How NIRS can predict the outcome of patient in low systemic pressure: a case series

Abstract

Mitral valve replacement (MVR) is a surgical procedure to treat mitral regurgitation (MR). As there is an increase in the afterload in the postoperative period, patients tend to have low cardiac output syndrome. This condition may limit oxygen delivery to body tissues. Improved venous saturation has been linked to positive neurological outcomes. Near-infrared spectroscopy (NIRS) is the new technique to monitor regional oxygenation in real time. This study reports on four patients who underwent MVR due to a combination of severe mitral stenosis (MS) and mild MR. All patients had complaints of dyspnea on exertion to unbearable chest pain. Physical and work-up examination led to a diagnosis of decompensated heart failure, concomitant valve disorder, fluid overload, and cardiomegaly. Preoperative catheterization to stratify the risks of the procedure was done on all four patients. The surgery planned was cardiopulmonary bypass (CPB) with standard monitoring and additional NIRS measurement. The measurement of mean arterial pressure (MAP) and NIRS were tightly monitored and maintained in each patient, with the use of vasoactive agents. All four patients suffered unstable hemodynamics and were admitted to intensive care unit with the support of mechanical ventilation and other supportive therapies. Cerebral perfusion can reach the baseline normal value even though in low cardiac output syndrome, and NIRS can predict the outcome of the patients better than the conservative monitoring.

Key words: CPB; Low Systemic Pressure; Cerebral perfusion; Mitral Valve Replacement; NIRS.

Citation: Purwoko, Permana SA, Dewi FH, Prihandana PA. How NIRS can predict the outcome of patient in low systemic pressure: a case series. Anaesth. pain intensive care 2023;27(6):757−762; DOI: 10.35975/apic.v27i6.2350

Received: May 29, 2023; Reviewed: September 20, 2023; Accepted: October 30, 2023