Combined Cerebral and Renal Near-Infrared Spectroscopy After Congenital Heart Surgery (original) (raw)
Related papers
2012
529 Objective: Near-infrared spectroscopy correlation with low cardiac output has not been validated. Our objective was to determine role of splanchnic and/or renal oxygenation monitoring using near-infrared spectroscopy for detection of low cardiac output in children after surgery for congenital heart defects. Design: Prospective observational study. Setting: Pediatric intensive care unit of a tertiary care teaching hospital. Patients: Children admitted to the pediatric intensive care unit after surgery for congenital heart defects. Interventions: None. Measurements and Main Results: We hypothesized that splanchnic and/or renal hypoxemia detected by near-infrared spectroscopy is a marker of low cardiac output after pediatric cardiac surgery. Patients admitted after cardiac surgery to the pediatric intensive care unit over a 10-month period underwent serial splanchnic and renal near-infrared spectroscopy measurements until extubation. Baseline near-infrared spectroscopy values were ...
Pediatric Critical Care Medicine, 2012
Objective: Near-infrared spectroscopy correlation with low cardiac output has not been validated. Our objective was to determine role of splanchnic and/or renal oxygenation monitoring using near-infrared spectroscopy for detection of low cardiac output in children after surgery for congenital heart defects. Design: Prospective observational study. Setting: Pediatric intensive care unit of a tertiary care teaching hospital. Patients: Children admitted to the pediatric intensive care unit after surgery for congenital heart defects. Interventions: None. Measurements and Main Results: We hypothesized that splanchnic and/or renal hypoxemia detected by near-infrared spectroscopy is a marker of low cardiac output after pediatric cardiac surgery. Patients admitted after cardiac surgery to the pediatric intensive care unit over a 10-month period underwent serial splanchnic and renal near-infrared spectroscopy measurements until extubation. Baseline near-infrared spectroscopy values were recorded in the first postoperative hour. A near-infrared spectroscopy event was a priori defined as ≥20% drop in splanchnic and/or renal oxygen saturation from baseline during any hour of the study. Low cardiac output was defined as metabolic acidosis (pH <7.25, lactate >2 mmol/L, or base excess ≤-5), oliguria (urine output <1 mL/kg/hr), or escalation of inotropic support. Receiver operating characteristic analysis was performed using near-infrared spectroscopy event as a diagnostic test for low cardiac output. Twenty children were enrolled: median age was 5 months; median Risk Adjustment for Congenital Heart Surgery category was 3 (1-6); median bypass and cross-clamp times were 120 mins (45-300 mins) and 88 mins (17-157 mins), respectively. Thirty-one episodes of low cardiac output and 273 near-infrared spectroscopy events were observed in 17 patients. The sensitivity and specificity of a near-infrared spectroscopy event as an indicator of low cardiac output were 48% (30%-66%) and 67% (64%-70%), respectively. On receiver operating characteristic analysis, neither splanchnic nor renal near-infrared spectroscopy event had a significant area under the curve for prediction of low cardiac output (area under the curve: splanchnic 0.45 [95% confidence interval 0.30-0.60], renal 0.51 [95% confidence interval 0.37-0.65]). Conclusions: Splanchnic and/or renal hypoxemia as detected by near-infrared spectroscopy may not be an accurate indicator of low cardiac output after surgery for congenital heart defects.
2012
Regional oxygen saturation measured by means of near-infrared spectroscopy (NIRS) plays nowadays an important role in the peri-operative management of patients with congenital heart disease and it represents an additional value to other markers of low output syndrome state as the mixed venous oxygen saturation and the lactate level. The use of NIRS in cardiac surgery provides a continuous, non-invasive and essential warning sign of hemodynamic or metabolic compromise, enabling early and rapid intervention to prevent or reduce the severity of life-threatening complications. The NIRS values are not “per se” absolute reliable indicators of tissue oxygenation, but the intra-operative rSO2 de-saturation score calculation (with a threshold of 3000%/sec) represents an important predictor of low cardiac output states which correlated significantly with a lower intra-operative central venous saturation, cardiac index and oxygen availability index. Contents: 1. Commonly used abbreviations 2. Near Infra-Red Spectroscopy (NIRS) 2.1 Principles of Physics 2.2 The equipment 2.3 Scientific validation 2.4 Clinical Applications 2.5 Limitations of NIRS 2.6 Spatial resolution 2.7 Distribution of cerebral arterial-venous blood flow 2.8 The extra-cerebral tissues 2.9 Tissue chromophores not containing haematin 2.10 Metabolically inactive tissues 2.11 Cardiac output 2.12 Low cardiac output syndrome (LCOS) 3. Original Contribution 3.1 Aim and methods 3.2 Results 3.3 Comments Authors Vladimiro L. Vida Staff Pediatric Cardiac Surgeon, Pediatric and Congenital Cardiac Surgery Unit, Dept. of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy Jose L. Zulueta Staff Cardiac Anesthesiologist, Institute of Anesthesia and Intensive Care, Department of Medicine, University of Padua, Italy Demetrio Pittarello Chief Cardiac Anesthesiologist, Institute of Anesthesia and Intensive Care, Department of Medicine, University of Padua, Italy Giovanni Stellin Professor of Cardiac Surgery, Director of the Pediatric and Congenital Cardiac Surgery Unit, Dept. of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
Cardiology in the Young, 2014
Objective: To establish whether the use of near-infrared spectroscopy is potentially beneficial in highrisk cardiac infants in United Kingdom paediatric intensive care units. Design: A prospective observational pilot study. Setting: An intensive care unit in North West England. Patients: A total of 10 infants after congenital heart surgery, five with biventricular repairs and five with single-ventricle physiology undergoing palliation. Interventions: Cerebral and somatic near-infrared spectroscopy monitoring for 24 hours post-operatively in the intensive care unit. Measurement and main results: Overall, there was no strong correlation between cerebral nearinfrared spectroscopy and mixed venous oxygen saturation (r = 0.48). At individual time points, the correlation was only strong (r = 0.74) 1 hour after admission. The correlation was stronger for the biventricular patients (r = 0.68) than single-ventricle infants (r = 0.31). A strong inverse correlation was demonstrated between cerebral near-infrared spectroscopy and serum lactate at 3 of the 5 post-operative time points (1, 4, and 12 hours: r = − 0.76, −0.72, and −0.69). The correlation was stronger when the cerebral near-infrared spectroscopy was <60%. For cerebral near-infrared spectroscopy <60%, the inverse correlation with lactate was r = − 0.82 compared with those cerebral near-infrared spectroscopy >60%, which was r = − 0.50. No correlations could be demonstrated between (average) somatic near-infrared spectroscopy and serum lactate (r = − 0.13, n = 110) or mixed venous oxygen saturation and serum lactate. There was one infant who suffered a cardiopulmonary arrest, and the cerebral nearinfrared spectroscopy showed a consistent 43 minute decline before the event. Conclusions: We found that cerebral near-infrared spectroscopy is potentially beneficial as a non-invasive, continuously displayed value and is feasible to use on cost-constrained (National Health Service) cardiac intensive care units in children following heart surgery.
