Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
Division of Cardiology, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Pediatr Crit Care Med. 2022 Jul 1;23(7):e347-e355. doi: 10.1097/PCC.0000000000002963. Epub 2022 May 9.
Superior vena cava oxygen saturation (SVC O 2 ) monitoring is well described for early detection of hemodynamic deterioration after neonatal cardiac surgery but inferior vena cava vein oxygen saturation (IVC O 2 ) monitoring data are limited.
Retrospective cohort study of 118 neonates with congenital heart disease (52 single ventricle) from February 2008 to January 2014.
Pediatric cardiac ICU.
Neonates (< 30 d) with concurrent admission IVC O 2 and SVC O 2 measurements after cardiac surgery with cardiopulmonary bypass.
None.
The primary aim was to correlate admission IVC O 2 and SVC O 2 . Secondary aims included: correlate flank or cerebral near-infrared spectroscopy with IVC O 2 and SVC O 2 , respectively, and exploratory analysis to evaluate associations between oximetry data and a composite adverse outcome defined as any of the following: increasing serum lactate or vasoactive support at 2 hours post-admission, cardiac arrest, or mortality. Admission IVC O 2 and SVC O 2 correlated ( r = 0.54; p < 0.001). However, IVC O 2 measurements were significantly lower than paired SVC O 2 (mean difference, -6%; 95% CI, -8% to -4%; p < 0.001) with wide variability in sample agreement. Logistic regression showed that each 12% decrease in IVC O 2 was associated with a 12-fold greater odds of the composite adverse outcome (odds ratio [OR], 12; 95% CI, 3.9-34; p < 0.001). We failed to find an association between SVC O 2 and increased odds of the composite adverse outcome (OR, 1.8; 95% CI, 0.99-3.3; p = 0.053). In an exploratory analysis, the area under the receiver operating curve for IVC O 2 and SVC O 2 , and the composite adverse outcome, was 0.85 (95% CI, 0.77-0.92) and 0.63 (95% CI, 0.52-0.73), respectively. Admission IVC O 2 had strong correlation with concurrent flank near-infrared spectroscopy value ( r = 0.74; p < 0.001). SVC O 2 had a weak association with cerebral near-infrared spectroscopy ( r = 0.22; p = 0.02).
In postoperative neonates, admission IVC O 2 and SVC O 2 correlate. Lower admission IVC O 2 may identify a cohort of postsurgical neonates at risk for low cardiac output and associated morbidity.
上腔静脉血氧饱和度（SVC O 2 ）监测在新生儿心脏手术后早期发现血流动力学恶化方面已有很好的描述，但下腔静脉血氧饱和度（IVC O 2 ）监测数据有限。
2008 年 2 月至 2014 年 1 月期间对 118 例患有先天性心脏病（52 例单心室）的新生儿进行的回顾性队列研究。
儿科心脏重症监护病房。
接受体外循环心脏手术后同时有 IVC O 2 和 SVC O 2 测量值的新生儿（<30 天）。
无。
主要目的是比较入院时 IVC O 2 和 SVC O 2 。次要目的包括：分别比较侧腹部或脑近红外光谱与 IVC O 2 和 SVC O 2 的相关性，以及进行探索性分析以评估血氧饱和度数据与定义为以下任何一种的复合不良结局之间的关联：入院后 2 小时内血清乳酸或血管活性支持增加、心脏骤停或死亡。入院时 IVC O 2 和 SVC O 2 呈正相关（r=0.54；p<0.001）。然而，IVC O 2 测量值明显低于配对的 SVC O 2（平均差值为-6%；95%CI，-8%至-4%；p<0.001），样本一致性的差异很大。逻辑回归显示，IVC O 2 每降低 12%，复合不良结局的几率就会增加 12 倍（比值比[OR]，12；95%CI，3.9-34；p<0.001）。我们未能发现 SVC O 2 与增加的复合不良结局几率之间存在关联（OR，1.8；95%CI，0.99-3.3；p=0.053）。在一项探索性分析中，IVC O 2 和 SVC O 2 以及复合不良结局的受试者工作特征曲线下面积分别为 0.85（95%CI，0.77-0.92）和 0.63（95%CI，0.52-0.73）。入院时 IVC O 2 与同期侧腹部近红外光谱值有很强的相关性（r=0.74；p<0.001）。SVC O 2 与脑近红外光谱的相关性较弱（r=0.22；p=0.02）。
在术后新生儿中，入院时 IVC O 2 和 SVC O 2 相关。较低的入院 IVC O 2 可能识别出术后发生低心输出量和相关发病率的新生儿亚群。
