Comparison of bilateral cerebral and somatic tissue oxygenation with near-infrared spectroscopy in cyanotic and acyanotic pediatric patients receiving cardiac surgery (original) (raw)
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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 ...
Research & innovation in anesthesia, 2016
Objective: Neurologic sequelae remain a well-recognized complication of pediatric cardiac surgery. The aetiology of neurologic injury is almost certainly multifactorial, imbalance between cerebral oxygen supply and demand is likely to play an important role. We sought to measure regional cerebral oxygenation in children undergoing cardiac surgery using nearinfrared spectroscopy to ascertain such vulnerable periods. Materials and methods: This study is an observational study of 18 children (median age 1.3 years) undergoing cardiac surgery. Regional cerebral oxygenation was monitored using the INVOS3100 cerebral oximeter and related to hemodynamic parameters at each stage of the procedure. Results: Prior to the onset of bypass, 10 patients had a decrease in regional cerebral oxygenation, reaching a saturation less than 35% in 5 cases. The most common cause was handling and dissection around the heart prior to and during caval cannulation. With institution of bypass, regional cerebral oxygenation increased. Discontinuation of bypass caused a precipitous decrease in regional cerebral oxygenation in three patients, reaching less than 40%. Conclusions: These observations suggest that the pre-and early post-bypass periods are vulnerable times for provision of adequate cerebral oxygenation. Near-infrared spectroscopy is a promising tool for monitoring O 2 supply/demand relationships especially during circulatory arrest.
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 ...
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.
Combined Cerebral and Renal Near-Infrared Spectroscopy After Congenital Heart Surgery
Pediatric Cardiology, 2015
The maintenance of an adequate oxygen supply to tissues after congenital heart surgery is essential for good outcomes. The objective of this study was to assess the usefulness of near-infrared spectroscopy (NIRS) for estimating central venous oxygen saturation (ScvO 2) using both cerebral and renal measurements, explore its relation with cardiac output measurements and check its ability to detect low cardiac output. A prospective observational pilot study was conducted in patients weighing \10 kg undergoing cardiopulmonary bypass surgery. Spectroscopy probes were placed on the forehead and renal area, and serial cardiac output measurements were obtained by femoral transpulmonary thermodilution over the first 24 h after surgery. In the 15 patients studied, ScvO 2 was correlated with cerebral (r = 0.58), renal (r = 0.60) and combined (r = 0.71) measurements. Likewise, the systolic index was correlated with the NIRS signals: cerebral (r = 0.60), renal (r = 0.50) and combined (r = 0.66). Statistically significant differences were found in the NIRS measures registered in the 29 low cardiac output events detected by thermodilution: cerebral: 62 % (59-65) versus 69 % (63-76); renal: 83 % (70-89) versus 89 % (83-95); and combined 64 % (60-69) versus 72 % (67-76). In our series, combined cerebral and renal monitoring was correlated with central venous oxygen saturation and cardiac output; low cardiac output detection associated a different spectroscopy pattern. Keywords Near-infrared spectroscopy Á Low cardiac output syndrome Á Congenital heart defect Á Regional oxygen saturation Á Monitoring Á Intensive care
An Evaluation of Bilateral Monitoring of Cerebral Oxygen Saturation During Pediatric Cardiac Surgery
Anesthesia & Analgesia, 2005
Cerebral oximetry is a technique that enables monitoring of regional cerebral oxygenation during cardiac surgery. In this study, we evaluated differences in bi-hemispheric measurement of cerebral oxygen saturation using near-infrared spectroscopy in 62 infants undergoing biventricular repair without aortic arch reconstruction. Left and right regional cerebral oxygen saturation index (rSO 2 i) were recorded continuously after the induction of anesthesia, and data were analyzed at 12 time points. Baseline rSO 2 i measurements were left 65 Ϯ 13 and right 66 Ϯ 13 (P ϭ 0.17). Mean left and right rSO 2 i measurements were similar (Յ2 percentage points/absolute scale units) before, during, and after cardiopulmonary bypass, irrespective of the use of deep hypothermic circulatory arrest. Further longitudinal neurological outcome studies are required to determine whether uni-or bi-hemispheric monitoring is required in this patient population.
