Matsui Kenta, Oka Norihiko, Shikata Fumiaki, Kohira Satoshi, Kitamura Tadashi, Mishima Toshiaki, Fukuzumi Masaomi, Kondo Ryoichi, Motoji Yusuke, Tamura Yoshimi, Ishikawa Saya, Fujii Kiyotaka, Fujii Masami, Miyaji Kagami
Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center Tochigi, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan.
J Artif Organs. 2025 Aug 30. doi: 10.1007/s10047-025-01524-9.
To investigate the feasibility of regional oxygen saturation (rSO) monitoring for preventing acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) caused by cardiopulmonary bypass (CPB) in infants undergoing ventricular septal defect (VSD) closure. This study included 49 infants who underwent VSD closure between January 2012 and December 2023. Patients with preoperative pulmonary hypertension were excluded. rSO of the head, abdomen, and thigh was monitored perioperatively. ALI/ARDS was defined as a PaO/FiO ratio (P/F ratio) ≤ 300 upon pediatric intensive care unit (PICU) admission. The median age at surgery was 4 (interquartile range: 3-5) months, and the median weight was 6.03 (interquartile range: 5.30-6.78) kg. Five (10%) patients developed postoperative ALI/ARDS and had a longer PICU stay (8 vs 5 days, P < 0.001) and hospital stay (10 vs 5 days, P = 0.005). According to multiple regression analysis, thigh rSO during CPB was a significant predictor of postoperative P/F ratio (β: 4.88, standard error: 1.99, P = 0.02). Receiver operating characteristic curve analysis showed that thigh rSO during CPB (area under the curve: 0.87, P = 0.01) significantly predicted postoperative ALI/ARDS. The optimal cutoff value for thigh rSO was 71%, with a sensitivity of 80% and specificity of 93%. Thigh rSO monitoring during CPB may be effective for detecting ALI/ARDS in infants who underwent VSD closure. Maintaining rSO levels above 71% might help prevent the onset of ALI/ARDS.
探讨区域氧饱和度（rSO）监测对预防室间隔缺损（VSD）修补术患儿体外循环（CPB）所致急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）的可行性。本研究纳入了2012年1月至2023年12月期间接受VSD修补术的49例婴儿。排除术前有肺动脉高压的患者。围手术期监测头部、腹部和大腿的rSO。ALI/ARDS定义为入住儿科重症监护病房（PICU）时动脉血氧分压/吸入氧分数值（P/F比值）≤300。手术时的中位年龄为4（四分位间距：3 - 5）个月，中位体重为6.03（四分位间距：5.30 - 6.78）kg。5例（10%）患者术后发生ALI/ARDS，PICU住院时间更长（8天对5天，P < 0.001），住院时间也更长（10天对5天，P = 0.005）。根据多元回归分析，CPB期间大腿的rSO是术后P/F比值的显著预测因素（β：4.88，标准误：1.99，P = 0.02）。受试者工作特征曲线分析表明，CPB期间大腿的rSO（曲线下面积：0.87，P = 0.01）可显著预测术后ALI/ARDS。大腿rSO的最佳截断值为71%，敏感性为80%，特异性为93%。CPB期间监测大腿rSO可能对检测接受VSD修补术婴儿的ALI/ARDS有效。将rSO水平维持在71%以上可能有助于预防ALI/ARDS的发生。
