Cerebral regional oxygen saturation variability in neonates following cardiac surgery

Spaeder, Michael C.; Surma, Victoria

doi:10.1038/s41390-020-01171-1

Cited by 10 publications

(7 citation statements)

References 30 publications

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“…In a study of 143 neonates, every 136 minutes spent with srSO2 <50% correlated to 1 more ventilator-day in postoperative single ventricle patients. 32 Further studies are needed to evaluate the benefit of transfusion when crSO2 is critically low.…”

Section: Discussionmentioning

confidence: 99%

Effect of Red Blood Cell Transfusion on Regional Tissue Oxygenation in Pediatric Cardiac Surgery Patients

Surma

Patel

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Red blood cell (RBC) transfusions are used frequently in pediatric patients admitted to the intensive care unit (ICU) after cardiac surgery. To improve data-driven transfusion decision-making in the ICU, we conducted a retrospective analysis to assess the effect of RBC transfusion on cerebral and somatic regional oxygenation (rSO2). METHODS: We evaluated post- versus pre-RBC transfusion cerebral rSO2 and somatic rSO2 in all consecutive pediatric patients (age >28 days to <18 years) who underwent biventricular cardiac surgery at a single center between July 2016 and April 2020. RESULTS: The final data set included 263 RBC postoperative transfusion events in 75 patients who underwent 83 surgeries. The median pretransfusion hemoglobin was 10.6 g/dL (25th–75th percentile, 9.3–11.6). The median pretransfusion cerebral and somatic rSO2 were 63% (54–71) and 69% (55–80), which increased by a median of 3 percentage points (–2 to 6) and 2 percentage points (–3 to 6), respectively, after transfusion. After adjusting for pretransfusion hemoglobin, change in hemoglobin posttransfusion versus pretransfusion, and potential confounders (age, sex, and STAT surgical mortality risk score), the posttransfusion versus pretransfusion change in cerebral or somatic rSO2 was not statistically significant. Pretransfusion cerebral rSO2 (crSO2) was ≤50%, a previously described threshold for increased risk for unfavorable neurological outcome, for 22 of 138 (16%) transfusion events with complete pre- and post-crSO2 data. Sixteen of these 22 (73%) transfusions resulted in a posttransfusion crSO2 >50%. When restricting analysis to the first (index) transfusion after arrival to the ICU from the operating room (administered at a median of 1.15 postoperative days [25th–75th percentile, 0.84–1.93]), between-patient pretransfusion hemoglobin was not associated with pretransfusion crSO2 but within-patient posttransfusion versus pretransfusion hemoglobin difference was significantly associated with posttransfusion versus pretransfusion crSO2 difference (mean posttransfusion versus pretransfusion crSO2 difference, 2.54; 95% confidence interval, 0.50–4.48). CONCLUSIONS: In this study, neither cerebral nor somatic rSO2 increased significantly post- versus pre-RBC transfusion in pediatric cardiac surgery patients admitted to the ICU after biventricular repairs. However, almost three-quarters of transfusions administered when pretransfusion crSO2 was below the critical threshold of 50% resulted in a posttransfusion crSO2 >50%. In addition, the significant within-patient change in crSO2 in relation to the change in posttransfusion versus pretransfusion hemoglobin in the immediate postoperative period suggests that a personalized approach to transfusion following within-patient trends of crSO2 rather than absolute between-patient values may be an important focus for future research.

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Section: Discussionmentioning

confidence: 99%

Effect of Red Blood Cell Transfusion on Regional Tissue Oxygenation in Pediatric Cardiac Surgery Patients

Surma

Patel

et al. 2023

Anesthesia &Amp; Analgesia

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“…Variability of ScO 2 is an issue of interest for this population. Recent studies have shown that patients following cardiac surgery had reduced ScO 2 variability [12], which has been shown to be associated with poor neurodevelopmental outcomes [13]. The hypothesis is that reduced variability of ScO 2 might signify impaired autoregulation or inadequacy of compensatory mechanisms of cardiovascular systems [13].…”

Section: Discussionmentioning

confidence: 99%

“…Then minute-by-minute estimated oxygen extraction ratio (eO 2 ER) was calculated as 1 -(eSjvO 2 / SpO 2 ). Variability of ScO 2 was also calculated using the root mean of successive squared differences [12,13]. Averages of ScO 2 (ScO 2ave ), eO 2 ER (eO 2 ER ave ), and variability of ScO 2 before CPB and after CPB were used for analyses.…”

