Cerebral Oxygen Metabolism Before and After RBC Transfusion in Infants Following Major Surgical Procedures

Neunhoeffer, Felix; Hofbeck, Michael; Schuhmann, Martin U.; Fuchs, Jörg; Schlensak, Christian; Esslinger, Martin; Gerbig, Ines; Icheva, Vanya; Heimberg, Ellen; Kumpf, Matthias; Michel, Jörg

doi:10.1097/pcc.0000000000001483

Cited by 15 publications

(21 citation statements)

References 33 publications

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“…In addition, Hb is an important factor in oxygen supply to the peripheral tissues and organs, including the brain; therefore, Hb level is expected to be associated with tissue rSO 2 . Thus far, in various clinical settings including hematology [44], surgery [45], pediatrics [46–48], and HD therapy [49], cerebral rSO 2 has been shown to significantly increase in line with the increasing Hb levels following blood transfusion. On the other hand, it has been reported that there is no relationship between Hb concentration and cerebral rSO 2 values in HD patients with well-maintained Hb levels [15,17].…”

Section: Discussionmentioning

confidence: 99%

Effects of dietary intake and nutritional status on cerebral oxygenation in patients with chronic kidney disease not undergoing dialysis: A cross-sectional study

Ookawara

Kaku

et al. 2019

PLoS ONE

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BackgroundDietary management is highly important for the maintenance of renal function in patients with chronic kidney disease (CKD). Cerebral oxygen saturation (rSO2) was reportedly associated with the estimated glomerular filtration rate (eGFR) and cognitive function. However, data concerning the association between cerebral rSO2 and dietary intake of CKD patients is limited.MethodsThis was a single-center observational study. We recruited 67 CKD patients not undergoing dialysis. Cerebral rSO2 was monitored using the INVOS 5100c oxygen saturation monitor. Energy intake was evaluated by dietitians based on 3-day meal records. Daily protein and salt intakes were calculated from 24-h urine collection.ResultsMultivariable regression analysis showed that cerebral rSO2 was independently associated with energy intake (standardized coefficient: 0.370) and serum albumin concentration (standardized coefficient: 0.236) in Model 1 using parameters with p < 0.10 in simple linear regression analysis (body mass index, Hb level, serum albumin concentration, salt and energy intake) and confounding factors (eGFR, serum sodium concentration, protein intake), and the energy/salt index (standardized coefficient: 0.343) and Hb level (standardized coefficient: 0.284) in Model 2 using energy/protein index as indicated by energy intake/protein intake and energy/salt index by energy intake/salt intake in place of salt, protein and energy intake.ConclusionsCerebral rSO2 is affected by energy intake, energy/salt index, serum albumin concentration and Hb level. Sufficient energy intake and adequate salt restriction is important to prevent deterioration of cerebral oxygenation, which might contribute to the maintenance of cognitive function in addition to the prevention of renal dysfunction in CKD patients.

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Section: Discussionmentioning

confidence: 99%

Effects of dietary intake and nutritional status on cerebral oxygenation in patients with chronic kidney disease not undergoing dialysis: A cross-sectional study

Ookawara

Kaku

et al. 2019

PLoS ONE

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“…A recent study [46] on cerebral oxygen metabolism before and after major surgery including congenital cardiac repair in infants raised the question of the impact of transfusion threshold on cerebral fractional tissue oxygen extraction and hence, neurodevelopment outcome. According to the study, as no previous studies had investigated cerebral metabolism and neurodevelopment, the non-inferiority of restrictive transfusion strategy should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Red blood cell transfusion threshold after pediatric cardiac surgery

Deng¹,

Wang²,

Huang³

et al. 2019

Medicine

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Background:Restrictive red blood cell transfusion strategy is implemented to minimize risk following allogeneic blood transfusion in adult cardiac surgery. However, it is still unclear if it can be applied to pediatric cardiac patients. The purpose of this systematic review and meta-analysis was to determine the effect of postoperative restrictive transfusion thresholds on clinical outcomes based on up-to-date results of randomized controlled trials (RCTs) and observational studies in pediatric cardiac surgery.Method:We searched for RCTs and observational studies in the following databases: the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ClinicalTrials.gov from their inception to October 26, 2017. We also searched reference lists of published guidelines, reviews, and relevant articles, as well as conference proceedings. No language restrictions were applied and no observational study met the inclusion criteria.Results:Four RCTs on cardiac surgery involving 454 patients were included. There were no differences in the pooled fixed effects of intensive care unit (ICU) stay between the liberal and restrictive transfusion thresholds (standardized mean difference SMD, 0.007; 95% confidence interval CI, −0.18–0.19; P = .94). There were also no differences in the length of hospital stay (SMD, −0.062; 95% CI, −0.28−0.15; P = .57), ventilation duration (SMD, −0.015; 95% CI, −0.25–0.22; P = .90), mean arterial lactate level (SMD, 0.071; 95% CI, −0.22–0.36; P = .63), and mortality (risk ratio, 0.49; 95% CI, 0.13–1.94; P = .31). There was no inter-trial heterogeneity for any pooled analysis. Publication bias was tested using Egger, Begg, or the trim-and-fill test, and the results indicated no significant publication bias.Conclusion:Evidence from RCTs in pediatric cardiac surgery, though limited, showed non-inferiority of restrictive thresholds over liberal thresholds in length of ICU stay and other outcomes following red blood cell transfusion. Further high-quality RCTs are necessary to confirm the findings.

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“…Neunhoeffer et al [50] found a positive effect of red blood cell transfusion on FTOE and cerebral r-SO 2 in postsurgical infants, suggesting the feasibility of both parameters as transfusion triggers.…”

Section: Recent Developments In Near-infrared Spectroscopy Monitoringmentioning

confidence: 97%

Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology

Wijk

Weber

Stolker

et al. 2020

Current Opinion in Anaesthesiology

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Purpose of review The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is challenging, due to lack of evidence, validity and size constraints. Most measured parameters are proxies for end organ function, in which an anesthesiologist is actually interested. Ideally, monitoring should be continuous, noninvasive and accurate. This present review summarizes the current literature on noninvasive monitoring in noncardiac pediatric anesthesia. Recent findings For cardiac output (CO) monitoring, bolus thermodilution is still considered the gold standard. New noninvasive techniques based on bioimpedance and pulse contour analysis are promising, but require more refining in accuracy of CO values in children. Near-infrared spectroscopy is most commonly used in cardiac surgery despite there being no consensus on safety margins. Its place in noncardiac anesthesia has yet to be determined. Transcutaneous measurements of blood gases are used mainly in the neonatal intensive care unit, and is finding its way to the pediatric operation theatre. Especially CO 2 measurements are accurate and useful. Summary New techniques are available to assess a child's hemodynamic and respiratory status while under anesthesia. These new monitors can be used as complementary tools together with standard monitoring in children, to further improve perioperative safety.

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Cerebral Oxygen Metabolism Before and After RBC Transfusion in Infants Following Major Surgical Procedures

Cited by 15 publications

References 33 publications

Effects of dietary intake and nutritional status on cerebral oxygenation in patients with chronic kidney disease not undergoing dialysis: A cross-sectional study

Effects of dietary intake and nutritional status on cerebral oxygenation in patients with chronic kidney disease not undergoing dialysis: A cross-sectional study

Red blood cell transfusion threshold after pediatric cardiac surgery

Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology

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