J Pediatr Intensive Care 2018; 07(04): 196-200
DOI: 10.1055/s-0038-1660788
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Correlation between Regional Cerebral Saturation and Invasive Cardiac Index Monitoring after Heart Transplantation Surgery

Awni M. Al-Subu
1   Division of Pediatric Critical Care Medicine, Department of Pediatrics, American Family Children's Hospital, The University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
,
Christoph P. Hornik
2   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina, United States
,
Ira M. Cheifetz
2   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina, United States
,
Andrew J. Lodge
3   Division of Pediatric Cardiac Surgery, Duke Children's Hospital, Durham, North Carolina, United States
,
George Ofori-Amanfo
4   Division of Pediatric Critical Care, Department of Pediatrics, Kravis Children's Hospital at Mount Sinai, New York, United States
› Author Affiliations
Further Information

Publication History

02 March 2018

30 April 2018

Publication Date:
11 June 2018 (online)

Abstract

The present study assessed the correlations between cerebral regional saturation detected by near infrared spectroscopy (NIRS) and cardiac index (CI) measured by pulmonary artery catheter. This was a retrospective cohort study conducted in the cardiac intensive care unit in a tertiary care children's hospital. Patients younger than 18 years of age who underwent heart transplantation and had a pulmonary artery catheter on admission to the pediatric cardiac intensive care unit between January, 2010, and August, 2013, were included. There were no interventions. A total of 10 patients were included with median age of 14 years (range, 7–17). Indications for transplantation were dilated cardiomyopathy (n = 9) and restrictive cardiomyopathy (n = 1). Mixed venous oxygen saturation (SvO2), cerebral regional tissue saturation (rSO2), and CI were recorded hourly for 8 to 92 hours post-transplantation. Spearman's rank correlation coefficient was used to assess correlations between SvO2 and cerebral rSO2 and between CI and cerebral rSO2. A total of 410 data points were collected. Median, 25th and 75th percentiles of cerebral rSO2, CI, and SvO2 were 65% (54–69), 2.9 L/min/m2 (2.2–4.0), and 75% (69–79), respectively. The correlation coefficient between cerebral rSO2 and CI was 0.104 (p = 0.034) and that for cerebral rSO2 and SvO2 was 0.11 (p = 0.029). The correlations between cerebral rSO2 and CI and between cerebral rSO2 and SvO2 were weak. Cerebral rSO2 as detected by NIRS may not be an accurate indicator of CI in critically ill patients.

Note

This study was conducted at Duke Children's Hospital, Durham, NC.


