Gestion peropératoire basée sur l’oxymétrie cérébrale pour améliorer les résultats périopératoires: méta-analyse d’essais randomisés contrôlés

Translated title of the contribution: Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials

Andres Zorrilla-Vaca, Ryan Healy, Michael C. Grant, Brijen Joshi, Lucia Rivera Lara, Charles Brown, Marek A Mirski

Research output: Contribution to journalArticle

Abstract

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.

Original languageFrench
Pages (from-to)1-14
Number of pages14
JournalCanadian Journal of Anesthesia
DOIs
StateAccepted/In press - Jan 18 2018

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Oximetry
Meta-Analysis
Randomized Controlled Trials
Length of Stay
Confidence Intervals
Delirium
Intensive Care Units
Odds Ratio
Incidence
PubMed
Libraries
Observational Studies
Clinical Trials
Databases
Control Groups
Cognitive Dysfunction

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{67a57e7aed5249e289970492037b769d,
title = "Gestion perop{\'e}ratoire bas{\'e}e sur l’oxym{\'e}trie c{\'e}r{\'e}brale pour am{\'e}liorer les r{\'e}sultats p{\'e}riop{\'e}ratoires: m{\'e}ta-analyse d’essais randomis{\'e}s contr{\^o}l{\'e}s",
abstract = "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.",
author = "Andres Zorrilla-Vaca and Ryan Healy and Grant, {Michael C.} and Brijen Joshi and {Rivera Lara}, Lucia and Charles Brown and Mirski, {Marek A}",
year = "2018",
month = "1",
day = "18",
doi = "10.1007/s12630-018-1065-7",
language = "French",
pages = "1--14",
journal = "Canadian Journal of Anaesthesia",
issn = "0832-610X",
publisher = "Springer New York",

}

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

PY - 2018/1/18

Y1 - 2018/1/18

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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