Prognostic Value of Perioperative Near-Infrared Spectroscopy During Neonatal and Infant Congenital Heart Surgery for Adverse In-Hospital Clinical Events

2012 ◽  
Vol 3 (2) ◽  
pp. 221-228 ◽  
Author(s):  
Jannika Dodge-Khatami ◽  
Urda Gottschalk ◽  
Christine Eulenburg ◽  
Ulrike Wendt ◽  
Clivia Schnegg ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Extracorporeal Membrane Oxygenation ◽  
Near Infrared Spectroscopy ◽  
Heart Surgery ◽  
Near Infrared ◽  
Length Of Hospital Stay ◽  
Inverse Correlation ◽  
Membrane Oxygenation ◽  
Icu Stay ◽  
Lactate Levels

Background: Perioperative monitoring with multisite near-infrared spectroscopy (NIRS) for congenital cardiac surgery with cardiopulmonary bypass may aid in predicting adverse clinical outcomes. Methods: Forty-one consecutive neonates and infants undergoing bypass were monitored with right + left cerebral and renal NIRS. Near-infrared spectroscopy and lactate were measured at 20 time points, from baseline 1 day preoperatively, during bypass and modified ultrafiltration (MUF; 10 minutes), until 24 hours postoperatively. Adverse events were extracorporeal membrane oxygenation (ECMO)/death, prolonged intensive care unit (ICU) or length of hospital stay. Results: Perioperative mean renal NIRS remained higher than baseline (n = 41) as did cerebral NIRS in all undergoing biventricular repair. During bypass (n = 41), mean right and left cerebral NIRS were equal. During MUF, cerebral and renal NIRS values increased ( P < .001). Cerebral NIRS and lactate inversely correlated during the first six postoperative hours. Extracorporeal membrane oxygenation /death occurred in four patients, correlating with cerebral and renal NIRS below 45% ( P = .030) and 40% ( P = .019) at anytime, respectively, and with mean lactate levels >9.3 mmol/L in the first postoperative 24 hours ( P < .001). Among survivors, renal NIRS below 30% at any time predicted a longer ICU stay. Conclusions: At bypass conclusion, 10 minutes of MUF does not adversely affect cerebral or renal NIRS. Left and right cerebral NIRS are equal, so that biparietal cerebral NIRS monitoring is probably not warranted. Perioperative cerebral and renal NIRS readings, respectively, below 45% and 40% correlate with ECMO/death and renal NIRS below 30% with prolonged ICU stay. Cerebral NIRS and lactate levels showed a strong inverse correlation during the first six postoperative hours.

scholarly journals Application of Near-Infrared Spectroscopy to Monitor Perfusion During Extracorporeal Membrane Oxygenation After Pediatric Heart Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Mingjie Zhang ◽  
Yinyu Yang ◽  
Xi Chen ◽  
Yixiao Song ◽  
Limin Zhu ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Near Infrared Spectroscopy ◽  
Heart Surgery ◽  
Near Infrared ◽  
Early Period ◽  
Circulatory Support ◽  
Membrane Oxygenation ◽  
Pediatric Heart Surgery

