TY - JOUR
T1 - Gestion peropératoire basée sur l’oxymétrie cérébrale pour améliorer les résultats périopératoires
T2 - méta-analyse d’essais randomisés contrôlés
AU - Zorrilla-Vaca, Andres
AU - Healy, Ryan
AU - Grant, Michael C.
AU - Joshi, Brijen
AU - Rivera-Lara, Lucia
AU - Brown, Charles
AU - Mirski, Marek A.
N1 - Funding Information:
Dr. Lucia Rivera Lara received a grant from Medtronic/Covidien, Dublin, Ireland. Andres Zorrilla-Vaca contributed to the study conception and design, drafting the manuscript, acquisition of data, and analysis and interpretation of data. Ryan Healy was involved in drafting the manuscript and literature search. Michael C. Grant was involved in drafting the manuscript and revising it for important intellectual content. Brijen Joshi was involved in drafting the manuscript and revising it for important intellectual content. Lucia Rivera-Lara was involved in drafting the manuscript and revising it for important intellectual content. Charles Brown was involved in drafting the manuscript and revising it for important intellectual content. Marek A. Mirski was involved in drafting the manuscript and revising it for important intellectual content. This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia. There was no funding source for this study. No authors were paid to write this article.
Publisher Copyright:
© 2018, Canadian Anesthesiologists' Society.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Purpose: Although evidence from observational studies in a variety of clinical settings supports the utility of cerebral oximetry as a predictor of outcomes, prospective clinical trials thus far have reported conflicting results. This systematic review and meta-analysis was designed to evaluate the influence of management associated with intraoperative cerebral oximetry on postoperative outcomes. The primary outcome was postoperative cognitive dysfunction (POCD), with secondary outcomes that included postoperative delirium, length of intensive care unit (ICU) stay, and hospital length of stay (LOS). Source: After searching the PubMed, EMBASE, Cochrane Library, Scopus, and Google Scholar databases, all randomized controlled trials (RCTs) assessing the impact of intraoperative cerebral oximetry-guided management on clinical outcomes following surgery were identified. Principal findings: Fifteen RCTs comprising 2,057 patients (1,018 in the intervention group and 1,039 in control group) were included. Intraoperative management guided by the use of cerebral oximetry was associated with a reduction in the incidence of POCD (risk ratio [RR] 0.54; 95% confidence interval [CI], 0.33 to 0.90; P = 0.02; I2 = 85%) and a significantly shorter length of ICU stay (standardized mean difference [SMD], −0.21 hr; 95% CI, −0.37 to −0.05; P = 0.009; I2 = 48%). In addition, overall hospital LOS (SMD, −0.06 days; 95% CI, −0.18 to 0.06; P = 0.29; I2 = 0%) and incidence of postoperative delirium (RR, 0.69; 95% CI, 0.36 to 1.32; P = 0.27; I2 = 0%) were not impacted by the use of intraoperative cerebral oximetry. Conclusions: Intraoperative cerebral oximetry appears to be associated with a reduction in POCD, although this result should be interpreted with caution given the significant heterogeneity in the studies examined. Further large (ideally multicentre) RCTs are needed to clarify whether POCD can be favourably impacted by the use of cerebral oximetry-guided management.
AB - Purpose: Although evidence from observational studies in a variety of clinical settings supports the utility of cerebral oximetry as a predictor of outcomes, prospective clinical trials thus far have reported conflicting results. This systematic review and meta-analysis was designed to evaluate the influence of management associated with intraoperative cerebral oximetry on postoperative outcomes. The primary outcome was postoperative cognitive dysfunction (POCD), with secondary outcomes that included postoperative delirium, length of intensive care unit (ICU) stay, and hospital length of stay (LOS). Source: After searching the PubMed, EMBASE, Cochrane Library, Scopus, and Google Scholar databases, all randomized controlled trials (RCTs) assessing the impact of intraoperative cerebral oximetry-guided management on clinical outcomes following surgery were identified. Principal findings: Fifteen RCTs comprising 2,057 patients (1,018 in the intervention group and 1,039 in control group) were included. Intraoperative management guided by the use of cerebral oximetry was associated with a reduction in the incidence of POCD (risk ratio [RR] 0.54; 95% confidence interval [CI], 0.33 to 0.90; P = 0.02; I2 = 85%) and a significantly shorter length of ICU stay (standardized mean difference [SMD], −0.21 hr; 95% CI, −0.37 to −0.05; P = 0.009; I2 = 48%). In addition, overall hospital LOS (SMD, −0.06 days; 95% CI, −0.18 to 0.06; P = 0.29; I2 = 0%) and incidence of postoperative delirium (RR, 0.69; 95% CI, 0.36 to 1.32; P = 0.27; I2 = 0%) were not impacted by the use of intraoperative cerebral oximetry. Conclusions: Intraoperative cerebral oximetry appears to be associated with a reduction in POCD, although this result should be interpreted with caution given the significant heterogeneity in the studies examined. Further large (ideally multicentre) RCTs are needed to clarify whether POCD can be favourably impacted by the use of cerebral oximetry-guided management.
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U2 - 10.1007/s12630-018-1065-7
DO - 10.1007/s12630-018-1065-7
M3 - Article
C2 - 29427259
AN - SCOPUS:85041846609
VL - 65
SP - 529
EP - 542
JO - Canadian Journal of Anaesthesia
JF - Canadian Journal of Anaesthesia
SN - 0832-610X
IS - 5
ER -