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    
Abstract/OtherAbstract:
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.
INTERVENTIONS: None.
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.
Authors:
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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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    
Affiliation:
Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. usbhalala@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Acidosis / blood,  diagnosis
Adolescent
Anoxia / blood,  diagnosis*
Area Under Curve
Cardiac Output, Low / blood,  diagnosis*
Cardiotonic Agents / administration & dosage
Child
Child, Preschool
Confidence Intervals
Female
Heart Defects, Congenital / surgery
Humans
Infant
Infant, Newborn
Male
Oxygen / blood*
Postoperative Complications / blood,  diagnosis*
Predictive Value of Tests
Prospective Studies
ROC Curve
Renal Circulation
Spectroscopy, Near-Infrared*
Splanchnic Circulation
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 7782-44-7/Oxygen
Comments/Corrections
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


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