Department of Anesthesiology and Reanimation, Vocational School of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
Turk J Med Sci. 2020 Aug 26;50(5):1280-1287. doi: 10.3906/sag-1911-135.
In patients undergoing congenital cardiac surgery, it is crucial to maintain oxygen demand-consumption balance. Central venous oxygen saturation (ScvO2) is a useful indicator of oxygen demand and consumption balance which is an invasive method. Near-infrared spectroscopy (NIRS) is a noninvasive, continuous monitoring technique that measures regional tissue oxygenation. NIRS that is placed over the internal jugular vein cutaneous area (NIRSijv) has the potential to show ScvO2 indirectly. In this study, we aimed to determine the correlation between ScvO2 with NIRSijv in pediatric patients undergoing congenital cardiac surgery.
Fifty children participated in the study. Four patients were excluded for the inability of internal jugular vein (IJV) catheterization due to technical difficulties. After anesthesia induction, NIRS probes were placed on the IJV site with ultrasound guidance for the measurement of continuous transcutaneous oxygen saturation. The catheter insertion was also done through the IJV from the other side using ultrasound guidance. Cerebral oxygenation monitoring was done using NIRS with a single pediatric probe placed on the right forehead. Values of NIRSijv, cerebral NIRS (NIRSc) and ScvO2, were recorded at certain times until postoperative 24th hour.
Data were collected at 8 different time points. There was a significant correlation between ScvO2 and NIRSijv in all measurement time points (r = 0.91), (P = 0.001). The mean bias between ScvO2 and NIRSijv was 2.92% and the limits of agreement were from 11% to –5.2%. There was a moderate correlation between ScvO2 and NIRSc (r = 0.45), (P = 0.001). The mean bias between ScvO2 and NIRSc was 2.7% and the limits of agreement were from +26% to –20%.
In this study, we found a strong correlation between ScvO2 and NIRS measurements taken from the internal jugular vein site. Accordingly, continuous noninvasive monitoring with transcutaneous NIRSijv can be an alternative method as a trend monitor for the central venous oxygen saturation in pediatric cardiac patients undergoing congenital cardiac surgery.
在接受先天性心脏手术的患者中，维持氧需求-消耗平衡至关重要。中心静脉血氧饱和度（ScvO2）是一种有用的氧需求和消耗平衡的指标，但它是一种有创方法。近红外光谱（NIRS）是一种非侵入性、连续监测技术，可测量局部组织氧合。放置在颈内静脉皮区的近红外光谱（NIRSijv）有可能间接显示 ScvO2。在这项研究中，我们旨在确定接受先天性心脏手术的儿科患者的 ScvO2 与 NIRSijv 之间的相关性。
50 名儿童参与了这项研究。由于技术困难，有 4 名患者因无法进行颈内静脉（IJV）置管而被排除在外。麻醉诱导后，在超声引导下将 NIRS 探头放置在 IJV 部位，以测量连续经皮血氧饱和度。也使用超声引导从另一侧通过 IJV 进行导管插入。使用放置在右额头上的单个儿科探头进行脑氧合监测。在特定时间记录 NIRSijv、脑 NIRS（NIRSc）和 ScvO2 的值，直到术后 24 小时。
共收集了 8 个不同时间点的数据。在所有测量时间点，ScvO2 与 NIRSijv 均呈显著相关（r=0.91）（P=0.001）。ScvO2 与 NIRSijv 之间的平均偏差为 2.92%，一致性界限为 11%至-5.2%。ScvO2 与 NIRSc 之间存在中度相关性（r=0.45）（P=0.001）。ScvO2 与 NIRSc 之间的平均偏差为 2.7%，一致性界限为+26%至-20%。
在这项研究中，我们发现 ScvO2 与从颈内静脉部位采集的 NIRS 测量值之间存在很强的相关性。因此，连续无创监测经皮 NIRSijv 可作为接受先天性心脏手术的儿科心脏病患者中心静脉血氧饱和度的趋势监测替代方法。
