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The Role of Intra o perative Regional Oxygen Saturation Using Near Infrared Spectroscopy in the Prediction of Low Output Syndrome After Pediatric Heart Surgery
Author(s) -
Zulueta Jose L.,
Vida Vladimiro L.,
Perisinotto Egle,
Pittarello Demetrio,
Stellin Giovanni
Publication year - 2013
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12122
Subject(s) - medicine , cardiac surgery , anesthesia , inotrope , oxygen saturation , extracorporeal membrane oxygenation , heart disease , cardiology , surgery , oxygen , chemistry , organic chemistry
Background We report on the applicability of intraoperative regional oxygen saturation (rSO 2 ) desaturation score by near‐infrared spectroscopy in the early detection of postoperative low output state (LOS) in infants with congenital heart disease who underwent cardiac surgery. Materials and Methods Between July and October 2011 the intra‐ and immediate postoperative courses of 22 patients undergoing elective cardiac surgery for congenital heart disease were analyzed. The intraoperative cerebral and somatic rSO 2 were measured and a rSO 2 desaturation score calculated (by multiplying the rSO 2 below 50% of the threshold by seconds). The aim of the study was to evaluate the applicability of intraoperative rSO 2 de‐saturation score in the early detection of postoperative LOS. Results Thirteen of 22 patients (62%) had an intraoperative cerebral rSO 2 desaturation score >3000% per second. Patients with a rSO 2 de‐saturation score >3000% per second had a significantly lower intraoperative central venous saturation (SvO 2 , p = 0.002), cardiac index (CI, p = 0.004), oxygen availability indexed (DO 2 I, p = 0.0004), and a significantly higher extraction of oxygen (ERO 2 , p = 0.0005) when compared to patients with a rSO 2 desaturation score <3000% per second. Nine patients had postoperative LOS; all of them had an intraoperative rSO 2 de‐saturation score >3000% per second (9/13 patients, 69%; p = 0.001) requiring prompt treatment with major inotropic support, surface hypothermia, and extracorporeal membrane oxygenation (ECMO) support (n = 4). Twenty‐one patients survived. One patient died from ventricular failure and inability to wean from ECMO support. Conclusion The intraoperative use of NIRS provided an early warning sign of hemodynamic or metabolic compromise, enabling early and rapid intervention to prevent or reduce the severity of potentially life‐threatening complications. doi: 10.1111/jocs.12122 (J Card Surg 2013;28:446–452)