Continuous monitoring of changes in cerebral oxygenation during hemodialysis in a patient with acute congestive heart fa
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CASE REPORT Artificial Kidney / Dialysis
Continuous monitoring of changes in cerebral oxygenation during hemodialysis in a patient with acute congestive heart failure Saori Minato1 · Susumu Ookawara1 · Kiyonori Ito1 · Hideyuki Hayasaka2 · Masaya Kofuji2 · Takayuki Uchida2 · Mitsutoshi Shindo1 · Haruhisa Miyazawa1 · Hirofumi Shimoyama1,3 · Taro Hoshino4 · Yoshiyuki Morishita1 Received: 21 September 2019 / Accepted: 11 December 2019 © The Japanese Society for Artificial Organs 2019
Abstract A 71-year-old man undergoing hemodialysis (HD) was admitted to our hospital with congestive heart failure (CHF) and pneumonia. After admission, ultrafiltration with HD was urgently performed because of a lack of respiratory improvement despite the use of noninvasive positive pressure ventilation. During HD, cerebral regional saturation of oxygen (rSO2) was monitored by INVOS 5100c oxygen saturation monitor (Covidien Japan, Japan) to evaluate changes in tissue oxygenation. At HD initiation, cerebral rSO2 was very low at 34% under the fraction of inspiratory oxygen (FiO2) of 0.4. Ultrafiltration was performed at the rate of 0.5 L/h thereafter, cerebral rSO2 gradually improved even as inhaling oxygen concentration decreased. At the end of HD, cerebral rSO2 improved at 40% under a FiO2 of 0.28 as excess body fluid was removed. After pneumonia and CHF improved, he was discharged. Reports of the association between cerebral oxygenation and acute CHF status in patients undergoing HD are limited; therefore, in our experience with this case, cerebral oxygenation deteriorated with the CHF status but was improved by adequate body-fluid management during HD. Keywords Acute heart failure · Cerebral oxygenation · Hemodialysis · Regional saturation of oxygen · Ultrafiltration
Introduction The leading cause of death in hemodialysis (HD) patients is reportedly cardiovascular disease including heart failure (HF), which accounts for 25% of deaths [1]. Indeed, we sometimes experience HD patients with HF, induced by excess body-fluid in addition to ventricular dysfunction itself being a risk factor for HF [2]. Therefore, congestive HF (CHF) should be prevented in the clinical setting of * Kiyonori Ito [email protected] 1
Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1‑847 Amanuma‑cho, Omiya‑ku, Saitama, Saitama 330‑8503, Japan
2
Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
3
Yuai Nisshin Clinic, Hakuyukai Medical Corporation, Saitama, Japan
4
Division of Nephrology, Saitama Red Cross Hospital, Saitama, Japan
HD therapy. Recently, near-infrared spectroscopy (NIRS) has been used to measure the regional saturation of oxygen (rSO2), which is a tissue oxygenation marker [3–6]. To date, reginal tissue oxygenation was reportedly evaluated in HD patients [7–12]. In particular, cerebral evaluations using NIRS were performed to possibly confirm the changes of oxygenation, including in the acute phase of variou
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