Objective: Venoarterial extracorporeal membrane oxygenation is an effective mechanical circulatory support that is used to rescue critically ill patients after congenital heart surgery. As there was still no recommended guideline for monitoring parameters during extracorporeal membrane oxygenation (ECMO), this study aimed to investigate the role of near-infrared spectroscopy (NIRS) in the early period of venoarterial (VA)-ECMO.Method: This study enrolled patients with NIRS monitoring during ECMO after pediatric cardiac surgery at Shanghai Children's Medical Center (2018–2020). The information obtained from the retrospective, the observational dataset included the demographic information, diagnoses, baseline characteristics, procedural details, ECMO data, monitoring data, in-hospital mortality, and complications of the patients.Results: The overall mortality rate was 43.6%. Lactate was significantly higher in non-survivors compared to survivors at 12 h (11.25 ± 7.26 vs. 6.96 ± 5.95 mmol/l, p = 0.022) and 48 h [2.2 (0.7, 20) vs. 1.4 (0.7, 5.8) mmol/l, p = 0.008] after initiation of ECMO. The cranial regional oxygen saturation (CrSO2) was significantly higher in survivors compared to non-survivors at 24 h (62.5 ± 14.61 vs. 52.05 ± 13.98%, p = 0.028), 36 h (64.04 ± 14.12 vs. 51.27 ± 15.65%, p = 0.005), and 48 h (65.32 ± 11.51 vs. 55.00 ± 14.18%, p = 0.008). Multivariate logistics regression analysis of the hemodynamic and laboratory parameters revealed that the CrSO2 at 36 h (OR = 0.945, p = 0.049) and 48 h (OR = 0.919, p = 0.032) was related to mortality. The use of continuous renal replacement therapy (OR = 14.940, p = 0.039) was also related to mortality. The optimal cutoff values for CrSO2 for predicting mortality after weaning off ECMO at 36 and 48 h were 57% (sensitivity: 61.5%, specificity: 80%) and 56% (sensitivity: 76.9%, specificity: 70%), respectively. The risk of mortality was higher among patients with a CrSO2(36h) &lt; 57% (p = 0.028) by Kaplan-Meier analysis.Conclusion: Near-infrared spectroscopy may be a useful tool for monitoring the hemodynamic stability during the early period of ECMO, while CrSO2 can predict the in-hospital mortality after ECMO.

Can upper extremity (deltoid) near infrared spectroscopy be used to assess cerebral tissue bed saturation on femorally cannulated veno-arterial extracorporeal membrane oxygenation patients?

Perfusion ◽  
2020 ◽  
pp. 026765912090676
Author(s):  
James R Beck ◽  
David W Holt ◽  
Christine Chan ◽  
Kenmond Fung ◽  
Killian Patton-Rivera ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Extracorporeal Membrane Oxygenation ◽  
Upper Extremity ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Regression Line ◽  
Study Group ◽  
Cerebral Tissue ◽  
Membrane Oxygenation ◽  
Moment Coefficient

Continuous cerebral tissue saturation monitoring with near infrared spectroscopy may help clinicians identify cerebral desaturation early; however, patients have reported discomfort from near infrared spectroscopy monitoring pads on the forehead. This study aims to compare upper extremity near infrared spectroscopy monitoring to cerebral near infrared spectroscopy monitoring to assess its viability as a surrogate for cerebral saturation. A retrospective analysis of 10 femorally cannulated veno-arterial extracorporeal membrane oxygenation patients was performed comparing left (L) and right (R) upper extremity (deltoid) near infrared spectroscopy monitoring to cerebral near infrared spectroscopy monitoring (n = 20 data sets, 10 left and 10 right) and right radial blood gasses. Deltoid and cerebral near infrared spectroscopy values were recorded every 15 minutes for at least 24 hours when possible, were plotted on scatter grams, and were analyzed using Pearson product-moment coefficient (r). Based on the concept of covariance, a moderate-good relationship r = 0.50-0.75 was noted in 10% (n = 2) of the study group. A fair relationship r = 0.25-0.50 was noted in 50% (n = 10), and little or no relationship was noted in 40% (n = 8). None of the study group displayed a good to excellent relationship (r = 0.75 or above). In addition, coefficient of multiple determination for multiple regression R2 was calculated and strong fit of the regression line was not noted. Although cerebral near infrared spectroscopy monitoring has been extremely helpful in identifying low cerebral tissue saturation on veno-arterial extracorporeal membrane oxygenation patients, the use of upper extremity (peripheral deltoid) tissue monitoring does not provide adequate correlation and should not be used as a surrogate to cerebral monitoring.

scholarly journals Near-infrared spectroscopy after high-risk congenital heart surgery in the paediatric intensive care unit

2014 ◽  
Vol 25 (3) ◽  
pp. 459-467 ◽  
Author(s):  
Lyvonne N. Tume ◽  
Philip Arnold
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Heart Surgery ◽  
Near Infrared ◽  
Inverse Correlation ◽  
Congenital Heart Surgery ◽  
Serum Lactate ◽  
Venous Oxygen Saturation

AbstractObjective: To establish whether the use of near-infrared spectroscopy is potentially beneficial in high-risk 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 near-infrared 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 near-infrared 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.

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