF) were 3.16% [interquartile range, -0.73% to 6.04%] and -12.5% [interquartile range, -24.0% to -6.19%], respectively. ΔSctO2 negatively correlated with ΔOEF after phenylephrine treatment (Spearman rank correlation coefficient [rs]=-0.76; P=0.007), ephedrine treatment (rs=-0.76; P=0.006), and any treatment (rs=-0.79; P<0.001). ΔSctO2 significantly associated with ΔOEF based on multivariable analysis with ΔOEF, relative changes in mean arterial pressure, arterial blood oxygen tension, and the bispectral index as covariates (P=0.036).

CONCLUSIONS: The negative correlation between changes in SctO2 and OEF suggests that SctO2 may reflect the cerebral metabolic demand-supply balance during vasopressor treatment. The generalizability of our findings in other clinical scenarios remains to be determined.

Original language	English
Journal	Journal of Neurosurgical Anesthesiology
Volume	35
Issue	2
Pages (from-to)	238-242
Number of pages	5
ISSN	0898-4921
DOIs	https://doi.org/10.1097/ANA.0000000000000822
Publication status	Published - Apr 2023

Keywords

Cerebral metabolic demand-supply balance
Cerebral near-infrared spectroscopy
Cerebral oxygen extraction fraction
Cerebral tissue oxygen saturation
Vasopressor treatment

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10.1097/ANA.0000000000000822

Cite this

Koch, K. U., Zhao, X., Mikkelsen, I. K., Espelund, U. S., Aanerud, J., Rasmussen, M., & Meng, L. (2023). Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration. Journal of Neurosurgical Anesthesiology, 35(2), 238-242. https://doi.org/10.1097/ANA.0000000000000822

@article{969c3e1642494d309de037f5df712c99,

title = "Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration",

abstract = "BACKGROUND: The speculation that cerebral tissue oxygen saturation (SctO2) measured using tissue near-infrared spectroscopy reflects the balance between cerebral metabolic rate of oxygen and cerebral oxygen delivery has not been validated. Our objective was to correlate SctO2 with cerebral oxygen extraction fraction (OEF) measured using positron emission tomography; OEF is the ratio between cerebral metabolic rate of oxygen and cerebral oxygen delivery and reflects the balance between these 2 variables.MATERIALS AND METHODS: This cohort study was based on data collected in a previously published trial assessing phenylephrine versus ephedrine treatment in anesthetized patients undergoing brain tumor surgery. The variables of interest were measured twice over the healthy hemisphere before surgery: the first measurement performed after anesthesia induction and the second measurement performed after induction of a ∼20% increase in blood pressure using either phenylephrine or ephedrine.RESULTS: Data from 24 patients were analyzed. The overall vasopressor-induced relative changes in SctO2 (ΔSctO2) and OEF (ΔOEF) were 3.16% [interquartile range, -0.73% to 6.04%] and -12.5% [interquartile range, -24.0% to -6.19%], respectively. ΔSctO2 negatively correlated with ΔOEF after phenylephrine treatment (Spearman rank correlation coefficient [rs]=-0.76; P=0.007), ephedrine treatment (rs=-0.76; P=0.006), and any treatment (rs=-0.79; P<0.001). ΔSctO2 significantly associated with ΔOEF based on multivariable analysis with ΔOEF, relative changes in mean arterial pressure, arterial blood oxygen tension, and the bispectral index as covariates (P=0.036).CONCLUSIONS: The negative correlation between changes in SctO2 and OEF suggests that SctO2 may reflect the cerebral metabolic demand-supply balance during vasopressor treatment. The generalizability of our findings in other clinical scenarios remains to be determined.",

keywords = "Cerebral metabolic demand-supply balance, Cerebral near-infrared spectroscopy, Cerebral oxygen extraction fraction, Cerebral tissue oxygen saturation, Vasopressor treatment",

author = "Koch, {Klaus U} and Xu Zhao and Mikkelsen, {Irene K} and Espelund, {Ulrick S} and Joel Aanerud and Mads Rasmussen and Lingzhong Meng",

year = "2023",

month = apr,

doi = "10.1097/ANA.0000000000000822",

language = "English",

volume = "35",

pages = "238--242",

journal = "Journal of Neurosurgical Anesthesiology",

issn = "0898-4921",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "2",

}

Koch, KU, Zhao, X, Mikkelsen, IK , Espelund, US, Aanerud, J, Rasmussen, M & Meng, L 2023, 'Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration', Journal of Neurosurgical Anesthesiology, vol. 35, no. 2, pp. 238-242. https://doi.org/10.1097/ANA.0000000000000822

Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration. / Koch, Klaus U; Zhao, Xu; Mikkelsen, Irene K et al.
In: Journal of Neurosurgical Anesthesiology, Vol. 35, No. 2, 04.2023, p. 238-242.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia

