Cerebral Oxygen Monitoring During Surgery and Recovery After Surgery in Patients Having Lung Surgery

Study Overview
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Brief Summary
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The current study proposes to address the question of whether patients' cerebral oxygen saturation levels are predictive of their recovery from thoracic surgery. Further, the study poses the hypothesis that a patient's poor recovery status goes on to increase a patient's risk of developing post-operative morbidities such as pneumonia, arrhythmias and delirium. The aim of this study is to address the observation that some patients struggle more than others in their recovery and that 1) this may be a result of intraoperative cerebral oxygen desaturations and 2) that this may affect their post-operative morbidity. If a potential means of predicting poor outcomes is identified this will lead to further research into how to adjust the associated variables, such as cerebral oxygenation, to improve patient post-operative outcome.

Detailed Description
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Despite advances in the field of thoracic surgery, post-operative morbidity continues to be a significant problem with limited understanding of the connection between the insult of surgery and anesthesia and the pathophysiology of the development of these morbidities. Surgeons in the thoracic department have noted that some patients seem to recover less vigorously than other patients. What accounts for these different recovery trajectories is unclear. Researchers have developed a Post-Operative Quality Recovery Scale (PQRS) which assesses six domains (physiologic, nociceptive, emotive, activities of daily living, cognitive, and overall patient experience) and has been suggested to serve as a means of tracking patients' recovery from surgery.

Official Title
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Cerebral Oximetry and Recovery Following Thoracic Surgery

Conditions
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Cerebral Oxygen Desaturation

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: speak English 18 yo or older willing to participate undergoing thoracic surgery at Mount Sinai Hospital that will require one lung ventilation Exclusion Criteria: prisoners lack capacity to consent to trial

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Exposed<br>Cerebral oximetry desaturation below 65% for a minimum of 3 minutes | |
| Not Exposed<br>Those patients who do not experience a cerebral oxygen desaturation below 65% for a minimum of 3 minutes | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-Operative Quality of Recovery Score (PQRS) | Patients are assessed 30 minutes, one hour, and three hours post extubation time on day of surgery and then once daily for however long they are hospitalized up to 14 days, patients are then assessed via phone at one month and three months post-op. Recovery is assessed via questions on multiple domains such as pain and nausea, emotional status, activities of daily living and cognitive status. | up to 3 months | 
| Post-Operative Morbidity Survey (POMS) Score | The POMS score measures morbidity across multiple categories with pre-defined thresholds, example: Pulmonary (de novo requirement of oxygen supplementation), Infectious (fever above 38C or require antibiotics) etc. | Post-Operative day 3 | 
| Post-Operative Morbidity Survey (POMS) Score | The POMS score measures morbidity across multiple categories with pre-defined thresholds, example: Pulmonary (de novo requirement of oxygen supplementation), Infectious (fever above 38C or require antibiotics) etc. | Post-Operative day 5 | 
| Post-Operative Morbidity Survey (POMS) Score | The POMS score measures morbidity across multiple categories with pre-defined thresholds, example: Pulmonary (de novo requirement of oxygen supplementation), Infectious (fever above 38C or require antibiotics) etc. | Post-Operative day 8 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognitive Assessment Method | Also measuring delirium each day of hospitalization POD1-POD14 via modified and validated version of the CAM (Cognitive Assessment Method). | up to 14 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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intraoperative, post-operative recovery, thoracic surgery, cerebral oximetry