Regional venous oxygen saturation versus mixed venous saturation after paediatric cardiac surgery

Moreno, Guillermo; Pilan, María L; Manara, C.; Magliola, Ricardo; Vassallo, Juan Carlos; Balestrini, M. R.; Lenz, Ana M; Krynski, Mariela; Althabe, María; Landry, Luis

doi:10.1111/aas.12016

Cited by 19 publications

(21 citation statements)

References 13 publications

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“…CBF is kept high even in case of low end-tidal pO 2 , low central venous saturation and increasing age [21][22][23]. Increased CBF due to cerebral autoregulation protecting the brain tissue against hypoxia may also serve as one possible explanation for the investigated time delay seen in Fig.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of near-infrared spectroscopy under apnea-dependent hypoxia in humans

Eichhorn

Erdfelder

Kessler

et al. 2015

J Clin Monit Comput

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In this study we investigated the responsiveness of near-infrared spectroscopy (NIRS) recordings measuring regional cerebral tissue oxygenation (rSO2) during hypoxia in apneic divers. The goal was to mimic dynamic hypoxia as present during cardiopulmonary resuscitation, laryngospasm, airway obstruction, or the "cannot ventilate cannot intubate" situation. Ten experienced apneic divers performed maximal breath hold maneuvers under dry conditions. SpO2 was measured by Masimo™ pulse oximetry on the forefinger of the left hand. NIRS was measured by NONIN Medical's EQUANOX™ on the forehead or above the musculus quadriceps femoris. Following apnea median cerebral rSO2 and SpO2 values decreased significantly from 71 to 54 and from 100 to 65%, respectively. As soon as cerebral rSO2 and SpO2 values decreased monotonically the correlation between normalized cerebral rSO2 and SpO2 values was highly significant (Pearson correlation coefficient = 0.893). Prior to correlation analyses, the values were normalized by dividing them by the individual means of stable pre-apneic measurements. Cerebral rSO2 measured re-saturation after termination of apnea significantly earlier (10 s, SD = 3.6 s) compared to SpO2 monitoring (21 s, SD = 4.4 s) [t(9) = 7.703, p < 0.001, r(2) = 0.868]. Our data demonstrate that NIRS monitoring reliably measures dynamic changes in cerebral tissue oxygen saturation, and identifies successful re-saturation faster than SpO2. Measuring cerebral rSO2 may prove beneficial in case of respiratory emergencies and during pulseless situations where SpO2 monitoring is impossible.

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Section: Discussionmentioning

confidence: 99%

Evaluation of near-infrared spectroscopy under apnea-dependent hypoxia in humans

Eichhorn

Erdfelder

Kessler

et al. 2015

J Clin Monit Comput

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“…Currently, the adequacy of perfusion is determined by the use of global measures of oxygen utilisation, such as mixed venous oxygen saturation (SvO 2 ), or evidence of tissue hypoxia, as implied by indicators of metabolic acidosis or elevated serum lactate, a marker of cell anaerobic metabolism. However, global measures may be normal in the presence of regional hypoxia 197,198 and it has been suggested that direct measures of cerebral oxygenation may have greater clinical utility for the development of goal-directed organ protection interventions during CPB. 44 Haemoglobin concentration is a key determinant of oxygen delivery during CPB.…”

Section: The Clinical Problemmentioning

confidence: 99%

“…NIRS monitoring meets many of these specifications: it is non-invasive and tissue specific and provides data that correlate closely with jugular venous saturations, a measure of cerebral oxygen extraction. 204 This has led to its use in multiple settings in addition to adult cardiac surgery, including the assessment of visceral perfusion in paediatric cardiac surgery 198 and cerebral oxygenation in neonatal intensive care. 252 It is important, therefore, to consider the negative findings that we have presented.…”

Section: Clinical Importancementioning

confidence: 99%

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Murphy

Mumford

Rogers

et al. 2017

Programme Grants Appl Res

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This report should be referenced as follows:Murphy GJ, Mumford AD, Rogers CA, Wordsworth S, Stokes EA, Verheyden V, et al. Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials. Programme Grants Appl Res 2017;5(17). Programme Grants for Applied ResearchISSN 2050-4322 (Print) ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10384. The contractual start date was in July 2008. The final report began editorial review in July 2016 and was accepted for publication in April 2017. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not ...