Interactive cardiovascular and thoracic surgery, 2011
In this study we monitored renal, hepatic and muscular oxygen saturations by near-infrared spectroscopy and we evaluated the correlation with variables that could affect tissue oxygenation in 16 paediatric patients during surgical heart procedure. We considered the following phases: 1) basal time (after induction of anaesthesia and before median sternotomy), 2) before starting cardiopulmonary bypass, 3) 15 min after starting it, 4) at half time, 5) 15 min before the end, 6) at the end, 7) 15 min after the end, and 8) 10 min before paediatric intensive care unit admission. Heart rate, mean arterial pressure, peripheral oxygen saturation, serum lactate, haemoglobin, blood gas analysis, and rectal temperature were registered. We found a decrease of all monitored regional saturations (rSO(2)) (cerebral P = 0.006, hepatic P = 0.005) before starting the bypass. After this time, cerebral saturation gradually increased without reaching the basal value; renal and liver saturations increased ...
The Journal of Thoracic and Cardiovascular Surgery, 2009
Objectives: Neurologic dysfunction is a problem in patients with congenital heart disease. Near-infrared spectroscopy may provide a real-time window into cerebral oxygenation. Enthusiasm for near-infrared spectroscopy has increased hopes of reducing neurologic dysfunction. However, potential gains need to be evaluated relative to cost before routine implementation. Responding to data in ways that seem intuitively beneficial can be risky when the long-term impact is unknown. Thus, we performed a systematic review of the literature on near-infrared spectroscopy in congenital heart disease.
Changes in Near-Infrared Spectroscopy After Congenital Cyanotic Heart Surgery
Frontiers in pediatrics, 2018
Since oxygen saturation from pulse oximetry (SpO) and partial pressure of arterial oxygen (PaO) are observed to improve immediately after surgical correction of cyanotic congenital heart disease (CHD), we postulate that cerebral (CrO) and somatic (SrO) oximetry also improves immediately post-correction. We aim to prospectively examine CrO and SrO, before, during, and after surgical correction as well as on hospital discharge in children with cyanotic CHD to determine if and when these variables increase. This is a prospective observational trial. Eligibility criteria included children below 18 years of age with cyanotic CHD who required any cardiac surgical procedure. CrO and SrO measurements were summarized at six time-points for comparison: (1) pre-cardiopulmonary bypass (CPB); (2) during CPB; (3) post-CPB; (4) Day 1 in the pediatric intensive care unit (PICU); (5) Day 2 PICU; and (6) discharge. Categorical and continuous variables are presented as counts (percentages) and median ...
Journal of Cardiothoracic and Vascular Anesthesia, 2007
Objective: Cerebral near-infrared spectroscopy (NIRS) was evaluated for use in monitoring global oxygenation in adult patients after cardiac surgery. Design: Prospective, randomized clinical monitoring study. Setting: Intensive care unit for cardiac surgery; university hospital. Participants: The study included 35 patients scheduled for cardiac surgery with insertion of a pulmonary artery catheter; patients with known cerebral-vascular perfusion disturbances were excluded. Interventions: Noninvasive cerebral NIRS oxygen saturation (rSO 2) and conventional intensive care monitoring parameters were assessed. Measurements and Main Results: Simple regression analysis was used to assess the correlation of rSO 2 to hemody-namic parameters. There was fair-to-moderate intersubject correlation to hemoglobin concentration (r ؍ 0.45, p < 0.0001) and mixed venous oxygen saturation (SmvO 2) (r ؍ 0.33, p < 0.0001). Sensitivity and specificity of rSO 2 to detect substantial (>1 standard deviation) changes in mixed venous oxygen saturation were 94% and 81%, respectively. Conclusions: Cerebral NIRS in adult patients might not be the tool to replace mixed venous oxygen monitoring. Further work has to be done to assess its potential to reflect intraindividual trends.
Role of near infrared spectroscopy in pediatric cardiac surgery
Progress in Pediatric Cardiology, 2010
Initial interest in near infrared spectroscopy for the prevention of neurological injury during cardiac surgery focused on intra-operative cerebral oximetry monitoring to minimize the potential negative impact of cardiopulmonary bypass and various perfusion strategies. However, it has become increasingly apparent, over the past decade, that neurological function can be impacted throughout the peri-operative period, particularly in the intensive care unit