T2 - Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration

AU - Koch, Klaus U

AU - Zhao, Xu

AU - Mikkelsen, Irene K

AU - Espelund, Ulrick S

AU - Aanerud, Joel

AU - Rasmussen, Mads

AU - Meng, Lingzhong

PY - 2023/4

Y1 - 2023/4

N2 - BACKGROUND: The speculation that cerebral tissue oxygen saturation (SctO2) measured using tissue near-infrared spectroscopy reflects the balance between cerebral metabolic rate of oxygen and cerebral oxygen delivery has not been validated. Our objective was to correlate SctO2 with cerebral oxygen extraction fraction (OEF) measured using positron emission tomography; OEF is the ratio between cerebral metabolic rate of oxygen and cerebral oxygen delivery and reflects the balance between these 2 variables.MATERIALS AND METHODS: This cohort study was based on data collected in a previously published trial assessing phenylephrine versus ephedrine treatment in anesthetized patients undergoing brain tumor surgery. The variables of interest were measured twice over the healthy hemisphere before surgery: the first measurement performed after anesthesia induction and the second measurement performed after induction of a ∼20% increase in blood pressure using either phenylephrine or ephedrine.RESULTS: Data from 24 patients were analyzed. The overall vasopressor-induced relative changes in SctO2 (ΔSctO2) and OEF (ΔOEF) were 3.16% [interquartile range, -0.73% to 6.04%] and -12.5% [interquartile range, -24.0% to -6.19%], respectively. ΔSctO2 negatively correlated with ΔOEF after phenylephrine treatment (Spearman rank correlation coefficient [rs]=-0.76; P=0.007), ephedrine treatment (rs=-0.76; P=0.006), and any treatment (rs=-0.79; P<0.001). ΔSctO2 significantly associated with ΔOEF based on multivariable analysis with ΔOEF, relative changes in mean arterial pressure, arterial blood oxygen tension, and the bispectral index as covariates (P=0.036).CONCLUSIONS: The negative correlation between changes in SctO2 and OEF suggests that SctO2 may reflect the cerebral metabolic demand-supply balance during vasopressor treatment. The generalizability of our findings in other clinical scenarios remains to be determined.

AB - BACKGROUND: The speculation that cerebral tissue oxygen saturation (SctO2) measured using tissue near-infrared spectroscopy reflects the balance between cerebral metabolic rate of oxygen and cerebral oxygen delivery has not been validated. Our objective was to correlate SctO2 with cerebral oxygen extraction fraction (OEF) measured using positron emission tomography; OEF is the ratio between cerebral metabolic rate of oxygen and cerebral oxygen delivery and reflects the balance between these 2 variables.MATERIALS AND METHODS: This cohort study was based on data collected in a previously published trial assessing phenylephrine versus ephedrine treatment in anesthetized patients undergoing brain tumor surgery. The variables of interest were measured twice over the healthy hemisphere before surgery: the first measurement performed after anesthesia induction and the second measurement performed after induction of a ∼20% increase in blood pressure using either phenylephrine or ephedrine.RESULTS: Data from 24 patients were analyzed. The overall vasopressor-induced relative changes in SctO2 (ΔSctO2) and OEF (ΔOEF) were 3.16% [interquartile range, -0.73% to 6.04%] and -12.5% [interquartile range, -24.0% to -6.19%], respectively. ΔSctO2 negatively correlated with ΔOEF after phenylephrine treatment (Spearman rank correlation coefficient [rs]=-0.76; P=0.007), ephedrine treatment (rs=-0.76; P=0.006), and any treatment (rs=-0.79; P<0.001). ΔSctO2 significantly associated with ΔOEF based on multivariable analysis with ΔOEF, relative changes in mean arterial pressure, arterial blood oxygen tension, and the bispectral index as covariates (P=0.036).CONCLUSIONS: The negative correlation between changes in SctO2 and OEF suggests that SctO2 may reflect the cerebral metabolic demand-supply balance during vasopressor treatment. The generalizability of our findings in other clinical scenarios remains to be determined.

KW - Cerebral metabolic demand-supply balance

KW - Cerebral near-infrared spectroscopy

KW - Cerebral oxygen extraction fraction

KW - Cerebral tissue oxygen saturation

KW - Vasopressor treatment

U2 - 10.1097/ANA.0000000000000822

DO - 10.1097/ANA.0000000000000822

M3 - Journal article

C2 - 34861671

SN - 0898-4921

VL - 35

SP - 238

EP - 242

JO - Journal of Neurosurgical Anesthesiology

JF - Journal of Neurosurgical Anesthesiology

IS - 2

ER -

Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration

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Keywords

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