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.
Cerebral oxygen supply and utilization during infant cardiac surgery
Annals of Neurology, 1995
The survival of infants with congenital heart disease has improved dramatically. However, the incidence of neurological injury in infants surviving cardiac surgery remains considerable. These neurological sequelae are attributable at least in part to hypoxia-ischemia/reperfusion, which inevitably accompanies infant heart surgery with deep hypothermia, cardiopulmonary bypass, and circulatory arrest. To begin to identify mechanisms of brain injury during infant cardiac surgery, we used near-infrared spectroscopy to study the relationship between cerebral intravascular (hemoglobin) and mitochondrial (cytochrome aa3) oxygenation in 63 infants (aged 1 day to 9 months) undergoing deep hypothermic repair of congenital heart defects, throughout the intraoperative period. Moreover, we assessed the effect of postnatal age on these changes. The cerebral concentration of oxidized cytochrome aa3 decreased from the onset of deep hypothermic cardiopulmonary bypass, despite apparent abundant intravascular oxygenation manifested by a simultaneous increase in the cerebral concentration of oxyhemoglobin. During this interval infants older than 2 weeks had a greater decrease in oxidized cytochrome aa3 than did infants 2 weeks old or younger. During deep hypothermic circulatory arrest, cerebral levels of oxidized cytochrome aa3 remained depressed while those of oxyhemoglobin declined. With reperfusion following circulatory arrest, the recovery of oxidized cytochrome aa3 was delayed, despite a rapid recovery of intravascular oxygenation (HbO,). After rewarming and 60 minutes of reperfusion, only 46% of infants recovered to the baseline level of cerebral oxidized cytochrome aa3. These findings demonstrate a paradoxical dissociation of changes in intravascular and mitochondrial oxygenation during hypothermic cardiopulmonary bypass; a pronounced decrease of mitochondrial oxygenation is established during induction of hypothermia and a delay in recovery of mitochondrial oxygenation occurs following circulatory arrest. These effects were more pronounced in infants older than 2 weeks than in younger infants. The data suggest potentially deleterious impairments of intrinsic mitochondrial function or of delivery of intravascular oxygen to the mitochondrion or both, effects previously undetected and apparently influenced by cerebral maturation. du Plessis AJ, Newburger J, Jonas RA, Hickey P, Naruse H, Tsuli M, Walsh A, Walter G, Wypij D, Volpe JJ. Cerebral oxygen supply and utilization during infant cardiac surgery. Ann Neurol 1995;37:488-497 During the past two decades, advances in cardiac surgical techniques have reduced dramatically the mortality of young infants with congenital heart disease [l). Palliative procedures have been replaced by definitive anatomical repair in newborns and very young infants, and currently more than 10,000 infants undergo open heart surgery annually in the United States El]. To achieve adequate exposure of intracardiac structures during infant open heart surgery, the support techniques of low-flow cardiopulmonary bypass (LFB) and deep hypothermic circulatory arrest (CA) are employed routinely. The accompanying alterations in cerebral metabolism and hemodynamics are marked, complex, and not well understood 12-11). These alterations result in clinically detectable cerebral ischemia/ reperfusion injury in a subset of survivors. As a conse-quence, infants surviving open heart surgery have a substantial incidence of neurological complications [12-181, and as mortality rates decrease, the number of neurologically impaired survivors is likely to increase. Prevention of this injury will require insight into pathogenetic mechanisms and their timing. Near-infrared spectroscopy (NIRS) is a relatively new technique that allows the simultaneous measurement of changes in intravascular (hemoglobin {Hb)) and mitochondrial (cytochrome aa,) oxygenation [ 19-23). The NIRS technique is based on several principles. Unlike visible light, near-infrared light (with wavelengths between 700-1,000 nm) penetrates skin,