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“…Median Aristotle score was 8 (6)(7)(8)(9)(10) and VIS, at CPB weaning, was 16 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). In all cases, it was possible to retrieve hemodynamic PRAM data recorded throughout the procedure.…”

Section: Description Of Enrolled Patientsmentioning

confidence: 99%

“…Median weight, age, and body surface area (BSA) of the remaining 25 patients were 3.9 (3.3-6) kg, 111 (47-203) days, and 0.24 (0.22-0.33) m 2 , respectively. Median Aristotle score was 8 (6-10) and VIS, at CPB weaning, was 16 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Median CPB time was 153 (135-228) min and median cross-clamp time was 85 (66-108) min.…”

Section: Description Of Enrolled Patientsmentioning

confidence: 99%

Multisite Near Infrared Spectroscopy During Cardiopulmonary Bypass in Pediatric Patients

et al. 2015

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Multisite near infrared spectroscopy (NIRS) monitoring during pediatric cardiopulmonary bypass (CPB) has not been extensively validated. Although it might be rational to explore regional tissue saturation at different body sites (namely brain, kidney, upper body, lower body), conflicting results are currently provided by experience in children. The aim of our study was to evaluate absolute values of multisite NIRS saturation during CPB in a cohort of infants undergoing pediatric cardiac surgery to describe average differences between cerebral, renal, upper body (arm), and lower body (thigh) regional saturation. Furthermore, the correlation between cerebral NIRS and cardiac index (CI) at CPB weaning was evaluated. Twenty-five infants were enrolled: their median weight, age, and body surface area were 3.9 (3.3-6) kg, 111 (47-203) days, and 0.24 (0.22-0.33) m(2) , respectively. Median Aristotle score was 8 (6-10), and vasoactive inotropic score at CPB weaning was 16 (14-25). A total of 17 430 data points were recorded by each sensor: two-way ANOVA showed that time (P < 0.0001) and site (P = 0.0001) significantly affected variations of NIRS values: however, if cerebral NIRS values are excluded, sensor site is no more significant (P = 0.184 in the no circulatory arrest [noCA] group and P = 0.42 in the circulatory arrest [CA] group). Analysis of NIRS saturation changes over time showed that, at all sites, average NIRS values increased after CPB start, even if the increase of cerebral saturation was less intense than other sites (P < 0.0001). Detailed analysis of interaction between site of NIRS measurement and time point showed that cerebral NIRS (ranging from 65 to 75%) was always significantly lower than that of other channels (P < 0.0001) that tended to be in the range of oversaturation (80-90%), especially during the CPB phase. Average cerebral NIRS values of patients who did not undergo circulatory arrest (CA) during CPB, 10 min after CPB weaning, were associated with average CI values with a significant correlation (r = 0.7, P = 0.003). In conclusion, during CPB, cerebral NIRS values are expected to remain constantly lower than somatic sensors, which instead tend to show similar elevated saturations, regardless of their position. Based on these results, positioning of noncerebral NIRS sensors during CPB without CA may be questioned.

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Regional venous oxygen saturation versus mixed venous saturation after paediatric cardiac surgery

Abstract: The regional oxygen saturation of brain and kidney did not match ScvO2 as estimation of global tissue perfusion. Nevertheless, NIRS may still provide information regarding regional circulation that may help in the management of neonatal cardiac surgery patients.

Cited by 19 publications

References 13 publications

Evaluation of near-infrared spectroscopy under apnea-dependent hypoxia in humans

Evaluation of near-infrared spectroscopy under apnea-dependent hypoxia in humans

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Multisite Near Infrared Spectroscopy During Cardiopulmonary Bypass in Pediatric Patients

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