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Cerebral desaturation in cystic fibrosis patients undergoing Double lung transplantation
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DOI：10.1016/j.rmed.2026.108770.png)
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Abstract
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Background: Perioperative cerebral oximetry is widely used during cardiopulmonary bypass (CPB) to monitor cerebral perfusion and guide intraoperative management. However, standard thresholds may not account for disease-specific physiology. In cystic fibrosis (CF), chronic hypoxia and hypercapnia may influence baseline cerebral oxygenation and intraoperative responses. Methods: This retrospective cohort study included adults who underwent bilateral lung transplantation with intraoperative CPB between January 2014 and February 2022 at a single academic center. Patients with CF (n = 18) were compared with non-CF controls (n = 128). Bilateral near-infrared spectroscopy (NIRS) was used to monitor cerebral oxygenation, with desaturation defined as a >= 20% decline from baseline. Arterial blood gases (ABGs) were collected during CPB, and postoperative neurologic outcomes were assessed through clinical documentation during the index hospitalization. Results: CF patients demonstrated significantly lower intraoperative cerebral oximetry values and higher PaCO2 compared with controls. Prior to CPB and during bypass, model-based mean rSO(2) values were significantly lower in CF patients (62.0% vs. 69.1%, p = 0.04; 42.6% vs. 57.0%, p < 0.001; and 40.3% vs 53.9%, p = 0.0001), with a significant group & times; time interaction (p = 0.002). Imaging-confirmed stroke was infrequent and did not differ significantly between groups (5.6% vs 3.1%, p = 0.487). Conclusion: CF patients exhibit lower cerebral oxygen saturation and distinct carbon dioxide physiology during CPB, yet similar short-term neurologic outcomes compared with non-CF patients. Cerebral oximetry values in CF should be interpreted in the context of chronic pulmonary physiology rather than uniform desaturation thresholds.
Keywords:
Cystic fibrosis
Lung transplantation
Cardiopulmonary bypass
Cerebral oximetry
Near-infrared spectroscopy (NIRS)
Neuromonitoring
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