Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Pediatr Crit Care Med. 2012 Sep;13(5):529-34. doi: 10.1097/PCC.0b013e3182389531.
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.
Prospective observational study.
Pediatric intensive care unit of a tertiary care teaching hospital.
Children admitted to the pediatric intensive care unit after surgery for congenital heart defects.
None.
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]).
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.
近红外光谱与低心输出量的相关性尚未得到验证。我们的目的是确定使用近红外光谱监测内脏和/或肾脏氧合在先天性心脏病手术后儿童低心输出量检测中的作用。
前瞻性观察性研究。
三级教学医院儿科重症监护病房。
先天性心脏病手术后入住儿科重症监护病房的儿童。
无。
我们假设近红外光谱检测到的内脏和/或肾脏低氧血症是小儿心脏手术后低心输出量的标志物。在心脏手术后的 10 个月期间，在儿科重症监护病房住院的患者接受了连续的内脏和肾脏近红外光谱测量，直到拔管。在术后第一小时记录基线近红外光谱值。近红外光谱事件是指研究期间任何 1 小时内脏和/或肾脏氧饱和度从基线下降≥20%的预先确定事件。低心输出量定义为代谢性酸中毒（pH<7.25，乳酸>2mmol/L，或碱剩余≤-5）、少尿（尿量<1mL/kg/hr）或正性肌力支持升级。使用近红外光谱事件作为低心输出量的诊断试验进行接收者操作特征分析。共纳入 20 名患儿：中位年龄为 5 个月；中位先天性心脏病手术风险调整分类为 3 级（1-6 级）；中位体外循环和阻断时间分别为 120 分钟（45-300 分钟）和 88 分钟（17-157 分钟）。17 名患者中有 31 次低心输出量和 273 次近红外光谱事件。近红外光谱事件作为低心输出量指标的敏感性和特异性分别为 48%（30%-66%）和 67%（64%-70%）。在接收者操作特征分析中，内脏和肾脏近红外光谱事件的曲线下面积均不能预测低心输出量（曲线下面积：内脏 0.45[95%置信区间 0.30-0.60]，肾脏 0.51[95%置信区间 0.37-0.65]）。
近红外光谱检测到的内脏和/或肾脏低氧血症可能不是先天性心脏病手术后低心输出量的准确指标。
