Noninvasive monitoring of central venous oxygen saturation by jugular transcutaneous near-infrared spectroscopy in pediatric patients undergoing congenital cardiac surgery

Abstract

Background and aim: In patients undergoing congenital cardiac surgery, it is crucial to maintain oxygen demand-consumption balance. Central venous oxygen saturation (ScvO 2) is a useful indicator of oxygen demand and consumption balance which is an invasive method. Near-infrared spectroscopy (NIRS) is a noninvasive, continuous monitoring technique that measures regional tissue oxygenation. NIRS that is placed over the internal jugular vein cutaneous area (NIRSijv) has the potential to show ScvO 2 indirectly. In this study, we aimed to determine the correlation between ScvO 2 with NIRSijv in pediatric patients undergoing congenital cardiac surgery. Materials and methods: Fifty children participated in the study. Four patients were excluded for the inability of internal jugular vein (IJV) catheterization due to technical difficulties. After anesthesia induction, NIRS probes were placed on the IJV site with ultrasound guidance for the measurement of continuous transcutaneous oxygen saturation. The catheter insertion was also done through the IJV from the other side using ultrasound guidance. Cerebral oxygenation monitoring was done using NIRS with a single pediatric probe placed on the right forehead. Values of NIRSijv, cerebral NIRS (NIRSc) and ScvO 2 , were recorded at certain times until postoperative 24th hour. Results: Data were collected at 8 different time points. There was a significant correlation between ScvO 2 and NIRSijv in all measurement time points (r = 0.91), (P = 0.001). The mean bias between ScvO 2 and NIRSijv was 2.92% and the limits of agreement were from 11% to-5.2%. There was a moderate correlation between ScvO 2 and NIRSc (r = 0.45), (P = 0.001). The mean bias between ScvO 2 and NIRSc was 2.7% and the limits of agreement were from +26% to-20%. Conclusion: In this study, we found a strong correlation between ScvO 2 and NIRS measurements taken from the internal jugular vein site. Accordingly, continuous noninvasive monitoring with transcutaneous NIRSijv can be an alternative method as a trend monitor for the central venous oxygen saturation in pediatric cardiac patients undergoing congenital cardiac surgery.

Oxygen saturation in intraosseous sternal blood measured by CO-oximetry and evaluated non-invasively during hypovolaemia and hypoxia – a porcine experimental study

“…Apart from PPG, Near infrared Spectroscopy (NIRS) is another optical method capable of measuring regional tissue oxygenation by determining the concentrations of oxygenated and deoxygenated haemoglobin [37][38][39]. The use of NIRS has been evaluated in several studies focusing on central or mixed venous oxygen saturation [30,[40][41][42]. In our study, SQV and SvO 2 changed in parallel during blood loss, whereas SaO 2 remained unaltered, indicating the potential for non-invasive measurement of SvO 2 over the sternum.…”

Correlation between central venous oxygen saturation and tissue oxygen saturation measured using time-resolved spectroscopy after major surgery: a prospective observational study

“…As this study evaluated a new measurement principle using t-NIRS, calculating an accurate sample size using agreement as an indicator was challenging. However, previous reports using conventional NIRS methods indicated a high correlation coe cient between test values for StO 2 _neck and ScvO 2 (approximately 0.9) [9,10], whereas StO 2 _thenar and SvO 2 exhibited a lower correlation (0.33-0.69) [11,12]. Therefore, we calculated the minimum number of samples required to con rm a correlation coe cient of 0.6, which was 20.…”

Near-Infrared Spectroscopy Monitoring in Pediatric Anesthesiology: A Pro-Con Discussion

“…Low cerebral oximetry values have been found to be correlated with mortality and major postoperative morbidity, including prolonged intensive care stay, prolonged mechanical ventilation, and the need for extracorporeal membrane oxygenation [ 2 ]. This has been demonstrated after the Norwood procedure (a three-stage heart surgery to create a functional systemic circuit in patients with hypoplastic left heart syndrome) and in mixed pediatric cardiac surgery cohorts in which cyanotic and noncyanotic patients were analyzed together [ 16 - 17 ]. NIRS measurements appear to be accurate both in noncyanotic and cyanotic patients [ 18 ].…”