Document Detail

Change in regional (somatic) near-infrared spectroscopy is not a useful indicator of clinically detectable low cardiac output in children after surgery for congenital heart defects.
MedLine Citation:
PMID:  22596064     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Near-infrared spectroscopy correlation with low cardiac output has not been validated. Our objective was to determine role of splanchnic and/or renal oxygenation monitoring using near-infrared spectroscopy for detection of low cardiac output in children after surgery for congenital heart defects.
DESIGN: Prospective observational study.
SETTING: Pediatric intensive care unit of a tertiary care teaching hospital.
PATIENTS: Children admitted to the pediatric intensive care unit after surgery for congenital heart defects.
MEASUREMENTS AND MAIN RESULTS: We hypothesized that splanchnic and/or renal hypoxemia detected by near-infrared spectroscopy is a marker of low cardiac output after pediatric cardiac surgery. Patients admitted after cardiac surgery to the pediatric intensive care unit over a 10-month period underwent serial splanchnic and renal near-infrared spectroscopy measurements until extubation. Baseline near-infrared spectroscopy values were recorded in the first postoperative hour. A near-infrared spectroscopy event was a priori defined as ≥20% drop in splanchnic and/or renal oxygen saturation from baseline during any hour of the study. Low cardiac output was defined as metabolic acidosis (pH <7.25, lactate >2 mmol/L, or base excess ≤-5), oliguria (urine output <1 mL/kg/hr), or escalation of inotropic support. Receiver operating characteristic analysis was performed using near-infrared spectroscopy event as a diagnostic test for low cardiac output. Twenty children were enrolled: median age was 5 months; median Risk Adjustment for Congenital Heart Surgery category was 3 (1-6); median bypass and cross-clamp times were 120 mins (45-300 mins) and 88 mins (17-157 mins), respectively. Thirty-one episodes of low cardiac output and 273 near-infrared spectroscopy events were observed in 17 patients. The sensitivity and specificity of a near-infrared spectroscopy event as an indicator of low cardiac output were 48% (30%-66%) and 67% (64%-70%), respectively. On receiver operating characteristic analysis, neither splanchnic nor renal near-infrared spectroscopy event had a significant area under the curve for prediction of low cardiac output (area under the curve: splanchnic 0.45 [95% confidence interval 0.30-0.60], renal 0.51 [95% confidence interval 0.37-0.65]).
CONCLUSIONS: Splanchnic and/or renal hypoxemia as detected by near-infrared spectroscopy may not be an accurate indicator of low cardiac output after surgery for congenital heart defects.
Utpal S Bhalala; Akira Nishisaki; Derrick McQueen; Geoffrey L Bird; Wynne E Morrison; Vinay M Nadkarni; Meena Nathan; Joanne P Starr
Related Documents :
2262214 - Aids cardiomyopathy: first rule out other myocardial risk factors.
15999474 - Association of coronary atherosclerosis with insulin resistance in patients with impair...
22255394 - A continuous, wearable, and wireless heart monitor using head ballistocardiogram (bcg) ...
2877454 - Can and should type a behaviour be changed?
9327694 - Effect of coronary angioplasty on qt dispersion.
576394 - Short left circumflex artery.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  13     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-10     Completed Date:  2013-03-12     Revised Date:  2013-04-12    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  529-34     Citation Subset:  IM    
Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Acidosis / blood,  diagnosis
Anoxia / blood,  diagnosis*
Area Under Curve
Cardiac Output, Low / blood,  diagnosis*
Cardiotonic Agents / administration & dosage
Child, Preschool
Confidence Intervals
Heart Defects, Congenital / surgery
Infant, Newborn
Oxygen / blood*
Postoperative Complications / blood,  diagnosis*
Predictive Value of Tests
Prospective Studies
ROC Curve
Renal Circulation
Spectroscopy, Near-Infrared*
Splanchnic Circulation
Reg. No./Substance:
0/Cardiotonic Agents; 7782-44-7/Oxygen
Comment In:
Pediatr Crit Care Med. 2013 Mar;14(3):340-1   [PMID:  23462365 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  The association between Cdc42 and Caveolin-1 is involved in the regulation of capacitation and acros...
Next Document:  Socioeconomic impact on device-associated infections in pediatric intensive care units of 16 limited...