Section: Study Variables and Data Sourcesmentioning

confidence: 99%

Regional Cerebral Oxygen Saturation and Estimated Oxygen Extraction Ratio as Predictive Markers of Major Adverse Events in Pediatric Cardiac Patients

Kimura

Shimizu

Izumi

et al. 2023

Preprint

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Regional cerebral oxygen saturation (ScO2) determined by near-infrared spectroscopy, monitoring both arterial and venous blood oxygenation of the brain, could reflect the balance between oxygen delivery and consumption. The aim of this study was to determine the predictabilities of ScO2 and estimated oxygen extraction ratio (eO2ER) with outcomes in pediatric patients with congenital heart disease (CHD). This study was a two-center, retrospective study of patients at 12 months of age or younger with CHD who underwent cardiac surgery. The primary outcome was a composite of one or more major adverse events (MAEs) after surgery: death from any cause, circulatory collapse that needed cardiopulmonary resuscitation, and requirement for extracorporeal membrane oxygenation. Based on the assumptions of arterial to venous blood ratio, eO2ER was calculated. A total of 647 cases were included in this study. MAEs occurred in 16 patients (2.5%). There were significant differences in the average post-bypass ScO2 [46.61 (40.90, 52.05) vs. 58.52 (51.52, 66.08), p < 0.001] and the average post-bypass eO2ER [0.66 (0.60, 0.78) vs. 0.52 (0.43, 0.61), p < 0.001] between patients with MAEs and patients without MAEs. Area under the receiver operating curve (AUROC) of the average of post-bypass ScO2 was 0.818 (95% confidence interval: 0.747–0.889), AUROC of the average of post-bypass eO2ER was 0.783 (0.697–0.870) and AUROC of post-bypass maximum serum lactate level was 0.635 (0.525–0.746). Both ScO2 and eO2ER, especially after weaning off bypass, are acceptable predictive markers for predicting MAEs after cardiac surgery in infants.

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“…In addition to average crSO 2 and srSO 2 , we calculated crSO 2 and srSO 2 desaturation indices defined as the duration of time over the first 48 h following surgery that crSO 2 and srSO 2 were below 50% [ 12 ]. Variability of crSO 2 and srSO 2 were calculated using the root mean of successive squared differences [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

Implementation of a Regional Oxygen Saturation Thought Algorithm and Association with Clinical Outcomes in Pediatric Patients Following Cardiac Surgery

et al. 2022

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Near infrared spectroscopy is routinely used in the noninvasive monitoring of cerebral and somatic regional oxygen saturation (rSO 2 ) in pediatric patients following surgery for congenital heart disease. We sought to evaluate the association of a bedside rSO 2 thought algorithm with clinical outcomes in a cohort of pediatric patients following cardiac surgery. This was a single-center retrospective cohort study of patients admitted following cardiac surgery over a 42-month period. The intervention was the implementation of an rSO 2 thought algorithm, the primary goal of which was to supply bedside providers with a thought aide to help identify, and guide response to, changes in rSO 2 in post-operative cardiac surgical patients. Surgical cases were stratified into two 18-month periods of observation, pre- and post-intervention allowing for a 6-month washout period during implementation of the thought algorithm. Clinical outcomes were compared between pre- and post-intervention periods. There were 434 surgical cases during the period of study. We observed a 27% relative risk reduction in our standardized mortality rate (0.61 to 0.48, p = 0.01) between the pre- and post-intervention periods. We did not observe differences in other post-operative clinical outcomes such as ventilator free days or post-operative ICU length of stay. Providing frontline clinical staff with education and tools, such as a bedside rSO 2 thought algorithm, may aide in the earlier detection of imbalance between oxygen delivery and consumption and may contribute to improved patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00246-022-03071-z.

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Cerebral regional oxygen saturation variability in neonates following cardiac surgery

Cited by 10 publications

References 30 publications

Effect of Red Blood Cell Transfusion on Regional Tissue Oxygenation in Pediatric Cardiac Surgery Patients

Effect of Red Blood Cell Transfusion on Regional Tissue Oxygenation in Pediatric Cardiac Surgery Patients

Regional Cerebral Oxygen Saturation and Estimated Oxygen Extraction Ratio as Predictive Markers of Major Adverse Events in Pediatric Cardiac Patients

Implementation of a Regional Oxygen Saturation Thought Algorithm and Association with Clinical Outcomes in Pediatric Patients Following Cardiac Surgery

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