Section of Paediatric Neurosurgery, Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.
Paediatric Intensive Care Unit, University Children's Hospital of Tuebingen, Tuebingen, Germany.
Paediatr Anaesth. 2022 Dec;32(12):1320-1329. doi: 10.1111/pan.14555. Epub 2022 Sep 16.
Advances in the treatment of pediatric congenital heart disease have increased survival rates. Despite efforts to prevent neurological injury, many patients suffer from impaired neurodevelopmental outcomes. Compromised cerebral autoregulation can increase the risk of brain injury following pediatric cardiac surgery with cardiopulmonary bypass. Monitoring autoregulation and maintaining adequate cerebral blood flow can help prevent neurological injury.
Our objective was to evaluate autoregulation parameters and to define the optimal blood pressure as well as the lower and upper blood pressure limits of autoregulation.
Autoregulation was monitored prospectively in 36 infants after cardiopulmonary bypass surgery for congenital heart defects between January and December 2019. Autoregulation indices were calculated by correlating invasive arterial blood pressure, cortical oxygen saturation, and relative tissue hemoglobin levels with near-infrared spectroscopy parameters.
The mean patient age was 4.1 ± 2.8 months, and the mean patient weight was 5.2 ± 1.8 kg. Optimal mean arterial pressure could be identified in 88.9% of patients via the hemoglobin volume index and in 91.7% of patients via the cerebral oxygenation index, and a lower limit of autoregulation could be found in 66.7% and 63.9% of patients, respectively. No significant changes in autoregulation indices at the beginning or end of the monitoring period were observed. In 76.5% ± 11.1% and 83.8% ± 9.9% of the 8 and 16 h monitoring times, respectively, the mean blood pressure was inside the range of intact autoregulation (below in 21.5% ± 25.4% and 11.3% ± 16.5% and above in 8.7% ± 10.4% and 6.0% ± 11.0%, respectively). The mean optimal blood pressure was 57.4 ± 8.7 mmHg and 58.2 ± 7.9 mmHg and the mean lower limit of autoregulation was 48.8 ± 8.3 mmHg and 45.5 ± 6.7 mmHg when generated via the hemoglobin volume index and cerebral oxygenation index, respectively.
Postoperative noninvasive autoregulation monitoring after cardiac surgery in children can be reliably and safely performed using the hemoglobin volume index and cerebral oxygenation index and provides robust data. This monitoring can be used to identify individual hemodynamic targets to optimize autoregulation, which differs from those recommended in the literature. Further evaluation of this subject is needed.
儿科先天性心脏病治疗的进步提高了生存率。尽管努力预防神经损伤，但许多患者的神经发育结果仍受损。心肺旁路手术后，脑自动调节受损会增加脑损伤的风险。监测自动调节并保持足够的脑血流可以帮助预防神经损伤。
我们的目的是评估自动调节参数，并确定最佳血压以及自动调节的下限和上限血压。
2019 年 1 月至 12 月期间，对 36 例因先天性心脏缺陷行心肺旁路手术后的婴儿进行前瞻性自动调节监测。通过将有创动脉血压、皮质氧饱和度和相对组织血红蛋白水平与近红外光谱参数相关联，计算自动调节指数。
患者平均年龄为 4.1±2.8 个月，平均体重为 5.2±1.8kg。通过血红蛋白容积指数可识别 88.9%的患者的平均动脉压最佳值，通过脑氧合指数可识别 91.7%的患者的平均动脉压最佳值，通过血红蛋白容积指数和脑氧合指数分别可找到 66.7%和 63.9%的患者的自动调节下限。在监测期开始和结束时未观察到自动调节指数的显著变化。在 8 和 16 小时监测时间的 76.5%±11.1%和 83.8%±9.9%中，平均血压分别在完整自动调节范围内（分别为 21.5%±25.4%和 11.3%±16.5%以下，8.7%±10.4%和 6.0%±11.0%以上）。通过血红蛋白容积指数和脑氧合指数分别生成的平均最佳血压分别为 57.4±8.7mmHg 和 58.2±7.9mmHg，平均自动调节下限分别为 48.8±8.3mmHg 和 45.5±6.7mmHg。
儿童心脏手术后使用血红蛋白容积指数和脑氧合指数进行非侵入性术后自动调节监测可以可靠和安全地进行，并且提供可靠的数据。这种监测可用于确定优化自动调节的个体血流动力学目标，这与文献中推荐的目标不同。需要进一步评估这个问题。