 
  • References

  • 1 Botte A, Leclerc F, Riou Y. , et al. Evaluation of a noninvasive cardiac output monitor in mechanically ventilated children. Pediatr Crit Care Med 2006; 7 (03) 231-236
  • 2 Nusmeier A, van der Hoeven JG, Lemson J. Cardiac output monitoring in pediatric patients. Expert Rev Med Devices 2010; 7 (04) 503-517
  • 3 Lyew MA, Bacon DR, Nesarajah MS. Right ventricular perforation by a pulmonary artery catheter during coronary artery bypass surgery. Anesth Analg 1996; 82 (05) 1089-1090
  • 4 McDaniel DD, Stone JG, Faltas AN. , et al. Catheter-induced pulmonary artery hemorrhage. Diagnosis and management in cardiac operations. J Thorac Cardiovasc Surg 1981; 82 (01) 1-4
  • 5 Bossert T, Gummert JF, Bittner HB. , et al. Swan-Ganz catheter-induced severe complications in cardiac surgery: right ventricular perforation, knotting, and rupture of a pulmonary artery. J Card Surg 2006; 21 (03) 292-295
  • 6 Romagnoli S, Ricci Z, Balsorano P. , et al. Comparison between mixed and central venous oxygen saturation in patients with severe acute heart failure after cardiac surgery: a prospective observational study. Int J Cardiol 2014; 175 (03) 566-567
  • 7 de la Rocha AG, Edmonds JF, Williams WG, Poirier C, Trusler RN. Importance of mixed venous oxygen saturation in the care of critically ill patients. Can J Surg 1978; 21 (03) 227-229
  • 8 Schumacker PT, Cain SM. The concept of a critical oxygen delivery. Intensive Care Med 1987; 13 (04) 223-229
  • 9 Al-Subu AM, Rehder KJ, Cheifetz IM, Turner DA. Non invasive monitoring in mechanically ventilated pediatric patients. Expert Rev Respir Med 2014; 8 (06) 693-702
  • 10 Yu Y, Zhang K, Zhang L, Zong H, Meng L, Han R. Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Cochrane Database Syst Rev 2018; 1: CD010947
  • 11 Ghanayem NS, Hoffman GM. Near infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatr Crit Care Med 2016; 17 (8, Suppl 1): S201-S206
  • 12 Marin T, Moore J. Understanding near-infrared spectroscopy. Adv Neonatal Care 2011; 11 (06) 382-388
  • 13 Rescoe E, Tang X, Perry DA. , et al. Cerebral near-infrared spectroscopy insensitively detects low cerebral venous oxygen saturations after stage 1 palliation. J Thorac Cardiovasc Surg 2017; 154 (03) 1056-1062
  • 14 Thavasothy M, Broadhead M, Elwell C, Peters M, Smith M. A comparison of cerebral oxygenation as measured by the NIRO 300 and the INVOS 5100 near-infrared spectrophotometers. Anaesthesia 2002; 57 (10) 999-1006
  • 15 Weiss M, Dullenkopf A, Kolarova A, Schulz G, Frey B, Baenziger O. Near-infrared spectroscopic cerebral oxygenation reading in neonates and infants is associated with central venous oxygen saturation. Paediatr Anaesth 2005; 15 (02) 102-109
  • 16 Dullenkopf A, Frey B, Baenziger O, Gerber A, Weiss M. Measurement of cerebral oxygenation state in anaesthetized children using the INVOS 5100 cerebral oximeter. Paediatr Anaesth 2003; 13 (05) 384-391
  • 17 Hoffman GM, Ghanayem NS, Scott JP, Tweddell JS, Mitchell ME, Mussatto KA. Postoperative cerebral and somatic near-infrared spectroscopy saturations and outcome in hypoplastic left heart syndrome. Ann Thorac Surg 2017; 103 (05) 1527-1535
  • 18 Hoffman GM, Brosig CL, Mussatto KA, Tweddell JS, Ghanayem NS. Perioperative cerebral oxygen saturation in neonates with hypoplastic left heart syndrome and childhood neurodevelopmental outcome. J Thorac Cardiovasc Surg 2013; 146 (05) 1153-1164
  • 19 Naguib AN, Winch PD, Sebastian R. , et al. The correlation of two cerebral saturation monitors with jugular bulb oxygen saturation in children undergoing cardiopulmonary bypass for congenital heart surgery. J Intensive Care Med 2017; 32 (10) 603-608
  • 20 Moreno GE, Pilán ML, Manara C. , et al. Regional venous oxygen saturation versus mixed venous saturation after paediatric cardiac surgery. Acta Anaesthesiol Scand 2013; 57 (03) 373-379
  • 21 Marimón GA, Dockery WK, Sheridan MJ, Agarwal S. Near-infrared spectroscopy cerebral and somatic (renal) oxygen saturation correlation to continuous venous oxygen saturation via intravenous oximetry catheter. J Crit Care 2012; 27 (03) 314.e13-314.e18
  • 22 Hoffman TM, Wernovsky G, Atz AM. , et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107 (07) 996-1002
  • 23 Wessel DL. Managing low cardiac output syndrome after congenital heart surgery. Crit Care Med 2001; 29 (10, Suppl): S220-S230
  • 24 Seear MD, Scarfe JC, LeBlanc JG. Predicting major adverse events after cardiac surgery in children. Pediatr Crit Care Med 2008; 9 (06) 606-611
  • 25 Al-Subu AM, Rehder KJ, Ofori-Amanfo G, Turner DA. Current use of invasive and noninvasive monitors in academic pediatric intensive care units. J Pediatr Intensive Care 2018; DOI: 10.1055/s-0038-1623480.
  • 26 Desmond F, Namachivayam S. Does near-infrared spectroscopy play a role in paediatric intensive care?. BJA Educ 2016; 16 (08) 281-285
  • 27 Bhutta AT, Ford JW, Parker JG. , et al. Noninvasive cerebral oximeter as a surrogate for mixed venous saturation in children. Pediatr Cardiol 2007; 28 (01) 34-41
  • 28 Paarmann H, Heringlake M, Heinze H. , et al. Non-invasive cerebral oxygenation reflects mixed venous oxygen saturation during the varying haemodynamic conditions in patients undergoing transapical transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg 2012; 14 (03) 268-272
  • 29 Schneider A, Minnich B, Hofstätter E, Weisser C, Hattinger-Jürgenssen E, Wald M. Comparison of four near-infrared spectroscopy devices shows that they are only suitable for monitoring cerebral oxygenation trends in preterm infants. Acta Paediatr 2014; 103 (09) 934-938