Association between regional oxygen saturation and central venous saturation in pediatric patients undergoing cardiac surgery: A prospective observational study.

BACKGROUND

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 .

PATIENTS AND METHODS

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.

RESULTS

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 .

CONCLUSION

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.