|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.|
|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|
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|Type: Journal Article|
|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|
|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|
|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. firstname.lastname@example.org|
|APA/MLA Format Download EndNote Download BibTex|
Anoxia / blood, diagnosis*
Area Under Curve
Cardiac Output, Low / blood, diagnosis*
Cardiotonic Agents / administration & dosage
Heart Defects, Congenital / surgery
Oxygen / blood*
Postoperative Complications / blood, diagnosis*
Predictive Value of Tests
|0/Cardiotonic Agents; 7782-44-7/Oxygen|
|Pediatr Crit Care Med. 2013 Mar;14(3):340-1
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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