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Effect of cerebral circulatory arrest on cerebral near‐infrared spectroscopy in pediatric patients
Author(s) -
Blohm Martin E.,
Obrecht Denise,
Hartwich Jana,
Singer Dominique
Publication year - 2014
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12328
Subject(s) - medicine , circulatory system , receiver operating characteristic , cerebral perfusion pressure , confidence interval , cardiology , area under the curve , anesthesia , perfusion
Summary Background/Aims The aim was to investigate whether cerebral transcutaneous near‐infrared spectroscopy ( NIRS ) or two‐site NIRS is a suitable monitoring tool to detect or confirm a cerebral circulatory arrest in pediatric intensive care unit ( PICU ) patients. Methods Prospective single‐center pediatric observational study. Simultaneous NIRS measurements over forehead (c NIRS , cr S 02) and kidney (r NIRS , rr SO 2), at the same time, the cardiac output were determined by transthoracic echocardiography. Area under the curve ( AUC ) in the receiver‐operating curve ( ROC ) was analyzed for NIRS regarding cerebral circulatory arrest. Results There were two groups of patients (weight 2.1–73 kg): Group A: patients with intact cerebral perfusion ( n = 36). Group B: patients with cerebral circulatory arrest ( n = 8) proven by Doppler ultrasound scan or perfusion scintigraphy. There was no difference in cardiac output between the groups. PICU mortality for Group A was 3/36 (8.3%), for Group B 8/8, (100%). Mean c NIRS values were significantly higher with 68.92 ( sem = 2.54, sd = 15.25) in Group A compared with 34.63 ( sem = 5.36, sd = 15.15) in Group B ( P < 0.001). ROC analysis for c NIRS detecting cerebral circulatory arrest was significant ( AUC 0.948, 95% confidence interval 0.876–1.000, se = 0.037, P < 0.001). Discrimination was optimal at 46 for c NIRS , at 36.5 for the difference r NIRS ‐c NIRS and at 0.5646 for the quotient c NIRS /r NIRS . The probability of a cerebral circulatory arrest was 77.8% (c NIRS ) and 87.5% (combinations of c NIRS and r NIRS ) at these cutoffs. Conclusions c NIRS did detect cerebral circulatory arrest with high sensitivity. Specificity was, however, not high enough to confirm a cerebral circulatory arrest.