Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Division of Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan.
Paediatr Anaesth. 2023 Nov;33(11):913-922. doi: 10.1111/pan.14741. Epub 2023 Aug 3.
We evaluated the correlation between regional oxygen saturation (rSO ) in the frontal and right renal dorsum (cerebral rSO and somatic rSO ) measured by near-infrared spectroscopy (INVOS™ 5100C, Medtronic) and central venous oxygen saturation (ScvO ) measured with a fiber-optic oximetry catheter (PediaSat™, Edwards Lifesciences) during surgery in order to determine whether noninvasive rSO could be used as an alternative to ScvO in pediatric cardiac surgery patients. We evaluated the correlation between regional tissue oxygen saturation (cerebral rSO and somatic rSO ) measured by near-infrared spectroscopy and other patient measures with central venous oxygen saturation (ScvO ) measured with a fiber-optic oximetry catheter to track global oxygen supply demand as a potential alternative or supplement to ScvO .
This single-center prospective observational study enrolled 33 children (weight < 10 kg) who underwent cardiac surgery for congenital heart disease between February 2018 and November 2021. ScvO , cerebral rSO , and somatic rSO were recorded simultaneously after anesthesia induction and central venous catheter placement. Pearson's correlation coefficient and Bland-Altman analysis were used to determine the relationship between ScvO and rSO . We conducted correlation, Bland Altman, and multiple regression analyses to identify associations between rSO , patient measures, and ScvO values.
The patients' median age was 11.0 (quartile 2.0-16.0) months. Their weight was 7.2 (quartile 4.5-9.2) kg. Cerebral rSO was significantly positively correlated with ScvO (r = 0.29, p = .002 in all patients; r = 0.61, p = .013 in the patients without mixing at the atrial level), whereas somatic rSO was not. The Bland-Altman analysis demonstrated biases [95% confidence interval; 95% CI] (lower and upper limits of agreement [95% CI]) of 0.27% [-4.26 to 4.80] (-24.79 [-32.61 to -16.96] to 25.33 [17.50 to 33.16]) between cerebral rSO and ScvO and 0.91% [-5.48 to 7.30] (-34.43 [-45.47 to -23.39] to 36.25 [25.21 to 47.29]) between somatic rSO and ScvO . Preoperative brain natriuretic peptide (BNP) and SpO were independent variables associated with ScvO and cerebral and somatic rSO .
Cerebral rSO , SpO , and BNP were significantly correlated with ScvO , although the cerebral rSO correlation was greater for lesions without atrial mixing. rSO , BNP, and SpO might be used to track changes in ScvO but cerebral rSO is not sufficiently precise to replace it.
我们评估了近红外光谱仪（INVOS™ 5100C，Medtronic）测量的额部和右肾背（脑 rSO 和体 rSO）与光纤血氧计测量的中心静脉血氧饱和度（ScvO）之间的相关性，以确定非侵入性 rSO 是否可用于儿科心脏手术患者替代 ScvO。我们评估了近红外光谱仪测量的区域组织氧饱和度（脑 rSO 和体 rSO）与其他患者测量值与光纤血氧计测量的中心静脉血氧饱和度（ScvO）之间的相关性，以跟踪全球氧供需情况，作为 ScvO 的潜在替代或补充。
这项单中心前瞻性观察性研究纳入了 2018 年 2 月至 2021 年 11 月期间因先天性心脏病接受心脏手术的 33 名儿童（体重 < 10kg）。在麻醉诱导和中心静脉导管放置后，同时记录 ScvO、脑 rSO 和体 rSO。采用 Pearson 相关系数和 Bland-Altman 分析来确定 ScvO 和 rSO 之间的关系。我们进行了相关性、Bland Altman 和多元回归分析，以确定 rSO、患者测量值和 ScvO 值之间的关联。
患者的中位年龄为 11.0（四分位距 2.0-16.0）个月，体重为 7.2（四分位距 4.5-9.2）kg。脑 rSO 与 ScvO 呈显著正相关（所有患者 r = 0.29，p = .002；无心房混合患者 r = 0.61，p = .013），而体 rSO 则无。Bland-Altman 分析显示脑 rSO 和 ScvO 之间存在偏差（95%置信区间；95%CI）（下和上限的一致性[95%CI]）为 0.27%[-4.26 至 4.80]（-24.79[-32.61 至 -16.96]至 25.33[17.50 至 33.16]），体 rSO 和 ScvO 之间的偏差为 0.91%[-5.48 至 7.30]（-34.43[-45.47 至 -23.39]至 36.25[25.21 至 47.29]）。术前脑利钠肽（BNP）和 SpO 是与 ScvO 以及脑和体 rSO 相关的独立变量。
脑 rSO、SpO 和 BNP 与 ScvO 显著相关，尽管脑 rSO 在无心房混合的病变中相关性更强。rSO、BNP 和 SpO 可能用于跟踪 ScvO 的变化，但脑 rSO 不够精确，无法替代它。
